1. Genetic study links tendency to undervalue future rewards with ADHD

    December 5, 2017 by Ashley

    From the University of California – San Diego press release:

    Researchers at University of California San Diego School of Medicine have found a genetic signature for delay discounting — the tendency to undervalue future rewards — that overlaps with attention-deficit/hyperactivity disorder (ADHD), smoking and weight.

    In a study published December 11 in Nature Neuroscience, the team used data of 23andme customers who consented to participate in research and answered survey questions to assess delay discounting. In all, the study included the data of more than 23,000 people to show that approximately 12 percent of a person’s variation in delay discounting can be attributed to genetics — not a single gene, but numerous genetic variants that also influence several other psychiatric and behavioral traits.

    “Studying the genetic basis of delay discounting is something I’ve wanted to do for the entirety of my 20 years of research, but it takes a huge number of people for a genetics study to be meaningful,” said senior author Abraham Palmer, PhD, professor of psychiatry and vice chair for basic research at UC San Diego School of Medicine. “By collaborating with a company that already has the genotypes for millions of people, all we needed was for them to answer a few questions. It would have been difficult to enroll and genotype this many research participants on our own in academia — it would’ve taken years and been cost prohibitive. This is a new model for science.”

    According to Palmer, every complicated nervous system needs a way of assessing the value of current versus delayed rewards. Most people think of the “marshmallow experiment,” he said, referring to the classic experiment where children were tested for their ability to delay gratification by giving them the choice between one marshmallow now or two marshmallows a few minutes later.

    “A person’s ability to delay gratification is not just a curiosity, it’s integrally important to physical and mental health,” Palmer said. “In addition, a person’s economic success is tied to delay discounting. Take seeking higher education and saving for retirement as examples — these future rewards are valuable in today’s economy, but we’re finding that not everyone has the same inclination to achieve them.”

    For the study, the team looked at data from 23andMe research participants who answered survey questions that could be used to assess delay discounting. For example, customers were asked to choose between two options: “Would you rather have $55 today or $75 in 61 Days?”

    “In less than four months, we had responses from more than 23,000 research participants,” said Pierre Fontanillas, PhD, a senior statistical geneticist at 23andMe. “This shows the power of our research model to quickly gather large amounts of phenotypic and genotypic data for scientific discovery.”

    By comparing participants’ survey responses to their corresponding genotypes and complementary data from other studies, Palmer’s team found a number of genetic correlations.

    “We discovered, for the first time, a genetic correlation between ADHD and delay discounting,” said first author Sandra Sanchez-Roige, PhD, a postdoctoral researcher in Palmer’s lab. “People with ADHD place less value in delayed rewards. That doesn’t mean that everyone with ADHD will undervalue future rewards or vice versa, just that the two factors have a common underlying genetic cause.”

    The researchers also found that delay discounting is genetically correlated with smoking initiation. In other words, people who undervalue future rewards may be more likely to start smoking and less likely to quit if they did.

    Body weight, as determined by body mass index (BMI), was also strongly correlated with delay discounting, suggesting that people who don’t place a high value on future rewards tend to have a higher BMI.

    The team determined that delay discounting negatively correlated with three cognitive measures: college attainment, years of education and childhood IQ. In other words, the genetic factors that predict delay discounting also predict these outcomes.

    In many studies that rely on surveys, particularly for those in which the participants are paid to fill out the survey, there’s always a chance that some answered randomly or carelessly. Palmer’s survey included three questions to assess how carefully the research participants were answering the questions. For example, one asked “Would you rather have $60 today or $20 today?” There’s only one correct answer and the team saw only 2.1 percent of participants get even one of those three questions wrong, assuring them that the vast majority were answering the questions carefully.

    “We are very thankful to the 23andMe research participants who took the time to complete our survey — they weren’t paid to do it, they are citizen-scientists volunteering their help,” Palmer said. “It’s quite a feeling to think that so many people were willing to help out in this interest of ours.”

