Primarily Inattentive ADD

UPDATE ON US AND Check Out Psychiatrist Michiel Bosman's Website

2016-10-05T11:22:00.001-04:00

Primarily Inattentive ADD: An Update

Soooooo, I have not posted in a while. I went back to almost full time work and have not had much time to keep up with the blog but I wanted to post an update. My sons are doing well. My son with ADHD-I is a senior in high school. He has many tools he uses to get his work done and you can find them all by trolling through my previous posts. He is now captain of both the Robotics team and the Cross Country team. He spent the last two summers in California working with a Financial Tech company and this past summer he worked for 12 weeks earning $15 a hour. They loved him, it was a great experience and he feels really rich. He still religiously drinks his coffee every morning and another cup if a long night of studying is ahead.

My younger son, the one with ADHD-C, has switched schools and he is no longer in the private prep school that my eldest son attends. He is doing as well as can be expected at the public school. He hates school but enjoys playing LaCrosse. He is on Vyvanse which he finally admits helps him and which he now tolerates well. He is thinking about perhaps attending an academy to be trained and get a certificate in movie, film and television production. We live in Georgia and the state has made a large push to attract movie and TV production companies to film here.

Nothing else to report. We have been busy at home with College Applications for my eldest son. Talk about needing checklists, reminders and spreadsheet help... Please keep in touch. It is always good to hear from you!!

Oh, by the way, I Wanted to give you guys a heads up on Psychiatrist Michiel Bosman's evidence-based mental health self-help website Open Forest (https://openforest.net; He has a articles on his site with overviews of some of the hottest ADHD topics today. He updates the post regularly with new posts. I recommend you check it out.

Additude Magazine Article on "Boosting Your Brain Activity".

2015-11-23T19:44:00.000-05:00

The Winter 2015 edition of ADDITUDE magazine has a bunch of cool ideas (including two of mine for folks with Inattentive ADD) for "Boosting your Brain Activity. They asked a bunch of folks how they keep their ADHD brains in shape and the responses are helpful. If you do not subscribe, buy a copy!

My life is busy. I am pretty much working full time now. This does not leave much time for anything except family responsibilities and enjoyment.

The family is all fine and my kids are doing well. They have very different strengths and weaknesses but now that they are both in high school, I feel that they are well on the road to managing their ADHD symptoms on their own.

My eldest is in the midst of his Junior year in high school and is knee deep in testing, AP classes, clubs and practicing learning to drive. He is doing well in school.

The little one is a freshman in high school and is happy to be at a new school where the sports he loves are played. Academics continues to be a struggle for him but the new school is a much better fit.

Keep your letters coming. I always answer though I have been very neglectful with regards to posting regularly. Have a great holiday season!

Inattentive ADHD is Different

2015-08-18T19:43:00.003-04:00

Inattentive ADHD is Different

Those of us who have Inattentive ADD or have children with Inattentive ADD know that we and our kids behave fundamentally differently from people who have Hyperactive or Combined type ADHD. To me, ADHD Inattentive feels different to the core but until fairly recently not everyone even believed the symptoms of Inattentive ADHD were different from the symptoms of Combined Type or Hyperactive Type ADHD.

Fifteen years ago Russell Barkley was the first ADHD researcher to speak of the difference between the three types of ADHD and in the last few years other ADHD researchers have taken a deeper look. Scientists are finding biological, even cellular differences between the ADHD types.

The researchers of a new study that was published last month in the Journal Frontiers in Molecular Neuroscience found chromosomal differences between ADHD children of different types. The researchers performed a study where they looked at a piece of genetic material called a telomere in nine year old kids with ADHD. What they found was that the length of the telomere was shortened in the Combined type kids but not in the Inattentive kids.

You have maybe heard of telomeres. What are they? In short, telomeres are chromosomal "caps". Like a the plastic cap at the end of our shoe laces, our telomeres keep our DNA filled chromosomes from unraveling. .

To further the biology lesson... Our DNA contains the codes that make our bodies work. Our Chromosomes are made of DNA molecules that are wrapped with proteins and then capped with telomeres to keep the DNA from unraveling. The cap or telomere is important because unraveled DNA does not work properly. Telomeres shorten as we age but stress, depression, illness, poor nutrition, lack of exercise and other life style factors (drug and alcohol use, smoking), speed up their shortening.

I always wonder when I read studies such as this one about the "chicken and the egg" questions. Do kids with Combined type ADHD have shortened telomeres because they were born that way or does the stress of having Combined type ADHD (and all the co-conditions that go along with that diagnosis such as depression, etc) cause their telomeres to shorten?

I also wonder about nutrition and exercise. Lots of studies have shown that we can protect the length of our telomeres by eating better, being at a normal weight and exercising. Might this be the reason that diet and exercise have been found to be beneficial for the treatment of ADHD?

Genetics plays a huge role in ADHD. We know that ADHD is very inheritable and that other genetic components also contribute to the condition. I have written a post on one of these components, Epigenes, that gives further insight on the importance of genetics and the environment as it relates to ADHD symptoms.

There is much more to learn about the differences between the ADHD types. Any study or research work that furthers our knowledge of this condition is helpful to our overall understanding. It is exciting to me that the pace of research into this topic appears to be quickening!

Frontiers in Molecular Neuroscience. 2015 Jul 10;8:28..

Telomere length is highly inherited and associated with hyperactivity-impulsivity in children with attention deficit/hyperactivity disorder.

Costa Dde S¹, Rosa DV¹, Barros AG¹, Romano-Silva MA¹, Malloy-Diniz LF¹, Mattos P², de Miranda DM¹.

INATTENTIVE ADHD, REFLECTIONS FROM MY MAILBOX

2015-05-18T14:36:00.002-04:00

INATTENTIVE ADHD, REFLECTIONS FROM MY MAILBOX

I receive emails from parents regularly. I often get emails regarding inattentive symptoms in very young school age children. The parents of these 4-6 year old children are writing to ask if the fact that their child does not pay attention when he/she is sitting "criss-cross applesauce" during story time, while writing his/her alphabet letters endlessly on a worksheet or while doing various math or reading drills is normal.

I want to scream at my computer. 'YOUR CHILD DOES NOT HAVE INATTENTIVE ADHD, YOUR CHILD IS FIVE YEARS OLD', but I do not. The sad fact is that many of these spaced out five year olds, will be space out 4th graders and the parents that are writing me are doing so because they know their child and they know that the child's level of spaciness goes beyond an inability to write the letter 'C' on lined paper, 30 times.

I could go on an on about the stupid demands that most school's place on Kindergartners but instead I want to address the fact that most parents know well before there is an official diagnosis, that their child's inattention is a problem and that. as a parent, once you become concerned about your child's inability to focus, it is time to:

A. Figure out how out of the normal range your child's lack of attention is.

B. Alert the child that focus an attention are skills that take practice but that can be learned (before a teacher or anyone else decides that they are nothing but an inattentive mess).

