ADHD

Therapy dogs effective in reducing symptoms of ADHD

July 18, 2018

Science Daily/University of California - Irvine

Researchers have found therapy dogs to be effective in reducing the symptoms of attention deficit/hyperactivity disorder (ADHD) in children.

 

In a first of its kind randomized trial, researchers from the UCI School of Medicine found therapy dogs to be effective in reducing the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. The study's main outcomes were recently published by the American Psychological Association in the Society of Counseling Psychology's Human-Animal Interaction Bulletin (HAIB). Additional new findings were presented at the International Society for Anthrozoology 2018 Conference held July 2-5 in Sydney, Australia.

 

Titled, "A Randomized Controlled Trial of Traditional Psychosocial and Canine-Assisted Interventions for Children with ADHD," the research involved children aged 7 to 9 who had been diagnosed with ADHD and who had never taken medicines for their condition. The study randomized participants to compare benefits from evidenced-based, "best practice" psychosocial interventions with the same intervention augmented by the assistance of certified therapy dogs. The research was led by Sabrina E. B. Schuck, PhD, MA, executive director of the UCI Child Development Center and assistant professor in residence in the Department of Pediatrics at UCI School of Medicine.

 

Results from Schuck's research indicate children with ADHD who received canine assisted intervention (CAI) experienced a reduction in inattention and an improvement in social skills. And, while both CAI and non-CAI interventions were ultimately found to be effective for reducing overall ADHD symptom severity after 12 weeks, the group assisted by therapy dogs fared significantly better with improved attention and social skills at only eight weeks and demonstrated fewer behavioral problems. No significant group differences, however, were reported for hyperactivity and impulsivity.

 

"Our finding that dogs can hasten the treatment response is very meaningful," said Schuck. "In addition, the fact that parents of the children who were in the CAI group reported significantly fewer problem behaviors over time than those treated without therapy dogs is further evidence of the importance of this research."

 

Guidelines from the American Academy of Pediatrics for the management of ADHD underscore the importance of both psychopharmacological and psychosocial therapies. Patients who receive psychosocial therapy prior to medications have shown to fare better. Additionally, many families prefer not to use medications in young children.

 

"The take away from this is that families now have a viable option when seeking alternative or adjunct therapies to medication treatments for ADHD, especially when it comes to impaired attention," said Schuck. "Inattention is perhaps the most salient problem experienced across the life span for individuals with this disorder."

 

This study is the first known randomized controlled trial of CAI for children with ADHD. It illustrates that the presence of therapy dogs enhances traditional psychosocial intervention and is feasible and safe to implement.

 

Animal assisted intervention (AAI) has been used for decades, however, only recently has empirical evidence begun to support these practices reporting benefits including reduced stress, improved cognitive function, reduced problem behaviors and improved attention.

https://www.sciencedaily.com/releases/2018/07/180718170258.htm

What can Twitter reveal about people with ADHD?

November 13, 2017

Science Daily/University of Pennsylvania

People with attention-deficit/hyperactivity disorder tend to tweet using words like 'hate' or 'disappointed,' messages related to lack of focus, self-regulation, intention and failure and expressions of mental, physical and emotional exhaustion, according to recent research. Better understanding this condition can help clinicians more effectively treat patients.

 

"On social media, where you can post your mental state freely, you get a lot of insight into what these people are going through, which might be rare in a clinical setting," said Guntuku, a postdoctoral researcher working with the World Well-Being Project in the School of Arts and Sciences and the Penn Medicine Center for Digital Health. "In brief 30- or 60-minute sessions with patients, clinicians might not get all manifestations of the condition, but on social media you have the full spectrum."

 

Guntuku and Ungar, a professor of computer and information science with appointments in the School of Engineering and Applied Science, the School of Arts and Sciences, the Wharton School and Penn Medicine, turned to Twitter to try to understand what people with ADHD spend their time talking about. The researchers collected 1.3 million publicly available tweets posted by almost 1,400 users who had self-reported diagnoses of ADHD, plus an equivalent control set that matched the original group in age, gender and duration of overall social-media activity. They then ran models looking at factors like personality and posting frequency.