    Palmer hopes to expand the study to a larger and more diverse population to strengthen their findings.

    “An even larger study would help start identifying specific genes with a higher level of confidence,” he said. “Then we can do hypothesis-driven studies of this trait with animal or cellular models.”

    While most research studies begin in test tubes, cells grown in the laboratory and animal models before moving to humans, the opposite is true here. After starting with these human observations, Palmer’s team is now studying the same delay discounting-related genetic traits in rodent models. They want to determine if changing those genes experimentally changes rodent behavior as expected. If it does, they will be able to use the animals to study how those delay discounting-related genes lead to those behaviors, at a molecular level.


  2. MRI shows brain differences among ADHD patients

    December 4, 2017 by Ashley

    From the Radiological Society of North America press release:

    Information from brain MRIs can help identify people with attention deficit hyperactivity disorder (ADHD) and distinguish among subtypes of the condition, according to a study appearing online in the journal Radiology.

    ADHD is a disorder of the brain characterized by periods of inattention, hyperactivity and impulsive behavior. The disorder affects 5 to 7 percent of children and adolescents worldwide, according to the ADHD Institute. The three primary subtypes of ADHD are predominantly inattentive, predominantly hyperactive/impulsive and a combination of inattentive and hyperactive.

    While clinical diagnosis and subtyping of ADHD is currently based on reported symptoms, psychoradiology, which applies imaging data analysis to mental health and neurological conditions, has emerged in recent years as a promising tool for helping to clarify diagnoses.

    Study co-author Qiyong Gong, M.D., Ph.D., and colleagues at West China Hospital of Sichuan University in Chengdu, China, recently introduced an analytical framework for psychoradiology that involves cerebral radiomics — the extraction of a large amount of quantitative information from digital imaging features that can be mined for disease characteristics. Radiomics, combined with other patient characteristics, could improve diagnostic power and help speed appropriate treatment to patients.

    “The main aim of the current study was to establish classification models that can assist the psychiatrist or clinical psychologist in diagnosing and subtyping of ADHD based on relevant radiomics signatures,” Dr. Gong said.

    With the help of his West China Hospital colleagues Huaiqiang Sun, Ph.D., and Ying Chen, M.D., Ph.D., Dr. Gong studied 83 children, ranging in age from of 7 to 14, with newly diagnosed and never-treated ADHD. The group included children with the inattentive ADHD subtype and the combined subtype. Researchers compared brain MRI results with those of a control group of 87 healthy, similarly aged children. The researchers used a relatively new feature that allowed them to screen relevant radiomics signatures from more than 3,100 quantitative features extracted from the gray and white matter.

    No overall difference was found between ADHD and controls in total brain volume or total gray and white matter volumes. However, differences emerged when the researchers looked at specific regions within the brain. Alterations in the shape of three brain regions (left temporal lobe, bilateral cuneus and areas around left central sulcus) contributed significantly to distinguishing ADHD from typically developing controls.

    Within the ADHD population, features involved in the default mode network, which is a network of brain regions active when an individual is not engaged in a specific task, and the insular cortex, an area with diverse functions related to emotion, significantly contributed to discriminating the ADHD inattentive subtype from the combined subtype.

    Overall, the radiomics signatures allowed discrimination of ADHD patients and healthy control children with 74 percent accuracy and discrimination of ADHD inattentive and ADHD combined subtypes with 80 percent accuracy.

    “This imaging-based classification model could be an objective adjunct to facilitate better clinical decision making,” Dr. Gong said. “Additionally, the present study adds to the developing field of psychoradiology, which seems primed to play a major clinical role in guiding diagnostic and treatment planning decisions in patients with psychiatric disorders.”

    The researchers plan to recruit more newly diagnosed ADHD patients to validate the results and learn more about imaging-based classification. They also intend to apply the analytic approach to other mental or neurological disorders and test its feasibility in a clinical environment, where the fully automatic analytic framework can be readily deployed, Dr. Gong said.