C. Forge a plan to teach attention skills.

D. Be your child's biggest fan and love them for all the other great skills and talents that make them who they are.

To give you an example of what might happen to an inattentive five year old once they get to a kindergarten classroom, I would like to post part of a letter I received (the writer has granted me permission to do so), and my response.

"My five year old son just started Kindergarten. He went to a small preschool where there were only 10 kids to a classroom and though he was shy and quiet, he was a favorite of the teachers as he just loved to quietly observe everything around him and they found him easy and smart. He learned to read, in preschool, when he was four and he now reads better than most first graders...

He is a dawdler and it often takes him 3 hours to complete a chore that could have been done in 5 minutes. He is obedient at home and at school and despite the fact that he is slow, spacey and a procrastinator, he is otherwise a creative, funny, insightful and delightful kid.

I am writing because my problem is his new school. Since he started Kindergarten his teacher has been calling me almost weekly to report that he does not pay attention, that he wonders around the classroom when he should be sitting "criss-cross applesauce", that he is slow to complete assignments and that they are worried about him socially because, for example, when he is on the playground he does not play, he just sits and watches the older kids play and the teachers talk...

I have started using a timer to make him aware of his dawdling and I have started to try to make him understand the 'new rules of Kindergarten'...

I am concerned with all the teacher calls, can you give me some advise as to what else I might do?"

I get a variation of this letter at least once a month. My response:

Thanks for your email. Your son sounds like a sweetheart and it sounds as though you are doing all the right things. With your continued support and guidance his procrastination, dawdling, organization and attention will improve.

My suggestions would include having him start walking or doing some kind of daily exercise, having him set some of his own goals to accomplish something HE wants and show him how the steps of that goal get performed in a timely way.

He is only 5, at this point you have to teach timeliness. I used timers a lot because my son had no internal clock and needed an external one to help him.

He will continue to need lots of organizational support and charts, cues, routines, etc will be more and more important as he ages.

His classrooms and teachers will need to have in place written and accessible assignments and deadlines. Many schools are using Schoology a program that keeps students and parents abreast of upcoming projects and homework. Some system, such as that, will be helpful so that you can help him help himself.

He will do great. Ages 5 to 7 are tough as are the start of middle school and high school. The good news is that once they reach middle school you will have been coaching him so long, the two of you as a team will be seasoned pros and will know exactly how to tackle the rising challenges.

Keep the faith and keep me posted.

Have a great summer, Please keep your letters coming! I love hearing from you.

BTW, I wanted my readers to know that I have two articles in the Summer edition of Additude Magazine which I hope you will read and enjoy!

Inattentive ADD, Coordination and Sensory Processing

2015-03-21T15:17:00.002-04:00

Inattentive ADD, Coordination and Sensory Processing

A study just posted in a Chinese medical journal and cited below confirms what I have observed in boys with Inattentive ADD. Children with Inattentive ADHD are less likely to engage in sports, more likely to have problems with motor coordination and more likely to have visual processing issues. These problems are bad enough but unfortunately, they also cause brain organization problems.

I have posted in the past about the connection between Inattentive ADHD and Sensory Integration problems and I have also posted about Inattentive ADD and motor and coordination difficulties.

Coordination difficulties are problematic in sports but there is a growing body of evidence that suggest that children that are not coordinated also have problems with brain development.

Optometrist believe that the brain, through balance and coordination organizes itself. As the body develops and practices tasks such as crawling and walking, a process called brain "lateralization" occurs.

Lateralization eventually leads the brain to establish a dominant side. Developing a dominant side is important for brain organization and the importance goes WAY beyond the ideas first introduced by psychologist who wrote about right sided versus left sides brain dominance.

Through studies on brain mapping, we now know that the entire brain works together to accomplish both artistic and analytic tasks but that having a dominant side or lateralizing is important for writing, reading and math as well as for sports.

It is through physical activity , specifically activities that "cross the midline" or that use both the left side and right side of the body, that the two sides or hemispheres of the brain learn to work together.

Coordinated children learn to use both sides of their bodies together to do things like crawling, pushing, pulling or walking. This coordinated body practice help the brains of these children become better organized for doing the tasks that will later be required at school and in life. Uncoordinated children get less practice at doing these things and are slower to develop a lateralized and well organized brain.

What the Chinese study confirms is that Inattentive boys (the study was performed on boys but likely applies to girls as well) are less coordinated that their non-inattentive peers and also less coordinated than their combined type peers. So, are the brain organization problems in inattentive boys the result of the motor and sensory coordination problems or vice versa? Well who knows. What we do know is that treating the coordination, motor and sensory problems with exercise and other modalities can help treat the brain organization issues that ultimately contribute to inattention.

Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder: a case-control study.

Ren Y1, Yu L2, Yang L1, Cheng J1, Feng L3, Wang Y4.

CONCLUSIONS:

ADHD boys had a poorer static postural control ability and impaired function of processing visual and vestibular information compared with the normal control. Boys with ADHD-I showed particularly severe defect of static postural control and vestibular function integrating conflict information than normal boys. These deficits may be an important contributor to the clinical presentation of ADHD children and their cognitive deficits. Assessment and training of postural control function would be suggested during the diagnosis and treatment of ADHD children.

Could This be Inattentive ADD?

2014-11-15T11:36:00.005-05:00

Could This be Inattentive ADD?

Recently I have received several questions from parents with young children with symptoms of:

Inattention
Disorganization
Procrastination
Plodding Work Pace
Lethargy

The parents of these kids want to know if these symptoms are Inattentive ADD symptoms and they want to know what to do. They often are concerned about the “labeling” of their kids and this is a legitimate concern and they are concerned about not acting on these issues as they fear that the symptoms will only become more of an issue as their children age.

As an aside, I am always heartened by the fact that 95% of the parents who write me, describe their children as poor students but “delightful people”. I always ask parents if their children are “good company” and they almost always say “yes”. I mention this because, at the end of the day, a person who is “good company” has a lot more potential than a person who is not. Excellent, A+ students, can be obnoxious, arrogant and “bad company” and I like to point this out to parents who are despairing about their children’s academic performance.

Anyway... back to the topic. The above symptoms may or may not be Inattentive ADD symptoms. It does not really matter as these children need help. In children who are ten and younger, the plan should be to help them establish life and academic skills that will support them in years to come. These skills include:

Regular Exercise
Healthy Diet Habits
Healthy Sleep Habits
Good Parent/Teacher Communication
Organizational Aids such as wall charts, Big visible task calendars,
Appropriate Incentives

For older kids, the support plan should include all the above plus:

Having a spare set of school books (a whole extra set) at home to help eliminate the issues of not having the right books to do whatever assignment is due.
Engaging the help of a high school student, paid minimum wage, to be your child’s "homework helper". Communicating teachers and asking that assignments be put online or available in such a way that you, the Homework Helper and the student know what it due, when it is due and what is required to complete the assignment.
In addition all the recommendations in this post talks about classroom changes that help all students and especially helps students with memory and organization problems.

To find more of my suggestions, you can use the search bar in the top right hand corner of my blog and search under the terms "teacher" and "classroom". This will bring up posts with more recommendations.