 

"Some of the findings are in line with what's already known in the ADHD literature," Guntuku said. For example, social-media posters in the experimental group often talked about using marijuana for medicinal purposes. "Our coauthor, Russell Ramsay, who treats people with ADHD, said this is something he's observed in conversations with patients," Guntuku added.

 

The researchers also found that people with ADHD tended to post messages related to lack of focus, self-regulation, intention and failure, as well as expressions of mental, physical and emotional exhaustion. They often used words like "hate," "disappointed," "cry" and "sad" more frequently than the control group and often posted during hours of the day when the majority of people sleep, from midnight to 6 a.m.

 

"People with ADHD are experiencing more mood swings and more negativity," Ungar said. "They tend to have problems self-regulating."

 

This could partially explain why they enjoy social media's quick feedback loop, he said. A well-timed or intriguing tweet could yield a positive response within minutes, propelling continued use of the online outlet.

 

Using information gleaned from this study and others, Ungar and Guntuku said they plan to build condition-specific apps that offer insight into several conditions, including ADHD, stress, anxiety, depression and opioid addiction. They aim to factor in facets of individuals, their personality or how severe their ADHD is, for instance, as well as what triggers particular symptoms.

 

The applications will also include mini-interventions. A recommendation for someone who can't sleep might be to turn off the phone an hour before going to bed. If anxiety or stress is the major factor, the app might suggest an easy exercise like taking a deep breath, then counting to 10 and back to zero.

 

"If you're prone to certain problems, certain things set you off; the idea is to help set you back on track," Ungar said.

 

Better understanding ADHD has the potential to help clinicians treat such patients more successfully, but having this information also has a downside: It can reveal aspects of a person's personality unintentionally, simply by analyzing words posted on Twitter. The researchers also acknowledge that the 50-50 split of ADHD to non-ADHD study participants isn't true to life; only about 8 percent of adults in the U.S. have the disorder, according to the National Institute of Mental Health. In addition, people in this study self-reported an ADHD diagnosis rather than having such a determination come from a physician interaction or medical record.

 

Despite these limitations, the researchers say the work has strong potential to help clinicians understand the varying manifestations of ADHD, and it could be used as a complementary feedback tool to give ADHD sufferers personal insights.

 

"The facets of better-studied conditions like depression are pretty well understood," Ungar said. "ADHD is less well studied. Understanding the components that some people have or don't have, the range of coping mechanisms that people use -- that all leads to a better understanding of the condition."

https://www.sciencedaily.com/releases/2017/11/171113111016.htm

School year 'relative age' causing bias in ADHD diagnosis

October 9, 2017

Science Daily/University of Nottingham

Younger primary school children are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than their older peers within the same school year, new research has shown.

 

The study, led by a child psychiatrist at The University of Nottingham with researchers at the University of Turku in Finland, suggests that adults involved in raising concerns over a child's behaviour -- such as parents and teachers -- may be misattributing signs of relative immaturity as symptoms of the disorder.

 

In their research, published in The Lancet Psychiatry, the experts suggest that greater flexibility in school starting dates should be offered for those children who may be less mature than their same school-year peers.

 

Kapil Sayal, Professor of Child & Adolescent Psychiatry at the University's School of Medicine and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan at the Institute of Mental Health in Nottingham, was the lead author on the study.

 

He said: "The findings of this research have a range of implications for teachers, parents and clinicians. With an age variation of up to 12 months in the same class, teachers and parents may misattribute a child's immaturity. This might lead to younger children in the class being more likely to be referred for an assessment for ADHD.

