When it comes to ADHD, age is more than just a number

You could be increasing your child’s chances of receiving an ADHD diagnosis by pushing them ahead in school.

A recent report by NPR claims that the youngest children in the classroom are at a higher risk of acquiring an ADHD diagnosis. The article cites multiple studies  done abroad which indicate that children who are young for their grade in school are diagnosed with ADHD more often than their older peers. In sum, these studies highlight the importance of considering a child’s age within their grade when diagnosing a child with ADHD or prescribing them medication.

While age within a grade seems to be a predictor of diagnosis, it may not be a compelling predictor of disorder. One factor that complicates matters is that teacher-report serves as a focal diagnosis tool. Teachers, however, can be biased against the youngest kids in the classroom because they constantly compare them to older, more mature students. A study recently conducted in the U.S. indicates that where a child’s birthdate falls in relation to their school’s kindergarten cut-off date significantly influences their likelihood of diagnosis due to teacher-report, which could be misconstrued: “A child’s birth date relative to the eligibility cutoff also strongly influences teachers’ assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a classroom.” Comparison is intrinsic to a classroom setting, but may play to the detriment of those who are behind in their social development.

Not only does social maturation influence teachers’ perception and subsequent diagnosis rates of younger children, but also biological maturation. That is, a child’s maturity is connected to both their bodies and their minds. Evidence shows that children diagnosed with ADHD early in their school careers often show a significant symptom reduction as they age, indicating that misdiagnosis often occurs and is correlated with biological immaturity: “This study gives support to the theory that there is a group of children with ADHD-symptoms who have a biological maturational-lag who will show a decrease in their ADHD-symptoms as they show a maturation catch-up with increasing age.” In essence, children exhibiting immature behavior do not necessarily have ADHD, yet there is a strong bias towards diagnosing them.

While these misdiagnoses are understandable and probably somewhat inevitable, they could be dangerous. First and foremost, it may not be advisable to put a child on stimulants if they’re simply young for their class, for fear of purposeless side effects. Moreover, their symptoms may remedy themselves as the child matures. Secondary dangers include social effects. Children diagnosed without cause could experience a type of Golem Effect,  a self-fulfilling prophecy whereby a child transforms into the label they are diagnosed with… This phenomenon has parallels to Malcolm Gladwell’s “relative-age effect,  by which an initial advantage attributable to age gets turned into a more profound advantage over time.” Gladwell discusses this in the context of professional Canadian hockey players, who are far more likely to be born in January, February and March than in other months, due to the junior hockey league’s cut-off of January 1st. Because the oldest kids are more physically mature and seem better, they get extra attention, better coaching, and more practice, factors that compound over time and eventually lead them to become professionals. The same idea could hold true for ADHD diagnosis, but unfortunately, in the opposite direction. Children who are younger seem symptomatic and are labelled as such, limiting their ability in the eyes of teachers, who in turn put less effort into cultivating their abilities.

Gladwell proposes an interesting solution. He suggests that elementary and middle schools put students with January through April birthdays in one class, the May through August birthdays in another, and those with September through December in a third, in order “to level the playing field for those who—through no fault of their own—have been dealt a big disadvantage.” Promising as it sounds, we’re unlikely to see these kinds of systematic changes anytime soon.

More attainable for you, however, is the possibility of training attention skills to compensate for relative immaturity in the classroom. Products like NeuroPlus can help improve attention skills in children who are developmentally behind their peers. In this way, children can accelerate the maturation of their attention abilities in a safe and controlled environment, void of negative side-effects.

Regardless of the course you take, if you have a child who is young for their grade and struggling in school, know that attention takes practice and time.

Methylphenidate: Effective or Defective?

New research concerning the efficacy of methylphenidate, brand-name Ritalin, revealed disturbing results. Study authors, led by Ole Jakob Storebø, performed a meta-analysis of 185 randomized-controlled trials which included 12,245 participants to determine the effects of methylphenidate in children and adolescents with ADHD.

The main findings reveal that most of the scientific information doctors use to prescribe methylphenidate is very low-quality evidence. What does “low-quality evidence” mean? Essentially, the research reveals that measures such as teacher reported symptoms, general behavior, quality of life, serious and non-serious adverse events, are all at high risk for reporting bias, imprecision, indirectness, heterogeneity, and publication bias. Although methylphenidate may improve concentration, hyperactivity and impulsivity, it is unclear what the magnitude of these benefits are, especially in comparison to the side-effects like sleeping problems and decreased appetite. In sum, it is uncertain whether taking methylphenidate over a long period of time is effective in treating ADHD: “At the moment, the quality of the available evidence means that we cannot say for sure whether taking methylphenidate will improve the lives of children and adolescents with ADHD,” the authors conclude.