  3. Study looks at language often used by people with ADHD on Twitter

    November 20, 2017 by Ashley

    From the University of Pennsylvania press release:

    What can Twitter reveal about people with attention-deficit/hyperactivity disorder, or ADHD? Quite a bit about what life is like for someone with the condition, according to findings published by University of Pennsylvania researchers Sharath Chandra Guntuku and Lyle Ungar in the Journal of Attention Disorders. Twitter data might also provide clues to help facilitate more effective treatments.

    “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.”


  4. Brain imaging study suggests ADHD is a collection of different disorders

    November 17, 2017 by Ashley

    From the Elsevier press release:

    Researchers have found that patients with different types of attention-deficit/hyperactivity disorder (ADHD) have impairments in unique brain systems, indicating that there may not be a one-size-fits-all explanation for the cause of the disorder. Based on performance on behavioral tests, adolescents with ADHD fit into one of three subgroups, where each group demonstrated distinct impairments in the brain with no common abnormalities between them.

    The study, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, has the potential to radically reframe how researchers think about ADHD. “This study found evidence that clearly supports the idea that ADHD-diagnosed adolescents are not all the same neurobiologically,” said first author Dr. Michael Stevens, of the Olin Neuropsychiatry Research Center, Hartford, CT, and Yale University. Rather than a single disorder with small variations, the findings suggest that the diagnosis instead encompasses a “constellation” of different types of ADHD in which the brain functions in completely different ways.

    The researchers tested 117 adolescents with ADHD to assess different types of impulsive behavior — a typical feature of ADHD. Three distinct groups emerged based on the participants’ performance. One group demonstrated impulsive motor responses during fast-moving visual tasks (a measure of executive function), one group showed a preference for immediate reward, and the third group performed relatively normal on both tasks, compared to 134 non-ADHD adolescents.

    “These three ADHD subgroups were otherwise clinically indistinguishable for the most part,” said Dr. Stevens. “Without the specialized cognitive testing, a clinician would have had no way to tell apart the ADHD patients in one subgroup versus another.” Dr. Stevens and colleagues then used functional magnetic resonance imaging (fMRI), a technique that allows researchers to make connections between behavior and brain function, to investigate how these different impulsivity-related test profiles related to brain dysfunction.

    “Far from having a core ADHD profile of brain dysfunction, there was not a single fMRI-measured abnormality that could be found in all three ADHD subgroups,” said Dr. Stevens. Instead, each subgroup had dysfunction in different brain regions related to their specific type of behavioral impairment.

    “The results of this study highlight that there are different neural systems related to executive functions and reward processing that may contribute independently to the development of ADHD symptoms,” said Dr. Cameron Carter, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

    It will take more research to prove that ADHD is a collection of different disorders, but this study provides a big step in that direction. “Ultimately, by being open to the idea that psychiatric disorders like ADHD might be caused by more than one factor, it might be possible to advance our understanding of causes and treatments more rapidly,” said Dr. Stevens.

    According to Dr. Carter, the findings suggest that future approaches using clinical assessments to identify the specific type of brain dysfunction contributing to a patient’s symptoms may allow a more targeted approach to treatment. For example, medications that may not appear to work well in a group of ADHD patients as a whole, may be effective for one particular subgroup that arises from a specific causal pathway.


  5. Study finds that keeping harsh punishment in check helps kids with ADHD

    November 13, 2017 by Ashley

    From the Ohio State University press release:

    Cutting back on yelling, criticism and other harsh parenting approaches, including physical punishment, has the power to calm children with attention deficit hyperactivity disorder, according to a new study.

    Researchers from The Ohio State University evaluated physiological markers of emotional regulation in preschool children with ADHD before and after a parent and child intervention aimed at improving family relations. Changes in parenting — including less yelling and physical discipline — led to improvements in children’s biological regulation.