The Difference Between Sluggish Cognitive Tempo and Inattentive ADD

2014-08-19T11:12:00.000-04:00

The Difference Between Sluggish Cognitive Tempo and Inattentive ADD

I have been posting to 'Primarily Inattentive ADD' very infrequently. The main reason for this is that I found about a year ago, after I finished my second book, Commanding Attention, that I had written about most of what I had to say. At that time I decided I would only post if some new Inattentive ADD news story warranted coverage.

I do not have any amazing new discoveries to post about but I wanted to address a question that I get emailed a lot. The question of the difference between Inattentive ADD and Sluggish Cognitive Tempo (SCT). These conditions are different but they are equally difficult to treat as they both often fail to respond to stimulants. New studies suggest that Strattera, a non-stimulant ADHD medication, may help SCT as well as helping Inattentive ADD but the amount of benefit that any individual ADD or SCT patient may get from Strattera is still highly variable.

My short answer to, What is the difference between SCT and Inattentive ADD? has always been this, Children and adults with Inattentive ADD are normally active. Not hyperactive, not hypo-active. The difficulty in diagnosing children with either condition (and with hyperactive ADHD for that matter) is that many children under the age of 12 have a normal development lag in their ability to regulate their activity levels. To make matters more complicated, teenagers can be perpetually tired because of all sorts of normal developmental issues (sleep deprivation, anxiety, depression, etc) and these same issues can cause some teenagers to be hyperactive.

There is no doubt in my mind that there are adults and children who are legitimately and concernedly sluggish but I believe that we are only now in the infancy or our medical understanding of the cause and possible solutions to this sluggishness. Until we understand better the causes of mental sluggishness, we cannot begin to treat it.

I am in classrooms a lot. In every third Kindergarten through 12th grade classroom there is at least one student who appears unable to stay awake. Teaching a child like this is obviously impossible but does every child who is half asleep have a diagnosis of SCT. I do not think so. Inattentive ADD is, in my opinion, more prevalent. You can find a Inattentive ADD kid in every K-12 classroom if you know what to look for. That kids is not falling asleep. That kid looks like he/she even may be paying attention. The problem is, that Inattentive ADD kid is paying attention to something going on in their head, NOT to what is going on in the classroom.

In an April article on SCT in the New York Times, Alan Schwarz reported that Psychiatrists and drug companies are "claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems". In his article, Schwarz reports that Steve S. Lee, an associate professor of psychology on the editorial board of The Journal of Abnormal Child Psychology, is concerned that SCT may be diagnosed in children with common behaviors that are the result of common youthful problems such as lack of sleep." Of course, the same concerns can be said of the diagnosis of both hyperactive ADHD and ADD.

So there is a difference but the take home message here is this. There are hyperactive kids and adults, there are inattentive kids and adults and there are sluggish (and usually inattentive) kids and adults and we know a lot more about the former two than we know about the latter.

Media Review of Coffee and Inattentive ADHD

2014-05-13T09:44:00.000-04:00

Coffee Bean Image By: https://www.facebook.com/pixabay

I am not posting much these days as my work schedule has been a bear. I, however, wanted to post today about an interesting article that I read in the Atlantic about caffeine. Regular blog readers will know that I am a regular coffee drinker and that I use caffeine to help me focus, to motivate me and to keep me on track throughout my day.

The Atlantic article focuses on the use of caffeine in Athletics. They come to the conclusion that caffeine helps performance but, as we all know, caffeine is also addictive. Their recommendation is that it be used carefully and purposefully. I would have to totally agree.

My 15 year old son is now making his own morning cup of coffee. He drinks it black. He seems to do fine with just that one cup though he just went through finals week and I did notice that on a few days he made himself a cup at 3:30 pm as well. He always has trouble falling asleep so it is unclear if the coffee kept him awake.

As you will remember, I am also a devout believer in exercise for ADHD. My younger son has taken up Lacrosse which thankfully he loves. My eldest is walking home from school every day now so he is getting 2.5 miles of exercise a day as well.

The road is always a bit bumpy when you are watching kids with ADHD mature and find their way. It seems that their lives are filled with periods of clear sailing, periods of dead winds and periods of hurricane winds. Well, come to think of it, that is probably true of all of our lives...

You can find more information on why caffeine may help ADHD in this post about caffeine and the brain and I briefly address caffeine and Sluggish Cognitive Tempo is this other post.

I hope you are having a happy Spring!

Inattentive ADHD Treatment Questions From the Primarily Inattentive ADD Mailbox

2014-02-24T09:58:00.003-05:00

Inattentive ADHD Treatment Questions From My Mailbox

As many of you have likely gathered, I am posting only very sporadically now. With one of my sons in middle school and the other in high school, I am finding that I am spending more time supporting them both by being at home for them and by working more to be able to afford their very expensive private school.

I am answering emails and lately I have had some good questions that I wanted to share with you. None of these questions have pat answers but if you are a regular reader of this blog, you know that there are no "one size fits all" answers. This question is kind of a composite of the questions that I have answered of late.

Hello Tess,

I recently came across your website as I was searching for info on how to help my son. He is 12 years old and was diagnosed at age eight with inattentive ADD. He is on a very lose dose of Ritalin SR (10 mg) daily and this does seem to help him a little bit.

He is really struggling at school despite having a tutor (since the beginning of the year) twice weekly. The tutor is charging us $80 per hour and our family can barely afford her. More importantly, I am not sure that she is making any difference. His grades have not changed, he is still really struggling in school and cannot seem to focus on his schoolwork for any real length of time and homework time is always "meltdown" time at our house.

I am sure that, like you, I had this going on as a kid – teachers couldn't believe that I was actually smart and I had an amazing imagination and daydreamed all the time – still considered “spacey” by many. My son is me times 10. When he was tiny, I knew we were kindred souls, and we are very similar in many ways.

We struggle with this diagnoses as you know very few people know the distinction of ADHD and ADHD-I. We are constantly looking at schools where we might qualify for financial aid and that might be a better fit but have not succeeded in finding one that we are willing to take the leap of faith with.

Any suggestion that you might have that could help our son would be greatly appreciated!

My Answer

Hi, Thanks for your questions. I guess, before I can make any suggestions, I have a few questions about your son.

What does he love to do?

Does he focus when he plays sports?

Does he have any other medical, emotional, psychological (anxiety, depression, hearing, Celiac...)?

What subjects in school are the most difficult?

Does he like school?

Does he have friends?

Does he ever focus on something?

How is your relationship with the school?

The reason I ask all these questions is that all these factors matter. If he loves sports and focuses during sports, he should continue to do them. ANYTHING that teaches an inattentive kid to focus (not counting hours of video games) will help them in the long run.

Melt downs over homework are really common. Forging a plan as a team (it sounds as though you are doing this) helps. Breaking down the tasks into pieces and interjecting fun activities, snacks, breaks all help. If you can meet with the teacher and have her make sure he stays on task at school, this would help. Sometimes asking the teacher for a recommendation of a kid who could do the homework with him (not for him but with him) with you out of the picture helps inattentive kids focus as they tend to "sync" better with someone their own age (Or slightly older. In the 4th grade my son had a neighbor in 7th grade who I paid $7 an hour to be a "homework" helper. Later, I got him a High School senior to be a homework helper for $10 an hour-my son never melted down with the homework helpers and they are cheap!!).