What does this mean for somebody with ADHD? If he or she is already on medthylphenidate without adverse effects, it is not advisable to stop use based on these results. Discontinuing treatment may have further adverse effects. You should consult your doctor if you have any questions about this new research.

What about doctors? The researchers urge clinicians to take extreme caution in prescribing methylphenidate, and consider the full scope of the situation before committing to its use.

What next? The authors encourage further research with depersonalized individual data and reliable reporting of all treatment outcomes. More research should also be conducted concerning non-pharmacological strategies for helping individuals living with ADHD.

It is likely that given these results, more analysis concerning the efficacy of ADHD-related drugs will occur. Keep on the look out for reports and new data. This is not the end of the story, more is to come!

ADHD Beyond Borders

This past semester I have been studying abroad in Copenhagen, Denmark. Living here has been a social experiment, immersing myself in a welfare state with progressive values. I have explored all over Europe as well, visiting thirteen countries and many more cities in my short time here. As the semester nears its end, it has come to my attention that ADHD, and many other neurological disorders, are viewed quite differently internationally than they are in the United States. A recent article by the New York Times details varying accounts of parents around the world who have experienced stigmatization and other difficulties surrounding their children’s ADHD diagnosis.

In Argentina, Olga Elizabet Abregu, mother of Santino, 8, testifies: “Here where we live no one knows about A.D.H.D., and the few people who’ve heard of it say they don’t believe in it, that it’s only rude kids without limits.”

In Georgia, stimulants are banned, so unless parents can smuggle the medications like Adderall and Ritalin from nearby Ukraine, children are left with neurologists’ prescriptions for sedatives and other drugs, typically used to treat dementia and psychosis: “They make the children dumb — I really feel sorry for them,” Nino Jakhua, mother of Nikoloz, 6, said.

In Istanbul, Sinan’s parents could not cope with the maltreatment of their son and his ADHD any longer. They moved him to a private school in Utah, paying $10,000 a year for fair treatment.

“In Germany,” one mother, Ms. Oedell, says, “it’s really not accepted to be different. Either people say ADHD. doesn’t exist, or they make it seem like some terrible moral problem.”

In Japan, the only stimulant permitted is methylphenidate, but all stimulants are treated as narcotics.

Studying abroad here in Copenhagen, however, I’ve experienced a different perception of ADHD. Maybe it’s the Scandinavian progressivity or the socialist welfare state, but Danish ADHD is not stigmatized like it is in the rest of Europe. It is however, over-diagnosed and over-medicated, according to my professor in “The Social Brain,” named Lone: “It’s so normal now. I’ve noticed in my practice as a neuropsychologist that parents come up to me and ask for advice all the time. It’s like asking about the weather.” However one of the problems she sees is Denmark’s over-acceptance of the disorder. Education is free and schools are now adopting an “inclusion” policy, whereby all kids, even those with special needs, are to be given appropriate accommodations. “Because ADHD is so common, kids with ADHD are no longer considered special because it’s too prevalent to accommodate so many children…we lose specificity and ADHD is no longer considered a real problem.” In contrast with other European countries, Denmark’s lack of stigmatization of ADHD has almost lead to trivialization.

All over the world, discrimination and misperception of ADHD threaten the well-being of patients and their families. Despite the international attitude towards ADHD, the number of diagnoses has soared in recent years. A recent meta-analysis revealed that the amount of children with ADHD worldwide hovers rather consistently around 5.29%. The authors concluded, “Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD prevalence estimates worldwide.” The recent rise in ADHD diagnoses worldwide is staggering. While in 2007, the international community accounted for 17% of the world’s use of Ritalin, by 2012 that number had doubled. Certain countries in particular have experienced dramatic increases. The number of prescriptions for stimulants in the UK rose by more than 50% in the same time period. Germany’s diagnosis rate rose 381% from 1989 to 2001. The international market for ADHD drugs now tallies at more than $11 billion.

