Coruscation

Twenty years ago, more than a dozen leaders in child psychiatry received $11 million from the National Institute of Mental Health to study an important question facing families with children with attention deficit hyperactivity disorder: Is the best long-term treatment medication, behavioral therapy or both?

The widely publicized result was not only that medication like Ritalin or Adderall trounced behavioral therapy, but also that combining the two did little beyond what medication could do alone. The finding has become a pillar of pharmaceutical companies' campaigns to market A.D.H.D. drugs, and is used by insurance companies and school systems to argue against therapies that are usually more expensive than pills.

But in retrospect, even some authors of the study -- widely considered the most influential study ever on A.D.H.D. -- worry that the results oversold the benefits of drugs, discouraging important home- and school-focused therapy and ultimately distorting the debate over the most effective (and cost-effective) treatments.

The study was structured to emphasize the reduction of impulsivity and inattention symptoms, for which medication is designed to deliver quick results, several of the researchers said in recent interviews. Less emphasis was placed on improving children's longer-term academic and social skills, which behavioral therapy addresses by teaching children, parents and teachers to create less distracting and more organized learning environments.

Continue reading "ADHD: Long term treatment ?" »

Posted by at 2:21 PM | Permalink | Comments (0) | TrackBacks (0)

He did not think she had early Alzheimer's disease. The woman's daughter and granddaughter had both been given a diagnosis of A.D.H.D. a few years earlier, and Dr. Goodman, who is also the director of a private adult A.D.H.D. clinical and research center outside of Baltimore, asked about her school days as a teenager.

After interviewing her extensively, noting the presence of patterns of impairment that spanned the decades, Dr. Goodman diagnosed A.D.H.D. He prescribed Vyvanse, a short-acting stimulant of the central nervous system.

A few weeks later, the difference was remarkable. "She said: 'I'm surprised, because I'm not misplacing my keys now, and I can remember things better. My mind isn't wandering off, and I can stay in a conversation.

Continue reading "Adult diagnosis of A.D.H.D." »

Posted by at 2:15 PM | Permalink | Comments (0) | TrackBacks (0)

An airport lounge once felt rich with possibilities for spontaneous encounters. Even if we did not converse, our attention was free to alight upon one another and linger, or not. We encountered another person, even if in silence. Such encounters are always ambiguous, and their need for interpretation gives rise to a train of imaginings, often erotic. This is what makes cities exciting.

The benefits of silence are off the books. They are not measured in the gross domestic product, yet the availability of silence surely contributes to creativity and innovation. They do not show up explicitly in social statistics such as level of educational achievement, yet one consumes a great deal of silence in the course of becoming educated.

-- The cost of paying attention by Matthew Crawford.

Continue reading "Benefits of silence are off the books" »

Posted by at 6:34 PM | Permalink | Comments (0) | TrackBacks (0)

Driving the "epidemic" of A.D.H.D. has gone unnoticed: the increasingly stark contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend their time outside school. Digital life, with its vivid gaming and exciting social media, is a world of immediate gratification where practically any desire or fantasy can be realized in the blink of an eye.

By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students' inattentive behavior, making their teachers more likely to see it and driving up the number of diagnoses.

Continue reading "Schooling getting more boring due to growing alternatives" »

Posted by at 5:38 PM | Permalink | Comments (0) | TrackBacks (0)

Stimulants were not "drugs of abuse" because people who overdose "feel nothing" or "feel bad." Yet these drugs are classified by the government among the most abusable substances in medicine, largely because of their effects on concentration and mood. Overdosing can cause severe heart problems and psychotic behavior.

Slides described side effects of Adderall XR as "generally mild," despite clinical trials showing notable rates of insomnia, significant appetite suppression and mood swings, as well as rare instances of hallucinations. Those side effects increase significantly among patients who take more pills than prescribed.

Another slide warned that later in life, children with A.D.H.D. faced "job failure or underemployment," "fatal car wrecks," "criminal involvement," "unwanted pregnancy" and venereal diseases, but did not mention that studies had not assessed whether stimulants decreased those risks.

Continue reading "Stimulants, abusable ?" »

Posted by at 4:15 PM | Permalink | Comments (0) | TrackBacks (0)

For children, the object of "hyperfocus" might be playing a video game or watching TV. For adults, it might be shopping or surfing the Internet. But whatever holds the attention, the result is the same: Unless something or someone interrupts, hours drift by as important tasks and relationships fall by the wayside.