 

"Parents and teachers as well as clinicians who are undertaking ADHD assessments should keep in mind the child's relative age. From an education perspective, there should be flexibility with an individualised approach to best meets the child's needs."

 

Evidence suggests that worldwide, the incidence of ADHD among school age children is, at around five per cent, fairly uniform. However, there are large differences internationally in the rates of clinical diagnosis and treatment.

 

Although this may partially reflect the availability of and access to services, the perceptions of parents and teachers also play an important role in recognising children who may be affected by ADHD, as information they provide is used as part of the clinical assessment.

 

The study centred on whether the so-called 'relative age effect' -- the perceived differences in abilities and development between the youngest and oldest children in the same year group -- could affect the incidence of diagnosis of ADHD.

 

Adults may be benchmarking the development and abilities of younger children against their older peers in the same year group and inadvertently misinterpreting immaturity for more serious problems.

 

Previous studies have suggested that this effect plays an important role in diagnosis in countries where higher numbers of children are diagnosed and treated for ADHD, leading to concerns that clinicians may be over-diagnosing the disorder.

 

The latest study aimed to look at whether the effect also plays a significant role in the diagnosis of children in countries where the prescribing rates for ADHD are relatively low.

 

It used nationwide population data from all children in Finland born between 1991 and 2004 who were diagnosed with ADHD from the age of seven years -- school starting age -- onwards. In Finland, children start school during the calendar year they turn 7 years of age, with the school year starting in mid-August. Therefore, the eldest in a school year are born in January (aged 7 years and 7 months) and the youngest in December (6 years and 7 months).

 

The results showed that younger children were more likely to be diagnosed with ADHD than their older same-year peers -- boys by 26 per cent and girls by 31 per cent.

 

For children under the age of 10 years, this association got stronger over time -- in the more recent years 2004-2011, children born in May to August were 37 per cent more likely to be diagnosed and those born in September to December 64 per cent, compared to the oldest children born in January to April

 

The study found that this 'relative age affect' could not be explained by other behavioural or developmental disorders which may also have been affecting the children with an ADHD diagnosis.

 

However, the experts warn, the study did have some important limitations -- the data did not reveal whether any of the young children were held back a year for educational reasons and potentially misclassified as the oldest in their year group when in fact they were the youngest of their original peers.

 

The flexibility in school starting date could explain why the rate of ADHD in December-born children (the relatively youngest) were slightly lower than those for children born in October and November.

 

And while the records of publicly-funded specialised services which are free at the point of access will capture most children who have received a diagnosis of ADHD, it will miss those who were diagnosed in private practice.

https://www.sciencedaily.com/releases/2017/10/171009191508.htm

Is ADHD really a sleep problem?

September 4, 2017

Science Daily/European College of Neuropsychopharmacology

Around 75 percent of children and adults with attention deficit hyperactivity disorder (ADHD) also have sleep problems, but until now these have been thought to be separate issues. Now a in a pulling together of the latest research, Scientists are proposing of a new theory which says that much of ADHD may in fact be a problem associated with lack of regular circadian sleep.

 

Presenting the proposal at the ECNP Conference in Paris, Professor Sandra Kooij (Associate Professor of Psychiatry at VU University Medical Centre, Amsterdam and founder and chair of the European Network Adult ADHD) said:

 

"There is extensive research showing that people with ADHD also tend to exhibit sleep problems. What we are doing here is taking this association to the next logical step: pulling all the work together leads us to say that, based on existing evidence, it looks very much like ADHD and circadian problems are intertwined in the majority of patients.

 

We believe this because the day and night rhythm is disturbed, the timing of several physical processes is disturbed, not only of sleep, but also of temperature, movement patterns, timing of meals, and so on.

 

If you review the evidence, it looks more and more like ADHD and sleeplessness are 2 sides of the same physiological and mental coin."