Unfortunately, in most countries, higher incidence of ADHD does not mean that the disorder is becoming more accepted. As diagnoses increase, public perception, education policy, medicine and insurance policy all remain stagnant, inhibiting proper care and treatment. Nessa Childers, co-chair of the European parliament’s mental health, well being, and brain disorders interest group, insists, “We all have to go back to our member states and publicize this situation (for ADHD sufferers)”. She went on to say, “ADHD is one of the most neglected and misunderstood psychiatric conditions in Europe.” The call to action is often drowned out by more pressing political matters. Another option may be to appeal to the academic community. More scientific studies and legitimate research may sway some of the international community’s opinions and highlight the importance of acceptance and proper treatment surrounding ADHD. Given the taboo surrounding stimulant medication in many countries, psychosocial treatment is typically endorsed. Alternative treatments and therapies may find faster and more widespread traction internationally than here in America. Maybe the international community would be interested in NEURO+!

October is ADHD Awareness Month!

ADHD Awareness Month aims to educate the public about ADHD, through publicizing reliable research and information. The organization boasts coalitions with five major members: the ADHD Coaches Organization,  Attention Deficit Disorder Association (ADDA), ADDitude Magazine, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), and The National Resource Center on ADHD (NRC). Together, these coalition members create a phenomenal collection of resources for parents, family-members, friends, professionals and patients with ADHD. The movement’s website also includes a list of relevant and popular blog posts surrounding ADHD, along with resources about symptoms, treatments, and diagnosis.

The movement seeks to not only educate the general population regarding ADHD, but also to target patients themselves in promoting a positive outlook and self-esteem. In featuring 31 stories of patients and their family-members, a central part of the movement’s focus is redefining ADHD as just one part of somebody’s personality that does not encompass who they are. The mission is to advocate against discrimination or daily stereotyping that people with ADHD face and to award legitimacy to the disorder which many still see as a personality flaw. Moreover, ADHD Awareness Month is extremely valuable in disseminating knowledge about ADHD’s less publicized issues, like receiving extra time on examinations in college and for raising funds for research.

This is a national project. U.S. Secretary of Education Arne Duncan issued the following statement earlier this month on Learning Disabilities, Dyslexia, and Attention Deficit Hyperactivity Disorder Awareness Month. He discussed the strides we have made as a country in matriculating more and more kids with ADHD and learning disabilities and emphasized the humanity aspect in understanding how the disorders affect patients and their families: “While we should celebrate these accomplishments, we also must recognize that there is more to do to ensure that students with learning disabilities, dyslexia, and ADHD have every opportunity to fulfill their potential, attain higher education, and obtain good jobs at the same rates as their peers.”  The support for ADHD Awareness Month is rapidly growing. Their Facebook page has over 15,000 likes.

However, not everyone is on board with ADHD’s popularity and awareness campaigns. In 2013, the CDC reported that 15% of high school students have been diagnosed with ADHD and the number of kids on medication had increased to 3.5 million from 600,000 in 1990. Dr. Conners, a psychologist and professor at Duke University claims, “The numbers make it look like an epidemic. Well, it’s not. It’s preposterous… This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” Many blame the wildly successful pharmaceutical campaign by drug companies to publicize the disorder and promote medication to doctors, educators, parents and patients. In ten years, sales of ADHD medication increased from $1.7 billion to $9 billion, according to the data company IMS Health. While raising awareness is necessary and noble, many argue that the awareness campaigns have gone too far in popularizing ADHD. For example, advocacy groups have recruited celebrities like Adam Levine of Maroon 5 for their campaign: “It’s you’re ADHD- Own It.” Some suggest this over-popularization of ADHD can lead to over-diagnosis and over-medication. Another complication is that many of the non-profit organizations involved in raising awareness are sponsored by pharmaceutical companies, raising the possibility of ulterior motives in publicizing ADHD. CHADD, one of ADHD Awareness Month’s coalition members, for example, was reported to have received about $1 million a year, one-third of its annual revenue, from pharmaceutical company grants and advertising. Does this impede the organization’s mission to raise awareness for the sake of education or empowerment? Maybe not, but it is something to keep in mind.

Regardless of the status of ADHD as a diagnosis, we can all agree that attention issues are important and deserve inspection. New research out of Duke University suggests that attention issues may even be the primary predictor of academic achievement. The study finds that children with more attention difficulties early on not only have lower achievement scores in reading and math, but also are 40% less likely to graduate from high school. Attention difficulties often go hand in hand with socio-emotional issues, which cause poor learning-enhancing behaviors like classroom engagement and relationships with teachers and peers, further contributing to decreased long-term academic success. Given the crucial role attention skills have in academic development, it is increasingly urgent that we develop new programs and tools for combatting the causes and effects of ADHD. Let’s pay attention to attention…it’s October!