If he likes school, that is a real plus. I do not know what you do but if you could help out at school, that often makes kids feel more like school is a family event rather than somewhere they are "sent off to". Since you had ADD as a kid, try to draw on your own experiences of what helped you. Kids with ADD/ADHD (as I am sure you know) often have other medical/emotional/psych things going on. They all do better if these things are treated.

Let me know if any questions that you might have.

Music and Inattentive ADD

2013-11-15T09:06:00.000-05:00

Music and Inattentive ADD

Recently I was asked by a reader if there was a connection between music and performance in kids with inattentive ADHD. This reader was a parent who had found that her ten year old daughter could do her math problems faster and with more accuracy if a certain type of music was playing. It seemed that music helped her attention.

As it turns out there is a correlation between math and music. Many composers have been found to have amazingly advanced mathematical minds and neurobiologist have found that music can stimulate the part of the brain that is used for memory and higher brain functions such as reasoning and spatial problem solving.

It may be that music also helps kids with ADHD do better in school. In one study (see below) boys with ADHD were tested on classroom performance with music on and off. Some, but not all of the boys, benefitted from having music playing while studying.

The differences in performance and the reason why some boys benefited from the music and others did not might be related to genetics. The second study listed below seems to point to the fact that music can act beneficially because it acts on some of the genetically determined pathways that are amiss in ADHD.

Not all music helps. It seems as though the tempo of the music makes a difference. Rock, Rap and some types of classical music seem to help more than say folk music. In my family, my son studies wearing ear phones and he listens to classical type music. He really feels that it helps him stay focused.

As I mentioned, it may not help everyone with Inattentive ADD but what the heck, if you have not tried working while listening to music, give it a try!

J Abnorm Child Psychol. 2011 Nov;39(8):1085-98. doi: 10.1007/s10802-011-9529-z.

Music and video as distractors for boys with ADHD in the classroom: comparison with controls, individual differences, and medication effects.

Pelham WE Jr, Waschbusch DA, Hoza B, Gnagy EM, Greiner AR, Sams SE, Vallano G, Majumdar A, Carter RL.

Abstract

This study examined the effects of music and video on the classroom behavior and performance of boys with and without attention deficit hyperactivity disorder (ADHD) and examined the effects of 0.3 mg/kg methylphenidate (MPH or Ritalin). In one study, 41 boys with ADHD and 26 controls worked in the presence of no distractor, music, or video. Video produced significant distraction, particularly for the boys with ADHD, and MPH improved the performance of boys with ADHD across distractor conditions.There were individual differences in response to the music such that some boys were adversely affected and others benefited relative to no-distractor.In a second study, music and MPH were assessed in an additional 86 boys with ADHD to examine further the music results. In the presence or absence of music, MPH improved performance relative to placebo. Similar individual differences were found as in Experiment 1.

Med Hypotheses. 2010 Mar;74(3):513-20. doi: 10.1016/j.mehy.2009.10.008. Epub 2009 Nov 14.

Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS).

Blum K, Chen TJ, Chen AL, Madigan M, Downs BW, Waite RL, Braverman ER, Kerner M, Bowirrat A, Giordano J, Henshaw H, Gold MS.

Research Update: BPA and ADHD behaviors

2013-07-26T08:22:00.005-04:00

Research Update: BPA and ADHD behaviors

Truth be told, there is not much new being reported about Inattentive ADHD in medical research journals these days but I did find a new report on bisphenol A (BPA) and ADHD like behaviors in the Environmental Research journal that confirms what researchers have suspected about the link between ADHD behaviors and BPA.

The report, cited below, concluded that, "Childhood urinary BPA concentrations were associated with increased externalizing behaviors, including conduct problems, in girls at age 7 and increased internalizing behaviors and inattention and hyperactivity behaviors in boys and girls at age 7."

This is not new information. The dangers of bisphenol A have been reported on for years and researchers have had concerns about the associations of BPA exposure in early life with ADHD and conduct problems as well as with problems such as anxiety, depression, and hyperactivity in children.

Many manufacturers such as the Coca-Cola company are now using BPA free containers and most companies that make baby bottles do the same but the Mayo Clinic recommends that you should avoid the use of plastic containers when storing hot foods and ligquids. They recommend the use of glass, porcelain or stainless steel containers instead.

Some plastics with BPA have the recycling symbol 7 on them. These are rigid plastics used in certain food containers and used to store three- and five-gallon water bottles. You can read more tips about avoiding BPA containers at this link.

Prenatal and early childhood bisphenol A concentrations and behavior in school-aged children.
Harley KG, Gunier RB, Kogut K, Johnson C, Bradman A, Environ Research. 2013 Jul 16. pii: S0013-9351(13)00112-6. doi: 10.1016/j.envres.2013.06.004. AM, Eskenazi B.

Guest Post by George Glade, Breakfast and Inattentive ADD

2013-07-02T09:47:00.003-04:00

Today I am thrilled to share a guest post by George (Woody) Glade, ARNP. Woody is the Author of the new e-book Eating for Cognitive Performance. He was named as one of the Top Doctors and Nurses by Seattle Metropolitan Magazine in 2012. He blogs at The Stimulus Driven Brain and his Stimulus Driven Brain podcasts can be found on iTunes. Woody's post explains why Diet and especially breakfast is so important for people with ADD.

Breakfast and Inattentive ADD

The jury is back and with a review of scientific information, they have rendered an absolute verdict.

Breakfast Matters!

We of all heard the expression “You are what you eat”. While this phrase has risen almost to the point of being cliché, at least as far as our brain is concerned, it is absolutely true. The brain places extraordinary demands on the body. While it represents only 2% of the body weight, it demands 25% of total body glucose utilization. The brain also receives 15% of the cardiac output and 20% of total body oxygen consumption. To work at its best, this metabolic powerhouse needs fuel, and plenty of it. We have all heard the advertisements for a particular energy drink as a way of dealing with the afternoon slump in energy. This simply does not happen if you provide what your brain needs in terms of energy.

So what happens when we don’t provide our brain the energy that it needs? The following is a list of many of the cognitive effects from low blood sugar. The irony is we do not even need to be fully “hypoglycemic” to experience these.

· Reduced declarative memory or the ability to have both immediate and delayed recall

· Decreased spatial memory

· Impaired decision-making and reaction time

· Reduced fine motor skills and ability to divide attention

· Reduced verbal fluency

· Less efficient visual processing

· Diminished auditory processing

· Reduced ability to sustain attention

· Increased reaction time and/or decreased accuracy

· Reduced ability to drive measured by steering, braking, and speed control.

For people who have the need to utilize medications, food plays another very important role. It provides the raw materials to form neurotransmitters. People with poor nutrition are much harder to treat what it comes to depressive disorders.

