The globalization of ADHD: 5 trends driving the surge in ADHD

It seems like everywhere you look, there’s someone lamenting over the  tremendous increase in ADHD cases in recent years. Just in the past few weeks, a variety of pundits and experts have put forward theories to explain the surge, from air pollution during pregnancy to over-stimulation of young minds.

But a recent study by Peter Conrad and Meredith Bergey points to an array of compounding factors that have caused an explosion of ADHD diagnoses both in the U.S. and abroad. They call it  the “globalization of ADHD,” and there’s a great deal of evidence showing that the growth of ADHD cases is indeed a global phenomenon. Leah Burrows of BrandeisNow writes:

According to the study, in the U.K., diagnosis of the disorder in school-age children grew from less than one percent in the 1990s to about five percent today. In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.

While acknowledging the limitations in understanding a complex disorder like ADHD, Conrad and Bergey have identified 5 key trends as the primary drivers of this growth.:

1) Pharmaceutical companies are well-resourced and determined lobbyists, and have coaxed some countries to allow stimulants, such as Ritalin and Adderall to be marketed more directly to consumers.

2) Treating patients with counseling and non-medical therapies is becoming less popular than treating them with medicine. (Many insurers, including Medicaid, will pay for drugs but not for psychotherapy, for example.) This incentivizes the labeling of children with a specific disorder.

3) The Diagnostic and Statistical Manual (DSM), the bible of mental disorders, is gaining more traction in Europe and South America. The DSM has slightly broader standards for diagnosing ADHD than the system used by many other countries, the International Statistical Classification of Diseases and Related Health Problems (ICD), hence more folks are falling within the standard.

4) ADHD advocacy groups are raising awareness of the condition.

5) Because everybody is occasionally fidgety and distracted and nearly everybody despairs of not getting enough done, people turn to the internet for answers and find checklists put up by drug companies, with overly general questions like: “Are you disorganized at work and home?” and “Do you start projects and then abandon them?” and encourage people to ask their doctors about medication.

All of these trends seem like reasonable explanations of the growth in ADHD diagnoses. But the question remains, should we do something about it? And if so, what?

There’s an ongoing debate over whether or not this growth represents better identification of previously overlooked ADHD cases or mis-diagnosis of normal individuals (Conrad and Bergey seem to support the latter). But this debate does little to help the actual people suffering from attention deficits.

The fact is, no matter how “over-diagnosed” ADHD may be, these cases represent  real people who are reporting struggles with inattention, hyperactivity, and/or impulsivity. We should be focusing on how to help these individuals instead of arguing about whether or not these deficits are severe enough to warrant a medical diagnosis.

The real debate should be about how we treat individuals with varying degrees of attention deficits. We can all agree that the status quo – prescribing stimulant medications, and only stimulant medications, in nearly 100% of cases – is unacceptable.

We at  NEURO+ support individualized therapies that involve the integration of one or more tools (pharmacological included) for the treatment and management of attention disorders. It’s our mission to build products that offer a safe, effective, and affordable solution to help childreB and adults overcome attention difficulties.

 

Children not receiving adequate ADHD care

A new study reports that many pediatricians provide substandard care for children with ADHD,  with doctors  failing to follow even basic guidelines for diagnosis and treatment.

Dennis Thompson of HealthDay writes:

“Nearly one-third of pediatricians who diagnose children with ADHD do not consult the Diagnostic and Statistical Manual of Mental Disorders, a necessary step in determining if the kids meet the criteria for the brain disorder, researchers found.

A large number of pediatricians also do not gather parent and teacher ratings of a child’s day-to-day behavior, information that is crucial in diagnosing ADHD and tracking whether prescribed therapies are working, the study said.

And finally, doctors appear to lean heavily on drugs for treating ADHD. Nine out of 10 kids with ADHD are on some sort of medication. But only one out of 10 kids is receiving behavioral therapy or psychotherapy as well, according to the study.”

Lead author of the study Jeffery Epstein, director of the Center for ADHD, Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital, is also concerned about the time pressure involved in these diagnoses: “Typical office visits are 10 to 15 minutes in length.” he says. “To try and assess ADHD in a 15-minute period is a very difficult thing to do. “

Thus, it can take less than 15 minutes to get a life-changing ADHD diagnosis, and in most cases these diagnoses are made without parent or teacher evaluations.