How young is too young? ADHD in Toddlers

The Center for Disease Control (CDC) just came out with a report estimating that more than 10,000 American toddlers are being medicated for ADHD.

Why is this a problem? First of all, guidelines for diagnosing children under three years old do not exist, so diagnoses themselves are purely speculative and subjective. Furthermore, no significant research surrounding stimulant use in this age bracket exists, so both the safety and the effectiveness of the medication are questionable. The American Academy of Pediatrics does not address the diagnosis of toddlers because hyperactivity and impulsivity,  two primary symptoms of ADHD, are developmentally appropriate at that age.

Despite the growing body of research surrounding stimulant medication in toddlers, the consensus among professionals is that behavioral therapy is always preferable in children who are so young. Some doctors do concede that medication in children under four is acceptable under rare circumstances and as a last resort, but the scientific research is inconsistent at best. A couple studies have found that young children are more sensitive to adverse side effects like delayed growth, insomnia, loss of appetite and anxiety. Yet, another review found that stimulants are safe for carefully diagnosed ADHD preschool children three years and older. In terms of effectiveness, one study found that methylphenidate doses significantly reduced symptoms in preschoolers; however, effect sizes were smaller than they were for school-aged children.

Given this conflicting research, it is clear that without large enough sample sizes and differing results, further research is needed for us to safely say that preschool children should be diagnosed and/or medicated for ADHD.

To complicate things further, the data show that toddlers covered by Medicaid are the most likely to be medicated by stimulants. Why is this the case? First, low-income children are simply more likely to be diagnosed with ADHD. Some experts say the difference may be due to low-income parents struggling to provide a consistent and structured home environment. Others say that teachers in low-income schools lack the resources to provide special services to children in the classroom. Still others point to differing diagnostic procedures used by primary care physicians, who are more likely to make the ADHD diagnosis in Medicaid patients (rather than a psychiatrist or psychologist). Also, Medicaid programs often cannot afford to invest in long term therapy treatments, especially given the lack of children’s psychiatrists in rural areas. Dr. Susanna Visser, the CDC’s top ADHD researcher, explains, “It’s hard to take away medications when therapy isn’t readily available.” Some states like Arizona and Illinois have implemented policies in their Medicaid programs to prevent harmful diagnosis and medication of ADHD in young children by requiring all physicians to seek pre-authorization from a panel of peers two weeks before prescribing stimulants to children under six. Other states like Missouri and Vermont may soon adopt similar policies.

It seems urgent that we take a step back and evaluate the rate of diagnosis and medication in toddlers, given the lack of information. While it is important that we catch and address ADHD symptoms early, it is also important not to misdiagnose or mistreat kids at such a vulnerable age. So, how young is too young? How do we close the socioeconomic gap across different treatments? What are the risks of diagnosing too early versus too late? These are the questions that face us, as medicine begins to outpace the science on this important issue.

Neurofeedback: A “Best Support” Intervention for ADHD

In November 2012, the American Academy of Pediatrics (AAP) elevated neurofeedback to a “Level 1- Best Support” intervention for Attention Deficit and Hyperactivity Disorders. Neurofeedback is the mechanism we use at NEURO+ to train the ADHD brain to function properly. In short, neurofeedback uses visual or auditory representations of brain activity to make the patient aware of what is healthy brain activity, and then provides a technique to help them achieve and maintain that healthy activity. For more information and evidence on neurofeedback and our product, please see our earlier post.

So what does this endorsement by the AAP mean? Previously, neurofeedback was classified as a “Level 2- Good Support” intervention for ADHD. Now, neurofeedback sits among medication and behavioral therapy as an equally viable and successful intervention. To achieve a Level 1 status, interventions need to have three things:

1. At least two randomized trials demonstrating efficacy by being either superior to placebo or equivalent to another Level 1 intervention in a pre- post change paradigm with significant statistical power.

2. Experiments conducted with treatment manuals.

3. Effects demonstrated by two or more investigator teams.

The studies that helped to promote neurofeedback demonstrated that the treatment condition showed improvements in both impulsivity and attention on a range of measures and tasks.   Moreover, neurofeedback has been shown to solve many of the fundamental problems in patients with ADHD like dysregulation of the arousal system, perceptual focus problems and stressed brain syndrome…all without taking medication!