Think about how you feel when you load yourself with particularly simple carbohydrates? These are fast release into our system. A sudden burst of energy followed is then by an inevitable "crash". This crash ultimately leaves you feeling even more sluggish than you were before you ate. There are some who have theorized that believe that this endless cycle of carb binging and carb crashing is strongly associated with chronic depression. People will actually crave carbohydrates when they are depressed.

Suicides in Teenagers with ADHD & Inattentive ADHD

2013-06-28T17:17:00.000-04:00

RESEARCH REVIEW

Suicides in Teenagers with Inattentive ADHD

Many studies have shown that teenagers and college students with a history of depression are at higher risk for suicide. A study just published has found that teenagers and college students with ADHD and depression have an even higher risk of suicide than students with depression without ADHD symptoms. Boys and men appear to be at a higher risk for suicide completion than girls and women.

These facts are alarming but the good news is that suicide is preventable. Statistics show that 70% percent of people who commit suicide have visited a medical provider within a month of their suicide and many mental health providers believe that people with a suicide plan see these providers in an attempt to get help. Unfortunately, suicide is rarely a discussion that is brought up by doctors, counselors, teachers or parents.

These conversations are not easy but we need to have them. Parents, teachers, counselors and physicians who interact with teenagers with a diagnosis of ADHD should be asking about them about suicidal ideas and about suicide plans. I would argue that these conversations should occur even if the kid with ADHD does not appear depressed.

The study that I am referencing and a slightly older study on the same topic are listed below.

Clin Psychol. 2013 Jun 17. doi: 10.1002/jclp.21994.

Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) Moderate Suicidal Behaviors in College Students With Depressed Mood. Patros CH, Hudec KL, Alderson RM, Kasper LJ, Davidson C, Wingate LR.

Acta Psychiatr Scand. 2012 Feb;125(2):93-102. doi:
10.1111/j.1600-0447.2011.01798.x. Epub 2011 Nov 25.
Completed suicide, ideation and attempt in attention deficit
hyperactivity disorder.
Impey M, Heun R.

Inattentive ADHD New Research Review

2013-06-27T10:52:00.001-04:00

RESEARCH REVIEWS

The summer is here and I am in vacation mode. This blog has been up
and running now for four summers. What I have found from years past
is that in the summer I keep up with current ADHD research but my blog
posting diminishes tremendously.

In an attempt to remedy this problem I am going to try to periodically
post very brief summaries of the new research findings that I find
interesting. Be on the look out for the first of these “New Research
Update” posts that is coming soon.

Happy Summer!!

Strattera Does Not Improve Inattentive ADHD as Much as Combined ADHD

2013-06-10T11:29:00.000-04:00

Short Changed
Strattera Does Not Improve Inattentive ADHD as Much as Combined ADHD

Treating the inattention component of Inattentive ADHD (ADHD-PI) is proving more difficult than treating the hyperactive and impulsive symptoms of Combined type ADHD. When Strattera (atomoxetine) became available, the hope was that this long acting ADHD medication might be a good treatment of the inattentive type ADHD. Initial studies had found that atomoxetine helped anxiety as well as ADHD and since many people with ADHD-PI also had anxiety symptoms (that were made worse, not better, by the stimulants), this seemed like it might be an ideal drug for this subtype.

Unfortunately, subsequent studies including one just published in the Attention Deficit Hyperactivity Disorder Journal, have found that atomoxetine treats the symptoms of combined type ADHD better than it treats the symptoms of ADHD-PI.

Russell Barkley recognized almost five years ago that only a subset of people with ADHD would benefit most from Strattera. The subset he identified were people with ADHD symptoms and coexisting:

Tic Disorders
Substance Abuse Problems
Anxiety
Oppositional Symptoms
Insomnia

Way back in May of 2009 Barkley published a report in ADHD Report, his monthly newsletter, entitled; What is the role of Atomoxetine in the management of ADHD? In this report he essentially outlined the benefits and limitations of Strattera and advised that this drug would best be used only in certain patients.

In the 2009 report Barkley made no mention of the benefits of Atomoxetine for the inattentive subtype of ADHD but he did report that it seemed that 25% to 35% of people with ADHD might respond only to Atomoxetine while not responding well to the stimulants. He termed this subset of people "Unique Responders" and speculated that people with ADHD and a combination of the other coexisting problems mentioned might be the ideal candidates to receive treatment with Strattera.

This new study reports that the "Unique Responders" that Barkley described are likely a subset of people with Combined type symptoms not people with primarily inattentive symptoms. From previous posts you know that people with Combined type symptoms and oppositional symptoms also get a better response from the stimulants and given that Intuniv, the other non-stimulant ADHD treatment, also appears to be more tailored to those with Combined type symptoms, it is hard, if you are a person with ADHD-PI, to not feel short changed.

Ercan ES, Akyol Ardic U, Kabukcu Basay B, Ercan E, Basay O
Atomoxetine response in the inattentive and combined subtypes of attention deficit hyperactivity disorder: a retrospective chart review.Attention Deficit Hyperactivity Disorder 2013 Jun 5.

Biased Against Disabiliteis/ ADHD?? Take the Free Prejudice Test.

2013-05-28T09:22:00.002-04:00

Biased Against Disabiliteis/ ADHD?? Take the Free Prejudice Test.

Are you biased against people with ADHD? I get letters often from patients who feel that their doctor have a bias against people with a diagnosis of ADHD. The trust problems caused by these biases are monumental! It is likely that many doctors and teachers are biased against people with ADHD but it is likely that many of us, even those people with ADHD, also have a biases against people with disabilities including biases against people with ADHD disabilities.

I began to give this some thought because of a study that I just read. This published study looked at the obesity biases of three hundred third year U.S. medical students. The study will soon be published in the Journal of Academic Medicine. The researchers of this study felt that medical student biases against obesity were important to understand since a large number of Americans are overweight and unknown prejudices can affect the way that doctors relate to their patients and this, in turn, can affect how comfortable patients feel with their health care provider. These feelings can also affect how likely these patients are to go to their health care provider for care or advice.

The Journal of Academic Medicine study found that almost 40% of the third year medical students had a bias against people who were obese and fewer than 25% of these students were aware of this bias. My guess is that if you were to give this test to health care providers across this country, many of us would test in the bias range.

The specific test that was used to test this bias is called the Implicit Association Test. Anyone can take the test and it is completely free. At the link you can chose what biases you would like to test. I have included the link so that you can test yourselves if you like. The test takes about 10 minutes and is a bit difficult to understand at first but once you get the hang of it, it is easy to complete. This test is designed to determine prejudice your prejudice towards people who are overweight, disabled, of certain ethnic backgrounds, etc.

I found the test pretty eye opening. I took the obesity prejudice test first and scored as being moderately biased against obese people. When I compared my scores to most of the other people taking the test, I found that I was far from alone. My scores on the disability bias test were a bit better in that I was less prejudice but my score still reflected a slight bias against disabilities. I was surprised by my scores.

Take the Implicit Association Test!. You might be surprised by what you find.