 

Professor Kooij laid out the links which have led to the synthesis:

 

  • ·      In 75% of ADHD patients, the physiological sleep phase -- where people show the physiological signs associated with sleep, such as changes in the level of the sleep hormone melatonin, and changes in sleep-related movement -- is delayed by 1.5 hours.
  • ·      Core body temperature changes associated with sleep are also delayed (reflecting melatonin changes)
  • ·      Many sleep-related disorders are associated with ADHD, including restless-leg syndrome, sleep apnea, and the circadian rhythm disturbance, the delayed sleep phase syndrome
  • ·      ADHD people often show greater alertness in the evening, which is the opposite of what is found in the general population
  • ·      Many sufferers benefit from taking melatonin in the evening or bright light therapy in the morning, which can help reset the circadian rhythm
  • ·      Recent work has shown that around 70% of adult ADHD sufferers show an oversensitivity of the eyes to light, leading many to wear sunglasses for long periods during the day -- which may reinforce the problems associated with a 'circadian shift'.
  • ·      Chronic late sleep leads to a chronic sleep debt, associated with obesity, diabetes, cardiovascular disease and cancer. This cascade of negative health consequences may in part be preventable by resetting the sleep rhythm.
  •  

Professor Kooij continued:

 

"We are working to confirm this physical-mental relationship by finding biomarkers, such as Vitamin D levels, blood glucose, cortisol levels, 24 hour blood pressure, heart rate variability, and so on. If the connection is confirmed, it raises the intriguing question: does ADHD cause sleeplessness, or does sleeplessness cause ADHD? If the latter, then we may be able to treat some ADHD by non-pharmacological methods, such as changing light or sleep patterns, and prevent the negative impact of chronic sleep loss on health."

 

"We don't say that all ADHD problems are associated with these circadian patterns, but it looks increasingly likely that this is an important element."

 

Commenting, Professor Andreas Reif (University Hospital, Frankfurt, and leader of the EU CoCA project on ADHD ), who was not involved in the research, said "A disturbance of the circadian system may indeed be a core mechanism in ADHD, which could also link ADHD to other mental illnesses such as depression or bipolar disorder. But also beyond these pathophysiological considerations, sleep problems and abnormalities of circadian rhythms are a huge problem for many patients, heavily impacting on their social life" He continued "More research into the interconnections between ADHD and the "inner clock" is thus very relevant to improve patients' lives and to shed light on the disease mechanism of ADHD."

 

Note: Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms with a neurobiological background, that include inattentiveness, hyperactivity, mood swings and impulsiveness. ADHD is highly heritable, and several differences in brain volume and function have been shown compared to controls. Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school. Most cases are diagnosed when children are 6 to 12 years old, but ADHD is also increasingly recognised in adults and older people, as ADHD can persist during the lifespan. People with ADHD often have additional problems, such as sleep, mood- and anxiety disorders. Between 2 and 5 % of children, adults and older people suffer from ADHD.

https://www.sciencedaily.com/releases/2017/09/170904093443.htm

How Exercise Affects the Brain: Age and Genetics Play a Role

May 18, 2012

Science Daily/Dartmouth College

May 18, 2012

Science Daily/Dartmouth College

Exercise clears the mind. It gets the blood pumping and more oxygen is delivered to the brain. This is familiar territory, but Dartmouth's David Bucci thinks there is much more going on.

"In the last several years there have been data suggesting that neurobiological changes are happening -- [there are] very brain-specific mechanisms at work here," says Bucci, an associate professor in the Department of Psychological and Brain Sciences.

From his studies, Bucci and his collaborators have revealed important new findings:

  • The effects of exercise are different on memory as well as on the brain, depending on whether the exerciser is an adolescent or an adult.
  • A gene has been identified which seems to mediate the degree to which exercise has a beneficial effect. This has implications for the potential use of exercise as an intervention for mental illness.

Bucci began his pursuit of the link between exercise and memory with attention deficit hyperactivity disorder (ADHD), one of the most common childhood psychological disorders. Bucci is concerned that the treatment of choice seems to be medication.