    “This is the first study to show that improved parenting changes kids biologically,” said Theodore Beauchaine, the study’s senior author and a professor of psychology at Ohio State.

    “The idea is to change family dynamics so these highly vulnerable kids don’t run into big problems down the road, including delinquency and criminal behavior.”

    The study appears in the journal Clinical Psychological Science.

    Parents of 99 preschoolers with ADHD received parenting coaching — half during 20 weekly two-hour sessions and half during 10 similar sessions. The parents learned skills including problem-solving, positive parenting techniques and effective responses to their children’s behaviors. Meanwhile, their children met with therapists who reinforced topics such as emotional regulation and anger management.

    Before the training began, parents (usually moms) and their children engaged in play sessions that included an intentionally frustrating block-building exercise. Parents dumped a large container of blocks on the floor and were told not to touch the blocks and to coach their children on how to build progressively complex structures.

    During the exercise, the children were tethered to equipment that recorded their heart activity. Abnormal patterns of heart activity are common among children who have trouble controlling their emotions, including some children with ADHD, Beauchaine said.

    After parent coaching was complete, the researchers had families return to the lab for retesting to determine if the training sessions led to changes in parenting and heart activity among children.

    Reductions in negative parenting were found to drive improved biological function in children. Increases in positive parenting had no effect.

    The researchers also observed each parent and child during a 30-minute play session in the family home and video-recorded positive and negative parenting approaches. Positive parenting included praise, encouragement and problem-solving. Negative parenting included critical statements, physical discipline and commands that gave children no opportunity to comply.

    Less-harsh parenting also was linked to improved behavior in children, a finding that bolsters previous research in this area.

    “Negative interactions between parents and children have a big effect on kids,” Beauchaine said.

    Greater improvements in parenting were seen in those who had 20 weeks of classes, versus 10. Regardless, the intervention was relatively short, Beauchaine said.

    “Just 20 weeks to observe this much change is somewhat surprising,” he said.

    Children in the study all struggled primarily with hyperactivity and impulsivity, as opposed to inattention. Most of them — 76 percent — were boys, which is similar to ADHD rates in the general population. Families were participants in Beauchaine’s work with collaborators at the University of Washington. One limitation of the study is that it did not include a control group of parents and children who did not receive lessons.

    Beauchaine said it is important to recognize the tremendous parenting challenges that moms and dads of children with ADHD face.

    “A lot of times, these young kids and their parents don’t like each other much. We strive to change that. It’s challenging for parents, because these kids can be hard to raise,” he said.

    “The idea is not to blame parents or kids, but to look for ways to help them both.”


  6. Study suggests brain activity is inherited, may inform treatment for ADHD, autism

    by Ashley

    From the Oregon Health & Science University press release:

    Every person has a distinct pattern of functional brain connectivity known as a connectotype, or brain fingerprint. A new study conducted at OHSU in Portland, Oregon, concludes that while individually unique, each connectotype demonstrates both familial and heritable relationships. The results published today in Network Neuroscience.

    “Similar to DNA, specific brain systems and connectivity patterns are passed down from adults to their children,” said the study’s principal investigator Damien Fair, Ph.D., P.A.-C., associate professor of behavioral neuroscience and psychiatry, OHSU School of Medicine. “This is significant because it may help us to better characterize aspects of altered brain activity, development or disease.”

    Using two data sets of functional MRI brain scans from more than 350 adult and child siblings during resting state, Fair and colleagues applied an innovative technique to characterize functional connectivity and machine learning to successfully identify siblings based on their connectotype.

    Through a similar process, the team also distinguished individual sibling and twin pairs from unrelated pairs in both children and adults.

    “This confirms that while unique to each individual, some aspects of the family connectome are inherited and maintained throughout development and may be useful as early biomarkers of mental or neurological conditions,” said lead author Oscar Miranda-Dominguez, Ph.D., research assistant professor of behavioral neuroscience, OHSU School of Medicine.