Disciplining Inattentive ADHD versus Disciplining Combined Type ADHD

2013-05-21T10:57:00.004-04:00

Disciplining Inattentive ADHD versus Disciplining Combined Type ADHD

This is the last in a series of posts that I have been writing about how the inattentive subtype of ADHD differs from the Combined type. In the first post I wrote about Inattentive ADD differences in response to ADHD medications. In the next two posts I described Inattentive ADD classroom strategy differences and in last week’s post I began a discussion on how disciplining kids with inattentive ADHD can differ from the disciplining approaches used for combined type kids.

I have written before about how ADHD expert Russell Barkley has described a function of our brain that speak to us about what behavior is appropriate. Barkley has examined this trait in people with attention deficit issues and has found that, in people with ADHD, this internal brain voice is faulty. The internalized speech that Barkley is describing is a key part of the executive function known as ‘Self regulation’. It is Barkley’s belief that this particular executive function is a key problem of the combined type of ADHD. Barkley, however, also believes that this internal voice is partially intact in kids with inattentive ADHD and this is the reason why they are often less impulsive, less positional and more self reflective.

Inattentive kids have trouble regulating their attention and motivation but the “internal voice” that speaks to them about appropriate speech and behaviors is loud and clear. I mention these executive function differences because the number one approach to disciplining my inattentive son involves using his intact internal voice and just reasoning with him.

My combined type son tends to be pretty oppositional and argumentative. Reasoning with him, or just talking out our differences, is not an option. I can go to my inattentive son, however, and ask him about his transgressions, discuss with him how best to improve the problematic behavior, and ask him to come up with an appropriate punishment. Believe it or not, he often is more hard on himself than I would be.

When the above strategy does not work, there are other disciplining tools that we have used at our house that have also worked pretty well. Plain, old fashion punishment sometimes are pretty effective. The negative incentives that have motivated him to behave appropriately include:

· Removing or decreasing his allowance
· Removing or decreasing his allotted screen time
· Increased household chores
· Removing dessert (he absolutely loves dessert)

Positive incentives have worked less well but on occasion we have used them with success. Examples of positive incentives include:

· Increased Screen Time
· Increased Allowance
· Buying him a gift.
· Taking him out to his favorite restaurant

The disciplining of kids with inattentive ADHD can be difficult. Strategies such as the removal of social opportunities or the removal from participation in sports activities, as I discussed in my last post, are often not effective. Punishments such as restriction, detention or “Time Outs” are also sometimes worthless because these kids are especially happiest when they are just left alone. Inattentive kids are generally a bit more cooperative than combined type kids however, so reasoning with them often works as do both negative and positive disciplining strategies.

Parenting Predominantly Inattentive Children vs. Parenting Combined Type Children

2013-05-14T11:49:00.000-04:00

Parenting Predominantly Inattentive Children vs. Parenting Combined Type Children

So this is the fourth in a series of posts that I am writing about the differences between Combined type ADHD (ADHD-C) and Predominantly Inattentive ADD (ADHD-I). In the first post I wrote about the best course of action for folks with ADHD-PI who do not respond well to stimulants. In the second and third posts I wrote about classroom interventions for inattentive ADD and in this and the next post I am going to address ADHD-I parenting advice.

As many of you know, I have two children with ADHD. One is inattentive and one is combined type ADHD. They are as different as night and day, chalk and cheese and hot and cold, . The combined type child is a fairly typical combined type ADHD kid. He is hyperactive, impulsive, extroverted, very social, lives in the moment, is not a worrier but is also not very reflective and can be pretty oppositional, combative and difficult.

The inattentive ADD son is also pretty typical of the inattentive type of ADHD. He is socially awkward, can be hypoactive, tends to be wary and is a worrier. On the other hand, this son is highly reflective, thinks a lot about consequences and is never oppositional or combative.

At first blush it would seem that the combined type child would be really difficult to parent and the inattentive child easier. Parenting is never easy and I would say that they are both easy and difficult to discipline but they are easy and difficult for completely different reasons.

As I am sure you have guessed the combined type child will argue with us. If we say fast, he will say slow, if we say yes, he will say no and if you say walk, he is sure to run. Kind of a pain, right? Sure, but the inattentive son sometimes does not move at all no matter what you say. They both get themselves into trouble though. One for being too aggressive and hyperactive and the other for being too passive and inactive.

What make the disciplining of the combined type sometimes easier than the disciplining of the inattentive child is that the combined type kid has lots of stuff that he loves to do. Even more importantly he really loves to do these things. Because he loves these activities so much, we have an arsenal of punishments that we can propose to him. These include:

· No sleepovers
· No Laser tag
· No sports
· No paintball
· No movies
· No screen time

The threat of removing these activites, because he loves them, motivate him to behave.

The inattentive son hates movies (too loud), laser tag (too fast), paintball (too violent), sleepovers (ruins his sleep habits) and sports (too uncoordinated). He does like screen time but as you can see, our punishment choices are kind of limited when it comes to motivating and disciplining our inattentive son. To make matters even worse, he is not very passionate about much so even removing screen time does not always have the impact that you would hope. He is pretty happy to sit in his room, lost in his "own private Idaho", doing nothing at all.

Given that inattentive kids can be perfectly happy in “Time Out", what is a parent to do when disciplining and motivation are in order? My next posts will give you suggestions for addressing these problems.

Part Two: Inattentive ADD Classroom Strategy Differences

2013-05-05T10:00:00.000-04:00

Part Two: Inattentive ADD Classroom Strategy Differences

This is the third in a series of post that I am writing about the differences between Inattentive ADD and the more common type of ADHD, combined type ADHD (ADHD-C). In the last post I started to outline how classroom interventions for Inattentive ADD are different. This is part two of that post.

You remember that in the last post we described how positive statements by a teacher that were specific to the child with Inattentive ADD made a huge difference in "on task" time in the classroom. In the last post I promised that I would explain why psychologists believe this matters. There are several reasons why a teacher's positive attention might make all the difference in the success of an inattentive student. The two most likely reasons that this type of teacher interaction helps is that we all perform better and more consistently when we:

1. Perceive ourselves to be part of a group.

People with Inattentive ADD in a classroom can socially distant themselves from the teacher and the rest of the students. Kids with Inattentive ADD can be introverted as well and this type of simple positive teacher attention can bring kids with ADHD-I into the social group. Studies have shown that a phenomena known as social facilitation or the act of being part of a group increases our arousal levels, improves the accuracy of tasks performed and also improves the speed of task performed.

2. Think we are being watched.

Psychologists have demonstrated that being observed changes our behavior for the better. Thomas Jefferson knew this. He is quoted as having said, “Whenever you do a thing, act as if all the world were watching.” An interesting study found that even a big poster with pair of eyes improved peoples behavior. Being watched is known to put us all on our best behavior and this likely applies to inattentive kids in a classroom as well.

The famous ADHD psychologist Russell Barkley has stated that emotional control problems, impulsive acts and problems with an executive function known as "inner dialogue" that allows people to consider the consequence of their own actions is NOT a part of Inattentive ADD. People with ADHD-I often have a very rich inner dialogue and sometimes over think the consequence of their own actions. Teachers need to understand these differences and use the positive benefits of having a rich capacity for inner dialogue, a positive response to belonging to a group, and a positive response to the perception of being watched in their classrooms.