Epstein advises concerned parents to ask their pediatrician about the diagnostic process and get referrals to pediatricians providing satisfactory care.

New study to treat ADHD with brain-training

The NIH is funding a study of neurofeedback-based brain training for ADHD.  Researchers at The Ohio State University and University of North Carolina  Asheville will investigate the effects of neurofeedback on ADHD symptoms in a double-blind, randomized, placebo-controlled trial with 140 participants – the first “gold standard” study of its kind:

“This is the first large study to test for a specific benefit of neurofeedback (NF) , a method of training the brain to function more efficiently. It’s also the first large study that will follow the patients for up to two years to examine enduring effect of NF treatment.”

Previous research has shown neurofeedback to significantly reduce symptoms of ADHD, and we’re excited to see more controlled studies in the works.

If you’d like to learn more about how NEURO+ is combining these same neurofeedback protocols with biofeedback and cognitive training exercises for ADHD,  please visit us at http://www.neuropl.us or shoot us an email at info@neurospire.com.

 

 

 

Long-term benefits of ADHD meds questioned

More than 6% of all children in the U.S.  take medications for ADHD, with significant increases in just the past few years.

And while there’s a great deal of controversy over the potential side effects and over-use of these drugs, their efficacy is less frequently called into question.  For most children, ADHD medications seem to induce  drastic and immediate improvements in behavior and attitude.

However, a recent article in Nature from Katherine Sharp examined the  long-term effects of ADHD meds on academic performance and found no evidence to support lasting benefits for children taking them:

As the drugs have become more widespread, so has their cultural cachet. Stimulant medications have gained a reputation for turbo-charging the intellect. Even news stories critical of their use refer to them as “good-grade pills”, “cognitive enhancers” and “mental steroids”.

For most people with ADHD, these medications — typically formulations of methylphenidate or amphetamine — quickly calm them down and increase their ability to concentrate. Although these behavioural changes make the drugs useful, a growing body of evidence suggests that the benefits mainly stop there. Studies indicate that the improvements seen with medication do not translate into better academic achievement or even social adjustment in the long term: people who were medicated as children show no improvements in antisocial behaviour, substance abuse or arrest rates later in life, for example. And one recent study suggested that the medications could even harm some children1.

After decades of study, it has become clear that the drugs are not as transformative as their marketers would have parents believe. “I don’t know of any evidence that’s consistent that shows that there’s any long-term benefit of taking the medication,” says James Swanson, a psychologist at the University of California, Irvine.

It’s important to note  that these medications can, and often do, provide a short-term boost that can be incredibly helpful for a child’s development. Sharp writes,

Many researchers think that a stint on medication, when it is needed, can create an upward spiral of self-esteem that may make a crucial difference to a child’s life — but there are no hard data to support this. “It may be that treatment doesn’t translate into better grades” in the long term, Volkow says. “But what I’d like to see is, are those kids overall better integrated?”

Some experts think that the focus on academic achievement is misguided — that the point of the drugs has never been to improve children’s grades, or increase their chances of admission to the best universities. “Medications are given for their short-term effects,” says Swanson. “Don’t expect medication to get rid of every problem a child has. But if the problem right now is not passing the second grade, or not having any friends in the third grade, we can do something about that now.”

Thus, it may be the case that the meds are working exactly  as intended, and it is we who are placing unreasonable expectations on these drugs.  We may need to look to other, non-pharmacological strategies for improving attention skills long-term.

 

Promising research supporting neurofeedback for ADHD

Our friends over at ADDitude reported recently on a successful neurofeedback trial conducted with Tufts University:

The neurofeedback group showed significant and lasting improvements in attention, executive functioning, and hyperactivity/impulsivity, compared with peers in the cognitive training group.

The study also showed that children maintained the significant gains they made six months after receiving neurofeedback in school.

This last finding is particularly intriguing. Not only did students experience significant reductions in their ADHD symptoms, but these gains were maintained 6 months after the neurofeedback training ended.