"People who think ADD means having a short attention span misunderstand what ADD is," says Kathleen Nadeau, Ph.D., a psychologist in Silver Spring, Maryland, and the author of ADD-Friendly Ways to Organize Your Life. "A better way to look at it is that people with ADD have a disregulated attention system."

Instant rewards: Like distractibility, hyperfocus is thought to result from abnormally low levels of dopamine, a neurotransmitter that is particularly active in the brain's frontal lobes. This dopamine deficiency makes it hard to "shift gears" to take up boring-but-necessary tasks.

"Children and adults with ADD have difficulty shifting attention from one thing to another," says Russell Barkley, Ph.D., a research professor of psychiatry at SUNY Upstate Medical University in Syracuse, New York. "If they're doing something they enjoy or find psychologically rewarding, they'll tend to persist in this behavior after others would normally move on to other things. The brains of people with ADD are drawn to activities that give instant feedback."

Posted by at 4:29 PM | Permalink | Comments (0) | TrackBacks (0)

Introverts, Rauch writes, "are people who find other people tiring." They're not necessarily shy or misanthropic, but rather enjoy solitary time. Extroverts, meanwhile, "are energized by people, and wilt or fade when alone," he writes. "They often seem bored by themselves, in both senses of the expression."

However bored extroverts might be by themselves, they tend to be a cheerier bunch on the whole. Time and again, in study after study, behavioral scientists have found that extroverts report themselves on well-being surveys as happier than introverts do. (In fact, introverts report more happiness when they act like extroverts, though they fail to anticipate this emotional kick-back.) The finding has proven so strong that some researchers believe positivity could rest at the core of what makes an extrovert an extrovert.

Recently, in an attempt to understand this link better, psychologists Wido Oerlemans and Arnold Bakker.

Posted by at 6:32 PM | Permalink | Comments (0) | TrackBacks (0)

Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological--psycho stimulant medications such as Ritalin and Adderall.

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress--not in the child's brain but in the child's social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child's brain.

Continue reading "French child psychiatrists" »

Posted by at 6:08 PM | Permalink | Comments (0) | TrackBacks (0)

For about nine weeks, Mitchell worked with the sleep therapist to adjust her sleep habits. She got under the covers only when she was extremely tired. She quit watching TV in bed. She stopped drinking caffeinated coffee in the evening. She also learned breathing exercises to relax and help her drift off. It was all quite simple and common sense, and, most importantly, noninvasive and didn't require popping any pills.

"It's common knowledge that sleep is needed for day to day function," says Dr. David Rapoport, director of the Sleep Medicine Program at NYU School of Medicine. "What isn't common knowledge is that it really matters--it's not just cosmetic." Rapoport has long seen people seek sleep therapy because they're chronically tired or suffering from insomnia, but an increasing number of patients are being referred to his center for common diseases, disorders, and mental health.

Researchers have known for some time that sleep is critical for weight maintenance and hormone balance. And too little sleep is linked to everything from diabetes to heart disease to depression. Recently, the research on sleep has been overwhelming, with mounting evidence that it plays a role in nearly every aspect of health. Beyond chronic illnesses, a child's behavioral problems at school could be rooted in mild sleep apnea. And studies have shown children with ADHD are more likely to get insufficient sleep. A recent study published in the journal SLEEP found a link between older men with poor sleep quality and cognitive decline. Another study out this week shows sleep is essential in early childhood for development, learning, and the formation and retention of memories. Dr. Allan Rechtschaffen, a pioneer of sleep research at the University of Chicago, once said, "If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made."

Posted by at 1:32 PM | Permalink | Comments (0) | TrackBacks (0)

"We don't control what they do. We do support them.

We do support broadly what they are trying to do in the marketplace
-- in society maybe is a better way to say it."

"We are a commercial organization trying to bring health care treatments to patients.
I think, on balance, we are helping people."

-- Tom Casola, the Shire vice president who oversees the A.D.H.D. division.

Mrs. Parry still has the pamphlet given to her by the school psychologist, which states: "Parents should be aware that these medicines do not 'drug' or 'alter' the brain of the child. They make the child 'normal.' " She and her husband, Michael, put Andy on Ritalin. The Parrys later noticed that on the back of the pamphlet, in small type, was the logo of Ciba-Geigy. A school official told them in a letter, which they provided to The Times, that the materials had been given to the district by a Ciba representative.

"They couldn't advertise to the general public yet," said Michael Parry, adding that his son never had A.D.H.D. and after three years was taken off Ritalin because of sleep problems and heart palpitations. "But somebody came up with this idea, which was genius. I definitely felt seduced and enticed. I'd say baited."