"The notion of pumping children full of psycho-stimulants at an early age is troublesome," Bucci cautions. "We frankly don't know the long-term effects of administering drugs at an early age -- drugs that affect the brain -- so looking for alternative therapies is clearly important."

Anecdotal evidence from colleagues at the University of Vermont started Bucci down the track of ADHD. Based on observations of ADHD children in Vermont summer camps, athletes or team sports players were found to respond better to behavioral interventions than more sedentary children. While systematic empirical data is lacking, this association of exercise with a reduction of characteristic ADHD behaviors was persuasive enough for Bucci.

Coupled with his interest in learning and memory and their underlying brain functions, Bucci and teams of graduate and undergraduate students embarked upon a project of scientific inquiry, investigating the potential connection between exercise and brain function. They published papers documenting their results, with the most recent now available in the online version of the journal Neuroscience.

Bucci is quick to point out that "the teams of both graduate and undergraduates are responsible for all this work, certainly not just me." Michael Hopkins, a graduate student at the time, is first author on the papers.

Early on, laboratory rats that exhibit ADHD-like behavior demonstrated that exercise was able to reduce the extent of these behaviors. The researchers also found that exercise was more beneficial for female rats than males, similar to how it differentially affects male and female children with ADHD.

Moving forward, they investigated a mechanism through which exercise seems to improve learning and memory. This is "brain derived neurotrophic factor" (BDNF) and it is involved in growth of the developing brain. The degree of BDNF expression in exercising rats correlated positively with improved memory, and exercising as an adolescent had longer lasting effects compared to the same duration of exercise, but done as an adult.

"The implication is that exercising during development, as your brain is growing, is changing the brain in concert with normal developmental changes, resulting in your having more permanent wiring of the brain in support of things like learning and memory," says Bucci. "It seems important to [exercise] early in life."

Bucci's latest paper was a move to take the studies of exercise and memory in rats and apply them to humans. The subjects in this new study were Dartmouth undergraduates and individuals recruited from the Hanover community.

Bucci says that, "the really interesting finding was that, depending on the person's genotype for that trophic factor [BDNF], they either did or did not reap the benefits of exercise on learning and memory. This could mean that you may be able to predict which ADHD child, if we genotype them and look at their DNA, would respond to exercise as a treatment and which ones wouldn't."

Bucci concludes that the notion that exercise is good for health including mental health is not a huge surprise. "The interesting question in terms of mental health and cognitive function is how exercise affects mental function and the brain." This is the question Bucci, his colleagues, and students continue to pursue.http://www.sciencedaily.com/releases/2012/05/120518132812.htm

Childhood Diagnosis of ADHD Increased Dramatically Over 9-Year Period

January 21, 2013

Science Daily/Kaiser Permanente

The rate of children diagnosed with Attention Deficit Hyperactivity Disorder rose dramatically between 2001 and 2010, with non-Hispanic white children having the highest diagnosis rates, according to a Kaiser Permanente study published in the journal JAMA Pediatrics (formerly Archives of Pediatrics and Adolescent Medicine). The study also showed there was a 90 percent increase in the diagnosis of ADHD among non-Hispanic black girls during the same nine-year period.

 

The study examined the electronic health records of nearly 850,000 ethnically diverse children, aged 5 to 11 years, who received care at Kaiser Permanente Southern California between 2001 and 2010.

 

It found that among these children, 4.9 percent, or 39,200, had a diagnosis of ADHD, with white and black children more likely to be diagnosed with the neurobehavioral disorder than Hispanics and Asian/Pacific Islander children. For instance, in 2010, 5.6 percent of white children in the study had an ADHD diagnosis; 4.1 percent of blacks; 2.5 percent of Hispanics; and 1.2 percent of Asian/Pacific Islanders.