The AAP is a consortium of over 60,000 American pediatricians who work to advise all pediatricians on best practices. They are the foremost trusted entity in pediatrics. Their validation of neurofeedback has sparked a surge of research in the field. Investigators and entrepreneurs alike have recognized biofeedback as a domain ripe for progress and success. We have taken an integrative approach to neurofeedback by combining the behavioral therapy with a captivating video game platform.

While the AAP’s recognition of neurofeedback has increased the incentives in research and business, it has also raised some important questions and controversies. Will the FDA approve neurofeedback as a treatment for ADHD? Neurofeedback is still a rather costly investment…will health insurance companies consider covering it now? Given the increase in diagnosis of ADHD in older people, will neurofeedback’s endorsement be extended to adults? How can we translate this new technology to make it the most accessible to the largest population?

 

 

Gender Inequality and ADHD

ADHD has always been seen as a disproportionately male disorder. Studies have estimated that boys with ADHD outnumber girls with ADHD anywhere from 2:1 to 9:1, and until the past couple decades it was believed that males were simply more susceptible. However, recent work has revealed that this may not be the case…

In her meta-analysis, Dr. Julia Rucklidge claims that the gender discrepancy is actually a matter of referral bias and not who is affected. In other words, boys are far more likely to be referred for treatment than girls. Rucklidge cites a study that found only 6% of girls with ADHD were prescribed medication and 8% received counseling, while 47% of boys with ADHD received medication and 38% received counseling. The difference is staggering. So why is it that male ADHD is so much more likely to be recognized?

One of the major reasons for the male bias in ADHD diagnosis is the presentation of symptoms in boys vs. girls. Many studies have found that while the hyperactivity symptom is more prevalent in males, inattention is far more prevalent in females. Hyperactivity is much easier for an outsider, like a teacher or parent, to identify, while inattention is often more internal and difficult to detect. Given the perception that ADHD is a predominantly male disorder, there is a belief that girls are not “supposed” to have ADHD, creating a stigma surrounding those affected and perpetuating the gender bias in diagnosis and treatment.

Another reason for the discrepancy is the diagnosis criteria. Dr. Ellen Littman, author of Understanding Girls with ADHD, claims that the misunderstanding of female ADHD stems from early research conducted in the 70’s: “These studies were based on really hyperactive young white boys who were taken to clinics,” Dr. Littman says. “The diagnostic criteria were developed based on those studies. As a result, those criteria over-represent the symptoms you see in young boys, making it difficult for girls to be diagnosed unless they behave like hyperactive boys.” Compounding this, ADHD is most commonly diagnosed during childhood. For boys, the timing fits because most boys experience a decrease in symptoms following puberty. For girls, however, ADHD symptoms intensify as estrogen increases, leaving a large portion of women undiagnosed until far later in life. In fact, many women are about 40 by the time that they are diagnosed with ADHD.

A new study released this past year found that almost 50% of mothers of daughters with ADHD reported that they initially attributed symptoms to normal adolescent struggles. About 60% reported that they initially hesitated seeking help from a doctor and that they wish they had taken action sooner. The regret is real. Despite the underrepresentation of females, girls with ADHD are more likely to develop an internalizing comorbid disorder like anxiety or depression than boys, and they display lower self-esteem, ineffectiveness and are more affected by negative life events. What’s even more astonishing is that women with ADHD are more likely than men to pass on the disorder to their children, 50% of whom are affected!

ADHD diagnosis in girls is critical, and we can no longer selectively intervene when the presentation is obvious. Detecting inattention symptoms is just as easy if parents and teachers know what to look for.

Does your daughter face stigmatization? Did you wait too long to seek professional health? Did any of this information change your perception of gender’s role in ADHD? Please share your stories and comments about girls with ADHD!

The Clock is Ticking: Extended Time and ADHD

It’s no secret that children with ADHD and other learning disabilities can receive extended time in the classroom and on standardized tests. This accommodation can be life changing for some students, leveling the playing field and allowing them to succeed. However, recently there has been a storm of controversy surrounding extended time. Who gets it? How do they get it? How much is it actually helping? Who is it hurting?