I would love to hear what you think. Write to me or leave a comment!!

Differences in Classroom Interventions For ADHD Inattentive Kids

2013-05-03T09:30:00.000-04:00

Differences in Classroom Interventions For Inattentive Kids

This is the second post in a series of posts that I am writing about the differences between combined type ADHD and the inattentive type of ADD. In my first "differences post I wrote about how people with inattentive ADD react to ADHD medications. In this post I will be writing about why ADHD classroom interventions for ADHD Combined type students do not generally help inattentive kids.

If you go to any medical or educational site and read the list of classroom management suggestions for ADHD kids in kindergarten to 8th grade you will find that some of the suggestions listed at the very top of the list involve controlling a child who is a disciplinary problem, who does consider the consequence of their own actions, or who is hyperactive, impulsive, hostile or aggressive. Further down this list you might find suggestions for improving attention.

If a classroom had only one ADHD child and that child happened to be inattentive, then teachers would likely start at the bottom of the ADHD classroom management list and implement only those interventions that helped the ADHD-I child. Unfortunately, most classrooms have at least three ADHD kids and at least two of them are combined type kids. What this means from a practical standpoint is that the teacher controls the most disruptive children in his or her classroom first by implementing the disciplinary, hyperactive and impulsive behavior controls and only when these are working do the interventions for inattention get addressed.

This is why the parenting of Inattentive ADD child is different and why a child advocate is essential. Kids with ADHD-I will happily sit back and focus on their entertaining "inner brain dialogue" while the combined type kids get disciplined. The teacher may not even recognize that they are not paying attention as kids with this type of ADHD (especially as they get older) are masterful at looking like any other non-disruptive kid in the classroom. You as a parent know that your child is spacing out so it is up to you to make sure that your kid's teacher knows this too.

The very best news about classroom intervention tips for ADHD-I is that these kids respond really well to the attention of a teacher, parent or student mentor. The attention does not even have to be constant as some people would imagine. Students with Inattentive ADD will engage if they have a reason to. Relationships can really make a difference to them. These kids are not combative or uncooperative and they do not even always need to be reminded that they are spacing out. What they do need is an attentive teacher. One really interesting study demonstrated that if a teacher engaged an inattentive child by simply acknowledging them in some way when they entered the classroom, "that shirt looks really nice on you", "I found that doodling you did on your last assignment really fascinating", their "on task" time improved from 15%-30% of the time at the beginning of the seven week study to 40% to 90% of the time by week seven.

What that study demonstrated is that inattention in a classroom can be improved if the inattentive child perceives that the teacher is paying attention to them. As I have mentioned before on this blog, this type of intervention does not only help kids with ADHD-I, this type of classroom intervention would help any child. In my next post I will explain to you what the pyshology medical literature reports on why this type of teacher intervention helps kids with Inattentive ADD.

Shoot me an email or leave a comment. I would love to hear from you!!

Inattentive ADD Treatment Differences

2013-05-01T09:24:00.000-04:00

Inattentive ADD Treatment Differences

I am going to start a series of posts on how Inattentive ADD (ADHD-I) is different from , combined type ADHD (ADHD-C), the more common form of ADHD. I get many private messages regarding treatment, medication, classroom help, work problems, parenting advice, etc and I decided today that it might be helpful to write some review posts on what happens when:

People with Inattentive ADD do not respond well to ADHD medication.
ADHD classroom interventions for ADHD Combined type do not help inattentive kids.
Parenting advice for a combined type child do not help the Inattentive ADD child.
The overall treatment goals for combined type ADHD do not address the core problems of the person with ADHD-I.

I answer, on average, one private email a day regarding medication for Inattentive ADD. I thought it would be appropriate then for my first review post to be about about medicating ADHD-I. First let me say that I learn so much from the emails that I receive from readers so thank you for asking these questions!! Ninety percent of the emails about medication come from readers who have had a bad reaction to stimulants. In order of side effects, the most common complaints from my readers include:

Anxiety.
"Zombie" like symptoms or depression.
Appetitive problems.
Sleep Problems.
No help for improving attention or focus.

If you read the side effects listed on the package inserts that come with any Ritalin type medication (Concerta, Focalin, Ritalin SR, etc) or the package insert that comes with any Adderall like preparation (Vyvanse, Adderall LA, etc) you will find that these drugs can commonly cause appetite and sleep problems but that side effects such as anxiety, depression or "zombie" like symptoms are not listed.

The reason that I get emails and the reason that people with Inattentive ADD have these symptoms is related to the fact that their response to the stimulants is sometimes different from the response of people who are hyperactive/impulsive. Medical studies are being performed to try to figure out how what is happening in the brains of people with ADHD-I is different from what is happening in the brains of people with ADHD-C but the jury is not yet out on the exact neurological similarities and differences between the types of ADHD. So what do people with ADHD-I do when side effects to the stimulants are so bad that taking them is worse than being inattentive???

Usually people will give other medications a try. The second medication that is most commonly used is Strattera or atomoxetine. Atomoxetine has been found to be helpful with focus and attention and it is especially helpful in people with ADHD-I and anxiety. Atomoxetine reaches its full therapeutic potential in about six weeks. Strattera has worked wonderfully for many of my readers but unfortunately, atomoxetine can cause side effects as well. Some of these side effects go away over time and some do not. About ten percent of people will have side effects that are so severe that they will have to stop their medication. Some of the most common side effects that my readers report include dry mouth and sleep disturbances but these often improve over time. The side effects that tend to persist and require stopping the medication can include upset stomach, decreased appetite and nausea or vomiting.

So what does someone with ADHD-I do when neither the stimulants or atomoxetine can be tolerated? The next non-stimulant medication to try in Intuniv or guanfacine. In my experience, Intuniv is really helpful for people with ADHD and impulsive behavior, oppositional behavior or sleep problems and less helpful for inattention though, in theory, it should be really helpful in improving attention.

What happens when none of these medicines help? I did not really have an answer for the readers of this blog that asked that question and that is the reason why I spent so much time researching and writing Commanding Attention, a book about non-drug treatments for ADHD.

Leave a comment or shoot me a message to let me know what medication or treatment is working well for you and thanks for reading!

Diet, ADHD, Disease, Stroke and Heart Attacks. How Little We Know!

2013-04-16T12:34:00.001-04:00

Diet, ADHD, Disease, Stroke and Heart Attacks. How Little We Know!

Those of you who have read Commanding Attention: A Parent and Patient Guide to More ADHD Treatment, know that of ALL the interventions available to treat ADHD, diet ADHD treatments reigns supreme in terms of bringing about the greatest symptom improvement.

You do not read much about diet for ADHD or for other health conditions because we are only now learning about the specific diet interventions that prevent medical illness. Today, doctors mention diets only in passing (if they mention them at all) and part of the reason for this is that diet studies are notoriously difficult to perform (we lie or forget about what we eat) and diet changes, in our culture, are extremely difficult to stick with. If they were not, less than 74% of us would be overweight.