 

"While the reasons for increasing ADHD rates are not well understood, contributing factors may include heightened awareness of ADHD among parents and physicians, which could have led to increased screening and treatment," said Dr. Getahun. "This variability may indicate the need for different allocation of resources for ADHD prevention programs, and may point to new risk factors or inequalities in care."

http://www.sciencedaily.com/releases/2013/01/130121161923.htm

Study Evaluates Treating Mothers with ADHD to Improve Outcomes in Kids

October 17, 2012

Science Daily/University of Illinois at Chicago

University of Illinois at Chicago researchers are conducting a study to determine if treating mothers with Attention Deficit Hyperactivity Disorder -- either with medication or parent training -- will help children at risk for ADHD.

 

"About 25 percent of the time, when a child has ADHD, there's a parent that has ADHD," said Mark Stein, UIC professor of pediatrics and psychiatry and principal investigator of the study. "We realize this is a weakness in our service delivery models, because often clinicians focus on just treating the child and ignore the fact that another family member has ADHD."

 

ADHD is often misdiagnosed as depression or anxiety in women, and it often contributes to marital, parenting, sleep and medical problems, Stein said. Many health care providers have not been trained in diagnosing and treating adult ADHD.

 

"When a mom complains about how bad her life is, she's given a prescription for Prozac versus understanding that she's always had issues with inattention, distractibility, or impulsivity, and that's why she's having problems," Stein says.

 

"When you think of ADHD, you think of a 7-year-old boy, not a mom who says 'I am overwhelmed, easily distracted, and just can't get things done,'" he said.

http://www.sciencedaily.com/releases/2012/10/121017131544.htm

Brain Development Delayed in ADHD

July 30, 2012

Science Daily/Elsevier

Is attention-deficit/hyperactivity disorder (ADHD) due to a delay in brain development or the result of complete deviation from typical development? In the current issue of Biological Psychiatry, Dr. Philip Shaw and colleagues present evidence for delay based on a study by the National Institutes of Health

 

They recruited 234 children with ADHD and 231 typically developing children and scanned each up to 4 times. The first scan was taken at about age 10, and the final scan was around age 17. Using advanced neuroimaging technology, they were able to map the trajectories of surface area development at over 80,000 points across the brain.

 

They found that the development of the cortical surface is delayed in frontal brain regions in children with ADHD. For example, the typically developing children attained 50% peak area in the right prefrontal cortex at a mean age of 12.7 years, whereas the ADHD children didn't reach this peak until 14.6 years of age.

 

"As other components of cortical development are also delayed, this suggests there is a global delay in ADHD in brain regions important for the control of action and attention," said Dr. Shaw, a clinician studying ADHD at the National Institute of Mental Health and first author of this study.

http://www.sciencedaily.com/releases/2012/07/120730094822.htm

Functional brain pathways disrupted in children with ADHD

November 30, 2011

Science Daily/Radiological Society of North America

Using functional magnetic resonance imaging, researchers have identified abnormalities in the brains of children with attention deficit/hyperactivity disorder that may serve as a biomarker for the disorder, according to a new study.

 

ADHD is one of the most common childhood disorders, affecting an estimated five to eight percent of school-aged children. Symptoms, which may continue into adulthood, include inattention, hyperactivity and impulsivity behaviors that are out of the normal range for a child's age and development.

 

According to the National Institute of Mental Health, there is no single test capable of diagnosing a child with the disorder. As a result, difficult children are often incorrectly labeled with ADHD while other children with the disorder remain undiagnosed.

 

"Diagnosing ADHD is very difficult because of its wide variety of behavioral symptoms," said lead researcher Xiaobo Li, Ph.D., assistant professor of radiology at the Albert Einstein College of Medicine in New York. "Establishing a reliable imaging biomarker of ADHD would be a major contribution to the field."