Receiving an ADHD diagnosis is one of the ways for students to qualify for extended time. In public schools, learning-disabled students typically create an IEP (Individualized Education Plan) or a Section 504 Plan that outlines specialized instruction, services, accommodations, and objectives. In private schools, however, explicit plans are not needed.  Accommodations occur informally, as a special agreement between teacher and student. Importantly, students with ADHD often also qualify for extended time on standardized tests like the SAT or ACT. College Board outlines their guidelines for receiving extended time here.

Extended time has been shown to have dramatic effects on students’ scores. One study in 1998 by the College Board showed that extended time can increase a student’s score by three times. On the other hand, a more recent 2005 study by the College Board showed that this accommodation has limitations: “Some extra time improves performance, but too much may be detrimental. Extra time benefits medium- and high-ability students but provides little or no advantage to low-ability students.” Unfortunately, because of the huge advantage extended time provides, nondisabled students (especially those who are “medium- and high-ability”) are doing what they can to get it too…

A recent change in policy states that students are not flagged for receiving extra time. In other words, colleges cannot tell whether or not a student was given special accommodations. This change has sparked a troublesome trend. Nationwide, more and more students are receiving extended time, raising suspicions of abuse. Granted, more and more students are receiving ADHD diagnoses, and while some of the reason for more diagnoses may be heightened attention to and awareness of the disorder, it’s certainly not always the case . Recent studies have shown that it’s actually easy to fake ADHD to get a diagnosis…and who wouldn’t want the diagnosis if it meant extended time on your SAT in a hyper-competitive college application environment? One study found that neither self-report tests nor neuropsychological tests could distinguish between students with ADHD and those faking it.

Financial and socio-economic differences in students receiving extended time are also troubling. Nondisabled, affluent students have more access to evaluators and doctors than many disabled students who may require more attention. Nationally, about 2% of students receive extended time on the SAT and about 4% receive extended time on the ACT. However, in wealthy areas, up to 1 in 5 students receives extended time. That’s nearly 10 times the national average!

Unfortunately, in these highly competitive high school environments where the pressure to succeed on tests and attend a prestigious college is extraordinary, people are resorting to unfair measures to give themselves (or their children) the best shot. It’s to the point where many students who do not have extended time feel disadvantaged.

So, what can we do about it? The first question is if it’s vital that students with disorders like ADHD receive extra time. What are standardized tests testing? If it’s academic ability, should a student’s ability be judged independently of their disorder? Should the playing field really be leveled? Are standardized tests with or without extended time a fair measure of academic ability when they intrinsically require hours of focus and preparation? What about students who cannot afford study guides, tutors, or other resources? Unfortunately,  standardized testing is less standardized than we’d like to believe…

Nevertheless, given our current environment with extended time, it may be unreasonable for us to expect a perfectly fair system. Removing flagging requirements for extended time students has allowed us to avoid damaging stigmatization, and we agree that everyone should be given the accommodations that they qualify for without being punished. Unfortunately, this acceptance has caused a perverse incentive for more and more students to seek accommodations. So what really is fair? How do you really “standardize” a test? How do we get back there? Do we want to go back there? Let us know in the comments below.

Adderall Abuse: “Smart Drug” by Day, “Kiddie Coke” by Night

Adderall is quickly becoming one of the most popular drugs on college campuses. Nicknamed “Addy” by young adults, the stimulant prescribed to patients with ADHD is now considered the most abused prescription drug in America. Estimates say that approximately 25% of college students abuse Adderall or Ritalin.

There are two primary abuses of Adderall and a multitude of reasons why. First, and most frequently, Adderall is used as a “smart drug”. It is taken by students when they need to grind through homework on a Sunday night or pull an all-nighter before an exam. Not surprisingly, the stimulant helps to promote productivity and focus. Often, students feel tremendous pressure to succeed, especially at top-tier universities, and feel that “Addy” will give them the extra kick that they need. The Cornell student newspaper published an article with personal anecdotes from students, one of which I will share here:

“Leah, who took Vyvanse, a stimulant similar to Adderall that is also used to treat ADHD, said she took 150 milligrams over the course of two days. The standard dose for a first-time user is 30 milligrams, according to clinical studies. ‘I needed to pass my multivariable calculus final, and I hadn’t gone to any of the lectures. I stayed awake for 72 hours. I started convulsing, and I was shaking and nauseous at the end. Afterwards, I fell asleep for a solid 24 hours,’ Leah said. ‘I won’t be doing Vyvanse again. I passed my final though, so that’s all that counts,’ she added.”