    Overall, the connectotype demonstrated heritability within five brain systems, the most prominent being the frontoparietal cortex, or the part of the brain that filters incoming information. The dorsal attention and default systems, important for attention or focus and internal mental thoughts or rumination, respectively, also showed significant occurrences.

    “These findings add to the way we think about normal and altered brain function,” said Fair. “Further, it creates more opportunity for personalized and targeted treatment approaches for conditions such as ADHD or autism.”


  7. Study suggests online parent training can help young kids with ADHD

    October 16, 2017 by Ashley

    From the Lehigh University press release:

    Parents of children with ADHD can feel desperate for resources or treatments to help their children who struggle with inattention, distractibility and impulsiveness affecting school and home. Researchers at Lehigh University have discovered that brief online or in-person behavioral therapy for parents is equally effective in improving children’s behavior and parental knowledge — a potential game changer for parents strapped for time and access.

    They report these findings in a new paper published in The Journal of Clinical Child & Adolescent Psychology.

    Few Use Behavior Therapy, Despite Recommendations

    While the American Academy of Pediatrics recommends behavior therapy support as the first line of treatment for preschool-age children with attention deficit hyperactivity disorder (ADHD), limited availability of clinicians, cost and challenges in transportation and child care — as well as reliance on pharmacological drugs — mean few families access such therapy for themselves and their children. A 2016 report from the Centers for Disease Control found that about 75 percent of young children with ADHD received medicine as treatment and only about 50 percent of young children with ADHD with Medicaid and 40 percent with employer-sponsored insurance got psychological services, which may include behavior therapy. ADHD occurs in 2 to 15 percent of young children, with 11 percent of children in the U.S. receiving an ADHD diagnosis at some point in their lives.

    The research by George DuPaul, professor of school psychology, and Lee Kern, professor of special education, at Lehigh University is the first to look at online ADHD behavior therapies in this age group (3-5 years old). It was conducted with a $1.2 million grant from the Institute of Education Sciences, the research arm of the U.S. Department of Education.

    Parents learned effective ways to anticipate and prevent child behavior problems, teach their children better ways to communicate their needs, and how to best reinforce their children’s positive behaviors with about 15 hours of parent education that can be delivered equally successfully in a typical face-to-face format or online,” DuPaul said of the findings. “The fact that parents can learn these strategies on their own schedule via an online platform has the potential to significantly improve current practice and present savings in terms of time and cost to families for whom access is an issue.”

    Training Benefits Parents and Children

    For the study, researchers created a program of parent education and support that was shorter in duration than most similar trainings. They recruited 47 families in the Lehigh Valley region of Pennsylvania who had 3- to 5-year-old children who met diagnostic criteria for ADHD. Families were randomly assigned to one of three groups (face-to-face parent education, online parent education or a wait-list control group), with parents taking part in 10 weekly education sessions.

    “We collected parent questionnaires, tested parent knowledge and observed parent-child interactions in family homes before and after parent education was delivered to evaluate whether our program made a difference relative to families who did not receive parent education,” DuPaul said.

    In addition to finding online training was similarly effective to face-to-face training, researchers found parents participating in the streamlined 10-week format were more likely to be engaged and to complete training than those participating in longer formats. Both in-person and online training formats had high attendance and significantly improved parent knowledge of interventions and adherence to treatment protocols.

    In addition, children in the study were better able to regulate their behavior, demonstrating reduced restlessness and impulsivity and improved self-control, affect and mood compared to the control group.

    Though behavioral parent training is known to have positive results for children with ADHD, fewer parents and mental health and medical practitioners know about it than medication prescribed for ADHD, which can come with side effects and is not recommended as a first-line treatment for preschool-age children, DuPaul said.

    Thus the study provides options both relative to medication and among behavioral therapy in terms of the effectiveness of both in-person and electronically delivered formats.