 

For the study, Dr. Li and colleagues performed fMRI on 18 typically developing children and 18 children diagnosed with ADHD (age range 9 to 15 years). While undergoing fMRI, the children engaged in a test of sustained attention in which they were shown a set of three numbers and then asked whether subsequent groups of numbers matched the original set. For each participant, fMRI produced a brain activation map that revealed which regions of the brain became activated while the child performed the task. The researchers then compared the brain activation maps of the two groups.

 

Compared to the normal control group, the children with ADHD showed abnormal functional activity in several regions of the brain involved in the processing of visual attention information. The researchers also found that communication among the brain regions within this visual attention-processing pathway was disrupted in the children with ADHD.

 

"What this tells us is that children with ADHD are using partially different functional brain pathways to process this information, which may be caused by impaired white matter pathways involved in visual attention information processing," Dr. Li said.

 

Dr. Li said much of the research conducted on ADHD has focused on the impulsivity component of the disorder. "Inattention is an equally important component of this disorder," she said, "and our findings contribute to understanding the pathology of inattentiveness in ADHD."

http://www.sciencedaily.com/releases/2011/11/111128120138.htm

 

Blue-Blocking Glasses to Improve Sleep and ADHD Symptoms Developed

November 14, 2007

Science Daily/John Carroll University

Scientists at John Carroll University, working in its Lighting Innovations Institute, have developed an affordable accessory that appears to reduce the symptoms of ADHD. Their discovery also has also been shown to improve sleep patterns among people who have difficulty falling asleep. The John Carroll researchers have created glasses designed to block blue light, therefore altering a person's circadian rhythm, which leads to improvement in ADHD symptoms and sleep disorders.

 

The individual puts on the glasses a couple of hours ahead of bedtime, advancing the circadian rhythm. The special glasses block the blue rays that cause a delay in the start of the flow of melatonin, the sleep hormone. Normally, melatonin flow doesn't begin until after the individual goes into darkness. Studies indicate that promoting the earlier release of melatonin results in a marked decline of ADHD symptoms.

http://www.sciencedaily.com/releases/2007/11/071112143308.htm

Children who take ADHD medicines have trouble sleeping

Study addresses decades of conflicting evidence of meds' effect on sleep

November 23, 2015

Science Daily/University of Nebraska-Lincoln

Children given ADHD stimulant medications take significantly longer to fall asleep, have poorer quality sleep and sleep for shorter periods, shows new research.

 

The study addresses decades of conflicting opinions and evidence about the medications' effect on sleep.

 

In what's known as a "meta-analysis," researchers from the UNL Department of Psychology combined and analyzed the results from past studies of how ADHD medications affect sleep.

 

In a study published online by the journal Pediatrics, the Nebraska researchers found children given the medicines take significantly longer to fall asleep, have poorer quality sleep, and sleep for shorter periods.

 

"We would recommend that pediatricians frequently monitor children with ADHD who are prescribed stimulants for potential adverse effects on sleep," said Katie Kidwell, a psychology doctoral student who served as the study's lead author.

 

About 1 in 14 children and adolescents in the U.S. are diagnosed with ADHD, a chronic condition that includes attention difficulty, hyperactivity and impulsiveness. In the most common form of ADHD treatment, about 3.5 million are prescribed stimulant medications such as Ritalin and Adderall.

 

Many research articles have been written in the past 30 years on whether ADHD medications harm the ability to sleep. Some researchers have found that the drugs do interfere with sleep, particularly if taken later in the day. Others maintain the medications improve patients with ADHD's ability to sleep, by relieving symptoms and reducing resistance to bedtime. Indeed, some suggest that sleep problems are caused by the medication wearing off near bedtime, creating withdrawal symptoms.

 

"One reason we did the study is that researchers have hypothesized different effects, and there are some conflicting findings in the literature," said Timothy Nelson, an associate professor of psychology involved in the study. "This is when a meta-analysis is most useful. By aggregating and previous research in a rigorous and statistical way, we can identify the main findings that we see across all these studies. It's essentially a study of studies."