Studies have shown that non-medical use of these drugs was highest in “college students who were male, white, members of fraternities and sororities and earned lower grade point averages,” and that “rates were higher at colleges located in the north-eastern region of the U.S. and colleges with more competitive admission standards.” Students may think that Adderall abuse is not that bad because they are taking the drug for the right reasons.

One of the biggest concerns with the rise in Adderall abuse is that students do not understand the risks involved. In a study of 1,800 college students, the authors found that 81% of students thought that the drug was “not dangerous at all” or only “slightly dangerous”. However, Adderall is an amphetamine. It hijack’s the brain’s reward system and can cause addiction and dependence just like its cousins: cocaine, meth and morphine. Adderall can also have dangerous side effects like anxiety, blood pressure elevations, seizures and cardiac arrest, in addition to more common side effects like appetite loss.

The second abuse of Adderall is as a party drug. Students will sometimes crush up the pills and snort them, with the drug causing users to stay active and alert late into the night. Sometimes its referred to as “kiddie coke”, because by snorting a larger dose you can achieve a similar high for far less money: $5-$25 a pill. When mixed with alcohol, the situation becomes even more dangerous. From 2005 to 2012 the amount of emergency room visits for brain stimulant abuse skyrocketed from 5,605 to 22,949, according to the Drug Abuse Warning Network.

Why have non-medical uses of stimulants become so popular recently? Other than the fact that they’re relatively cheap and don’t seem as “bad” to students, Adderall is so pervasive because of its widespread availability. With the steep rise in prescriptions for stimulants, almost everyone in college knows someone who has access to extra pills. One study showed that although American children are not more hyperactive or inattentive than other children, the United States holds 83%-90% of the total market share of ADHD medications. Because the drugs are prescribed in such quantities, the surplus on campuses has inevitably led to abuse.

If stimulant abuse isn’t on your radar, it should be. It may be one of the most threatening drug epidemics to hit young adults yet.

Why Your Child with ADHD Should Be Exercising

Children with ADHD have trouble paying attention largely due to dopaminergic dysfunction in the prefrontal cortex. In the typically developing brain, dopamine, a common neurotransmitter, works to help the brain tune in to the environment. In other words, dopamine acts as an amplifier helping the brain to pay attention. In children with ADHD, dopamine does not work as effectively in the prefrontal cortex, the part of the brain responsible for executive control, and thus patients have difficulty paying attention. Dopamine is critical for attention…so how can we help our kids to produce more dopamine and therefore pay more attention? One answer is exercise.

Exercise has been shown to increase neurotransmitter release, improving cognitive function. People often describe this effect as an endorphin high, and it is this natural high that can be leveraged to help treat inattention in ADHD. Studies have shown that acute aerobic exercise for just 30 minutes can significantly improve patients’ ability to pay attention. Further studies have shown that this improvement in attention occurs regardless of whether the patient uses stimulants like methylphenidate.

What’s even more promising is that exercise’s effects on the brain are long lasting. In fact, consistent exercise leads to “positive morphological, chemical and cognitive effects on the brain across the lifespan”. Because early childhood is the time period where there is the greatest amount of plasticity in the brain, it is vital that young children, especially those with ADHD, are encouraged to exercise, and that playtime is incorporated into their daily activities. In essence, physical activity may be a way to teach the brain how to mitigate the harmful symptoms of ADHD by prompting efficient dopamine signaling.

Exercise is a game changer for kids with ADHD, and not just because of its effects on attention. ADHD has high comorbidity with obesity, and research has shown that the link may again be dopamine. Dopamine may be acting to cause overeating in children with ADHD, increasing their risk for obesity. So, while dopamine is malfunctioning to decrease attention and increase obesity, exercise is acting to increase attention and decrease obesity. It’s like hitting two birds with one stone! While exercising may not be the be-all-end-all treatment for children with ADHD, it is certainly proving itself to be worthwhile in helping fight both symptoms and other comorbid disorders like obesity.

Physical exercise is really just another type of behavioral intervention that effectively helps your brain to function properly. In the case of exercise, it is likely through increasing dopamine signaling, and with our product at NeuroPlus, it is through correcting brain wave patterns. Either way, exercises, be they physical or mental, are rapidly revealing themselves to be remarkable treatments for ADHD that leverage the brain’s plasticity and alter the underlying dysfunction. More and more people are taking note of these alternative therapies as they hit mainstream media. So, what are you waiting for? It’s summertime and the perfect time to play outside and get some sunshine!