    “I hope these findings add to the existing evidence that behavioral parent training is an effective approach for young kids with ADHD even when applied over a relatively short time, and show that both in-person and online formats can be effective in parent and child behavior change,” said DuPaul, who hopes the research also spurs more development of alternative ways of delivering interventions to parents.

    “The implications are substantial given barriers that many families experience with face-to-face behavioral parent training,” the study states.

    In addition to parents, the findings will be useful for others who interact with young children at risk for ADHD, from mental health practitioners and pediatricians to preschool teachers and early childhood education professionals, DuPaul said.


  8. Study suggests school year ‘relative age’ may cause bias in ADHD diagnosis

    October 15, 2017 by Ashley

    From the University of Nottingham press release:

    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.


  9. Study suggests ADHD kids can be still, if they’re not straining their brains

    September 30, 2017 by Ashley

    From the University of Central Florida press release:

    How’s this for exasperating: Your ADHD child fidgets and squirms his way through school and homework, but seems laser-focused and motionless sitting in front of the TV watching an action thriller.

    Well, fret not, because new research shows lack of motivation or boredom with school isn’t to blame for the differing behavior. It turns out that symptoms of Attention Deficit Hyperactivity Disorder such as fidgeting, foot-tapping and chair-swiveling are triggered by cognitively demanding tasks — like school and homework. But movies and video games don’t typically require brain strain, so the excessive movement doesn’t manifest.

    “When a parent or a teacher sees a child who can sit perfectly still in one condition and yet over here they’re all over the place, the first thing they say is, ‘Well, they could sit still if they wanted to,'” said Mark Rapport, director of the Children’s Learning Clinic at the University of Central Florida. “But kids with ADHD only need to move when they are accessing their brain’s executive functions. That movement helps them maintain alertness.”

    Scientists once thought that ADHD symptoms were always present. But previous research from Rapport, who has been studying ADHD for more than 36 years, has shown the fidgeting was most often present when children were using their brains’ executive functions, particularly “working memory.” That’s the system we use for temporarily storing and managing information required to carry out complex cognitive tasks such as learning, reasoning and comprehension.

    As recently published in the Journal of Abnormal Child Psychology, Professor Rapport’s senior doctoral student Sarah Orban and research team tested 62 boys ages 8 to 12. Of those, 32 had ADHD. Thirty did not have ADHD and acted as a control group.

    During separate sessions, the children watched two short videos, each about 10 minutes long. One was a scene from “Star Wars Episode I — The Phantom Menace” in which a young Anakin Skywalker competes in a dramatic pod-race. The other was an instructional video featuring an instructor verbally and visually presenting multistep solutions to addition, subtraction and multiplication problems.

    While watching, the participants were observed by a researcher, recorded and outfitted with wearable actigraphs that tracked their slightest movements. The children with ADHD were largely motionless while watching the Star Wars clip, but during the math video they swiveled in their chairs, frequently changed positions and tapped their feet.

    That may not seem surprising. After all, weren’t the children absorbed by the sci-fi movie and bored by the math lesson? Not so, Rapport said.

    “That’s just using the outcome to explain the cause,” he said. “We have shown that what’s really going on is that it depends on the cognitive demands of the task. With the action movie, there’s no thinking involved — you’re just viewing it, using your senses. You don’t have to hold anything in your brain and analyze it. With the math video, they are using their working memory, and in that condition movement helps them to be more focused.”

    The takeaway: Parents and teachers of children with ADHD should avoid labeling them as unmotivated slackers when they’re working on tasks that require working memory and cognitive processing, researchers said.

    The study builds on Rapport’s earlier research, including a 2015 study that found that children with ADHD must be allowed to squirm to learn.


  10. Study suggests ADHD may be linked to sleep problems

    September 16, 2017 by Ashley

    From the European College of Neuropsychopharmacology press release:

    Around 75% 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.