Posted by at 12:10 AM | Permalink | Comments (0) | TrackBacks (0)

Proper A.D.H.D. diagnoses and medication have helped millions of children lead more productive lives, concerns remain that questionable diagnoses carry unappreciated costs.

Studies had shown that stimulant medication helped some elementary school children with carefully evaluated A.D.H.D. to improve scores in reading and math tests, primarily by helping them concentrate. The concern, some doctors said, is that long-term, wider academic benefits have not been proved -- and that ads suggesting they have can tempt doctors, perhaps subconsciously, to prescribe drugs with risks to healthy children merely to improve their grades or self-esteem.

A.D.H.D. patient advocates often say that many parents resist having their child evaluated because of the stigma of mental illness and the perceived risks of medication. To combat this, groups have published lists of "Famous People With A.D.H.D." to reassure parents of the good company their children could join with a diagnosis. One, in circulation since the mid-1990s and now posted on the psychcentral.com information portal beside two ads for Strattera, includes Thomas Edison, Abraham Lincoln, Galileo and Socrates.

Shire's long-acting version of Adderall, Adderall XR:

Drug companies used the research of Dr. Biederman and others to create compelling messages for doctors. "Adderall XR Improves Academic Performance," an ad in a psychiatry journal declared in 2003, leveraging two Biederman studies financed by Shire. A Concerta ad barely mentioned A.D.H.D., but said the medication would "allow your patients to experience life's successes every day."

Continue reading "Stimulant medication helped " »

Posted by at 5:06 PM | Permalink | Comments (0) | TrackBacks (0)

Workplace Well-Being

Q. How can you and other researchers publicize the hidden but massive costs imposed by inflexible workplace management so that managers learn to do better by their employees? The short-term emphasis on benchmarks and cutting costs, at the longer-term expense of institutional health, employee well-being, customer service and societal balance is very destructive. -- Dean, U.S.

A. Businesses should be concerned about worker sleep health, as Dean points out, for the many destructive impacts of having a narrow, short-term focus. Coincidentally, this narrowness of focus mirrors the mental state of sleep-deprived individuals. In the United States, being at work but not fully functional because of insomnia (called "presenteeism") has been estimated to cost $63 billion annually. We have evidence of multiple pathways by which the workplace impacts health and wellness.

Management can either be a part of the problem, or be a part of long-term solutions. We need evidence-based solutions that both improve worker health and benefit employers. Stay tuned. We also need a platform for broader conversations, like this Booming blog, than academic journals offer, because in part this is a social problem of cultural norms around balancing work and nonwork, the corporation and the individual.

-- Orfeu Marcello Buxton

Continue reading "be concerned about worker sleep health" »

Posted by at 3:28 AM | Permalink | Comments (0) | TrackBacks (0)

Why Your Brain Needs More Downtime.

A 2010 LexisNexis survey of 1,700 white collar workers in the U.S., China, South Africa, the U.K. and Australia revealed that on average employees spend more than half their workdays receiving and managing information rather than using it to do their jobs; half of the surveyed workers also confessed that they were reaching a breaking point after which they would not be able to accommodate the deluge of data.

Research on naps, meditation, nature walks and the habits of exceptional artists and athletes reveals how mental breaks increase productivity, replenish attention, solidify memories and encourage creativity

scientificamerican.com/article.cfm?id=mental-downtime&WT.mc_id=SA_MindFacebook.

scientificamerican.com/article.cfm?id=mental-downtime.

Continue reading "Scientific American Why Your Brain Needs More Down time Research on naps, meditation, nature walks and the habits of exceptional artists and athletes reveals how mental breaks increase productivity, replenish attention, solidify memories, creativity" »

Posted by at 7:32 PM | Permalink | Comments (0) | TrackBacks (0)

Workaholic I work hard; I always have. That helps on the job. Unfortunately, since ADD/ADHD makes some things -- such as being prompt, focused, and respectful -- that are simple for others, challenging for me, this work ethic doesn't apply to all tasks. I can tackle assignments that require these skills, but doing so costs me far more time and energy than average person.

My vain attempts to try and pass off or over this kind of unrewarding and mundane work have led me to waste many days arguing with my bosses. My point? They were asking me to do something inane. Theirs? The work needed to be done regardless. Naturally, I always lost. And at what cost?