The New England Journal of Medicine just published the results of a study that looked at how effectively the Mediterranean diet prevented heart disease or stroke in people such as smokers who were at high risk of developing heart problems. After five years, the study was stopped and the researchers concluded that a diet rich in either extra-virgin olive oil or tree nuts reduced the risk of having a heart attack or a stroke by 30 percent.

This was a huge finding! This simple diet intervention brought about a very large reduction in cardiac and stroke risk. Medicines such as beta blockers that people at high risk for heart attacks are frequently prescribed do not reduce the risks by 30%, not even close.

Researchers have known for years that diets that are rich in vegetables, whole grains, beans, seeds, high in fiber, fish and vegetables protect us against obesity, diabetes, heart disease, cancer and some brain disorders. Most nutritionist believe that there are multiple factors in diets such as the Mediterranean diet that makes them beneficial. This study is one of many that in attempting to drill down on the exact reason for these health benefits. While this study was able to single out tree nuts and extra virgin olive oil as being a key component contributing to health benefits, many scientists agree that taking vitamins, mineral or supplements will not replace the synergistic effect of all the antioxidants, vitamins, minerals and micro-nutrients contained in a whole foods diet.

It may not only be the nutritious components of foods that affects health, some scientists believe that hidden food sensitivities are making us fat, diabetic, prone to heart disease and prone to ADHD. According to the well respected INCA study, the diet that has proven to be most helpful for ADHD is a diet that is very anti-allergenic and almost Paleo like. The INCA ADHD Restricted diet study

allowed kids to eat only rice meat, vegetables, pears, and water. After nine weeks, greater than 65% of the kids that consumed the restricted diet had reductions in both oppositional and ADHD symptoms. Some researchers have looked at the Omega-3 fatty acids and have found that this supplement helps ADHD but most studies have found that supplementing with Omega-3 fatty acids without reducing the amount of bad fatty acids consumed, will do little for the symptoms of ADHD.

With rates of obesity, diabetes and ADHD skyrocketing, the medical research community is finally taking a very close look at how and what we are eating is effecting our health. We need to know more. This research cannot be completed soon enough!

Sluggish Cognitive Tempo is Under Recognized

2013-04-08T10:00:00.000-04:00

Sluggish Cognitive Tempo is Under Recognized and Under treated

I promised to write about other recent studies that have been performed on people with Sluggish Cognitive Tempo (SCT) symptoms. The question that psychiatrists and psychologists are trying to answer relates to the difference between inattention with sluggish symptoms and and inattention without SCT symptoms and if inattention with sluggish symptoms constitutes a new medical condition that is sufficiently different from ADHD to warrant a separate diagnosis.

Most of the studies that have looked at this question, such as the Barkley study that I reported on a couple of posts ago, have found that there is considerable overlap in the symptoms of these two conditions. A study published in the Journal of Attention Disorders almost a year ago reported that kids with inattention and SCT had fewer sustained attention problems than kids diagnosed with ADHD and that they had greater problems with self monitoring, one of the executive functions that gives people the ability to monitor one's own performance and to measure it against some standard of what is needed or expected. The kids in this study, as Barkley’s study also found, seemed to also have more depression related problems.

Self monitoring is a meta-cognition executive function. It requires thinking and monitoring how you think. Recent studies have found that kids and adults with ADHD have a wide variety of executive funtion problems but kids and adults with SCT have specific executive function problems that relate mostly to decreased procession speeds, decreased self monitoring/self regulation skills and decreased arousal levels.

These specific findings have led these researchers to believe that SCT is sufficiently different from ADHD to warrant a diagnosis all its own. People with SCT will not have their symptoms properly addressed and treatment studies will not be initiated unless psychiatrists come to see SCT as a problem that is distinct from ADHD. As more studies are published indicating, as these have, that SCT is not ADHD, researchers will begin their investigations into how best to treat this condition. Until then, people with SCT will go under treated and under-served.

Capdevila-Brophy C, Artigas-Pallarés J, Navarro-Pastor JB, García-Nonell K, Rigau-Ratera E, Obiols JE. ADHD Predominantly Inattentive Subtype With High Sluggish Cognitive Tempo: A New Clinical Entity? Journal of Attention Disorder. 2012 May 31
Becker SP, Langberg JM. Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo Dimensions in Relation to Executive Functioning in Adolescents with ADHD. Child Psychiatry Hum Dev. 2013 Feb 27.
Langberg JM, Becker SP, Dvorsky MR. The Association Between Sluggish Cognitive Tempo and Academic Functioning in Youth with Attention-Deficit/Hyperactivity Disorder (ADHD). J Abnorm Child Psychol. 2013 Jan 29.

Lincoln, Darwin and Sluggish Cognitive Tempo

2013-04-03T10:00:00.000-04:00

Darwin, Lincoln and SCT

In the January 28th, 2013 edition of the New Yorker, the writer Adam Gopnik has written an article on how our brain’s turn music into meaning and on how we come to understand music and sound in general. His article was interesting from the standpoint of understanding auditory perception but it was also interesting to me because he mentions an old professor of his and describes him as being highly intelligent in an unusual way.

Gopnik describes two types of highly intelligent people. One type, the most common type, have a ‘sharp’ intelligence. These people have minds that fight and slash and slay. The second type of highly intelligent people are quite different. Gopnik describes the rarer type as having a ‘soft’ intelligence. Darwin and Lincoln had these types of minds. Gopnik describes his old professor as having the Darwin type of mind and describes these minds as ones that, “absorb great quantities of data and opinions, often silently, even sluggishly, and turn them around slowly until a solution appears.”

A letter to the editor regarding Gopnik’s article mentioned that Abraham Lincoln said this about his own mind, “My mind is like a piece of steel; very hard to scratch anything on it and almost impossible after you get it there to rub it out.” Darwin was described as a “Trifler” (distracted by insignificant things like bugs and plants) by his teachers and Darwin’s father was so frustrated by his lack of school progress that he is reportedly took him out of school early.

You cannot help but think about intelligent people with Sluggish Cognitive Tempo when you read about Gopnik’s old professor and about Darwin and Lincoln. Gopnik seems to suggest (he has written a book on the similarities between Darwin and Lincoln, who happened to be born on the same day and who were similar in other ways, called Angels and Ages ) that this type of intelligence serves a different but important analytic purpose. That the sluggishness of Lincoln and Darwin helped them and is part of what made them great thinkers.

Obviously, sluggishness may not always serve such an exalted purpose but I think it is good to remember, every once in a while, that traits like sluggishness are not always as terrible as they sound.

Paperback edition of Commanding Attention is Now Available

2013-04-01T00:00:00.000-04:00

Paperback Edition

The paperback edition of Commanding Attention: A Parent and Patient Guide to More ADHD Treatment is now available on Amazon and should be available at Barnes and Noble and other book outlets soon. The Amazon link is here.

Eventually both the paperback and the Kindle edition should be on the same Amazon page but apparently these things happen in stages and as of today, the two editions have their very own page.