These findings are just part of an onslaught of recent neurofeedback research that supports its use with ADHD children. We look forward to seeing more well-designed controlled studies like this one in the near future.

Welcome to the NEURO+ Brain Blog

At NeuroPlus, we believe in equipping children and adults with the tools they need to manage and control their ADHD.

Check here for updates on the latest therapies, diagnostic tools, and helpful tips & tricks for improving attention and reducing hyperactivity.

Also check out our attention training software for kids and adults with ADHD at http://www.neuro.plus.

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Is ADHD a prehistoric gift?

There’s no question that ADHD presents challenges to millions of people suffering from the disorder. But recent research seems to suggest that ADHD conveyed advantages to early humans that aided in their survival.

Different Genes

ADHD is associated with novelty-seeking behavior, and there seems to be a higher genetic threshold for which ADHD individuals find an experience rewarding . From the New York Times:

“Dr. Nora D. Volkow, a scientist who directs the National Institute on Drug Abuse, has studied the dopamine reward pathway in people with A.D.H.D. Using a PET scan, she and her colleagues compared the number of dopamine receptors in this brain region in a group of unmedicated adults with A.D.H.D. with a group of healthy controls. What she found was striking. The adults with A.D.H.D. had significantly fewer D2 and D3 receptors (two specific subtypes of dopamine receptors) in their reward circuits than did healthy controls. Furthermore, the lower the level of dopamine receptors was, the greater the subjects’ symptoms of inattention. Studies in children showed similar changes in dopamine function as well.

These findings suggest that people with A.D.H.D are walking around with reward circuits that are less sensitive at baseline than those of the rest of us. Having a sluggish reward circuit makes normally interesting activities seem dull and would explain, in part, why people with A.D.H.D. find repetitive and routine tasks unrewarding and even painfully boring.”

This doesn’t really sound like a gift to me, but if you think about early humans living in hunter-gatherer communities it begins to make sense:

As hunters, we had to adapt to an ever-changing environment where the dangers were as unpredictable as our next meal. In such a context, having a rapidly shifting but intense attention span and a taste for novelty would have proved highly advantageous in locating and securing rewards — like a mate and a nice chunk of mastodon. In short, having the profile of what we now call A.D.H.D. would have made you a Paleolithic success story.

Taking it a step further

While this explanation sounds reasonable enough, it still involves a great deal of speculation – and doesn’t quite amount to scientific evidence supporting ADHD as an evolutionary advantage. So researchers took things a step further and looked at modern-day hunter-gatherer societies. Specifically, they examined the nomadic Ariaal people of Kenya, a sub-group of which only recently settled and begun practicing agriculture. The results were astounding:

Dan T. A. Eisenberg, an anthropologist at the University of Washington, examined the frequency of a genetic variant of the dopamine type-four receptor called DRD4 7R in the nomadic and settler groups of the Ariaal. This genetic variant makes the dopamine receptor less responsive than normal and is specifically linked with A.D.H.D. Dr. Eisenberg discovered that the nomadic men who had the DRD4 7R variant were better nourished than the nomadic men who lacked it. Strikingly, the reverse was true for the Ariaal who had settled: Those with this genetic variant were significantly more underweight than those without it.

So if you are nomadic, having a gene that promotes A.D.H.D.-like behavior is clearly advantageous (you are better nourished), but the same trait is a disadvantage if you live in a settled context. It’s not hard to see why. Nomadic Ariaal, with short attention spans and novelty-seeking tendencies, are probably going to have an easier time making the most of a dynamic environment, including getting more to eat. But this same brief attention span would not be very useful among the settled, who have to focus on activities that call for sustained focus, like going to school, growing crops and selling goods.

As fascinating as this research is, it’s obviously not very comforting to those dealing with ADHD in a modern world with grocery stores and 9-5 desk jobs.

However, this research does help us to reconsider ADHD as not necessarily a disease so much as a set of cognitive traits that are advantageous in certain situations. With this mindset we can focus on controlling ADHD in the scenarios that require it (taking a test or completing an assignment), while embracing the gifts it can offer in others (creative problem solving).