 

After screening nearly 10,000 articles, Kidwell and her colleagues reviewed 167 full texts before selecting nine studies of sufficient rigor for their analysis. Tori Van Dyk and Alyssa Lundahl, also psychology doctoral students, assisted in the effort.

 

Studies chosen for the analysis were peer-reviewed, randomized experiments. The studies did not rely on parental reports of their children's sleeping patterns, instead requiring objective measures obtained through clinical sleep studies or wristband monitors used at home.

 

The researchers found that both methylphenidate medications like Ritalin and amphetamines like Adderall cause sleep problems, without identifying differences between the two. Although they were unable to determine whether varying dosage amounts changed the effect on sleep, they found that more frequent dosages made it harder for children to fall asleep.

 

They found that drugs tend to cause more sleep problems for boys. The problems dissipate, but never completely go away, the longer children continue to take the medication.

 

"Sleep impairment is related to many cognitive, emotional and behavioral consequences, such as inattention, irritability and defiance," Kidwell said. "Sleep adverse effects could undermine the benefits of stimulant medications in some cases. Pediatricians should carefully consider dosage amounts, standard versus extended release, and dosage frequencies to minimize sleep problems while effectively treating ADHD symptoms."

 

She also recommended considering behavioral treatments, such as parental training and changes to classroom procedures and homework assignments, to reduce ADHD's negative consequences.

 

"We're not saying don't use stimulant medications to treat ADHD," Nelson said. "They are well tolerated in general and there is evidence for their effectiveness. But physicians need to weigh the pros and cons in any medication decision, and considering the potential for disrupted sleep should be part of that cost-benefit analysis with stimulants."

http://www.sciencedaily.com/releases/2015/11/151123202819.htm

 

Brainwave training boosts network for cognitive control and affects mind-wandering

- October 24, 2012

Science Daily/University of Western Ontario

A breakthrough study has found that training of the well-known brainwave in humans, the alpha rhythm, enhances a brain network responsible for cognitive-control. The training technique, termed neurofeedback, is being considered as a promising new method for restoring brain function in mental disorders such as attention deficit hyperactivity disorder, schizophrenia, depression and post-traumatic stress disorder.

 

During neurofeedback, users learn to control their own brain activity with the help of a brain-computer interface. In the simplest case, this consists of a computer that records brainwaves through surface sensors on the scalp, known as an EEG (electroencephalogram).

 

The system is then able to process and simultaneously represent a user's real-time brain activity, displayed from moment-to-moment during a training game on a computer. This setup is known as a neurofeedback loop, because information of brain activity is continually fed-back to a user reflecting their level of control. Such real-time feedback allows users to reproduce distinct brain states under physiologically-normal conditions, promising to be an innovative way to foster brain changes without adverse effects. This is possible because of neuroplasticity, a natural property of the brain that enables it to reorganise after continual training, resulting from adjustments to its own activity.

 

The new findings firstly help to address a long-standing issue in the field: whether neurofeedback training can trigger any brain changes at all? "The effects we observed were durable enough to be detected with functional MRI up to 30 minutes after a session of neurofeedback which allowed us to compare brain and behavioral measures more closely in time," says Tomas Ros, PhD, lead author of the study, now at University of Geneva.

 

"We were excited to find that increased metabolic coupling within a key cognitive network was reflected in the individual level of brainwave change provoked by neurofeedback. The same measures were found to be tightly correlated with reductions in mind-wandering during an attention task. Amazingly, this would imply that the brain's function may be entrained in a direction that is more attentive and quiet. In other words, our findings speak for the exquisite functional plasticity of the adult brain, whose past activity of little more than 30 minutes ago can condition its future state of processing. This has already been hinted at in meditation research, but we arrived at a direct and explicit demonstration by harnessing a brain-computer interface."

http://www.sciencedaily.com/releases/2012/10/121024124741.htm

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