I wouldn't dare to generalize my personal experience -- work circumstances and ADD/ADHD behaviors are simply too diverse -- but I will offer the following observation: There's a fine line between being a creative, honest workaholic and turning into a scatterbrained procrastinator with a big mouth. Even when I couldn't tell the difference, my soon-to-be-former employers always could. You need to make sure you're on the right side.

Continue reading "Fine line between being a creative, honest workaholic and turning into a scatterbrained procrastinator with a big mouth" »

Posted by at 4:20 AM | Permalink | Comments (0) | TrackBacks (0)

Exercise and Academic Performance

As schools everywhere strive to improve the academic performance of their students, many have cut physical education and recess periods to leave more time for sedentary classroom instruction. A sensible new report from the Institute of Medicine, a unit of the National Academy of Sciences, shows how shortsighted this trend can be. It found that exercise can significantly improve children's cognitive abilities and their academic performance, as well as their health.

Students who exercise have lower body fat, greater muscular strength, and better cardiovascular and mental health. While admitting that the studies are limited, a panel of experts assembled by the institute says that "a growing body of evidence" suggests children who are more active are better able to focus their attention, are quicker to perform simple tasks, and have better working memories and problem solving skills than less-active children. They also perform better on standardized academic tests.

Academic performance is influenced by factors like parental involvement and socioeconomic status, but the panel reported that active children tended to have stronger performance, especially in reading and mathematics. It believes that the benefits of exercise during the school day outweigh the benefits from increasing class time.

-- NY Times THE EDITORIAL BOARD, May 24, 2013

Posted by at 7:40 PM | Permalink | Comments (0) | TrackBacks (0)

FRESNO, California. -- Lisa Beach, a senior at California State University, Fresno, endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract -- promising to submit to drug testing, to see a mental health professional every month and to not share the pills.

Continue reading "Fresno State tightening the rules on diagnosis of A.D.H.D. and the subsequent prescription of amphetamine-based medications like Vyvanse and Adderall" »

Posted by at 6:45 AM | Permalink | Comments (0) | TrackBacks (0)

In the flowering of modernism between the end of the First World War and the beginning of the Second, architects forged a stainless-steel connection between housing and health. Victorian homes were a nightmare to them, a cesspit at any level of society: they were dark and stuffy; they were filled with carpets and hangings and ornate picture frames that harbored dirt and were difficult to clean; their primitive plumbing made it hard to bathe.

See Light, Air and Openness: Modern Architecture Between the Wars
By Paul Overy, reviewed by Edwin Heathcote.

The early modernists wanted to wash away this squalor with an ocean of shining chrome, tile and white plaster. Dirt-hoarding fabrics with grime-concealing patterns would be consigned to the efficient rubbish chutes. Furniture would be made from wipe-clean leather and steel. Generous windows and electric light would expose every speck of dirt. In "Light, Air and Openness," the architectural historian Paul Overy showed how the early modernists were obsessed with healthful living and influenced by the design of sanitariums.

The better home would lead to better people. Love of purity, in the words of the Swiss architect Le Corbusier, "leads to the joy of life: the pursuit of perfection." He was far from the first to tie minimalist hygiene in the home to moral purity. Adolf Loos famously connected decoration with degeneracy in his 1908 essay "Ornament and Crime." A person's soul could be cleansed only when his domestic surroundings were purged: "Soon the streets of the town will shine like white walls. ... Then fulfillment shall be ours."

Continue reading "Clean as I've been" »

Posted by at 10:11 PM | Permalink

The consultant has since been moved to another company, where he has done well at his professional tasks but still misses social cues. In Denmark, there is a tradition of bringing cake to the office on Fridays, and Oblom recently learned from the on-site supervisor that the consultant happily eats cake but has never volunteered to bring one himself. Then there was the time he tasted a co-worker's cake and pronounced it terrible. Oblom told me that he plans to tell the consultant that he has to bring in cake now and then -- and he will do it, Oblom predicts, without understanding the reason -- but he's not going to encourage the consultant to be more polite. The concept of socially mandated dishonesty would mystify him, Oblom said, so the other employees will just have to deal with it.

Continue reading "Autistic consultants" »

Posted by at 5:16 AM | Permalink | Comments (0) | TrackBacks (0)

Most important, perhaps, those already found to have A.D.H.D. before surgery subsequently behaved so much better in many cases that they no longer fit the criteria.

The National Institutes of Health has begun a study, called the Childhood Adenotonsillectomy Study, to understand the effect of surgically removing adenoids and tonsils on the health and behavior of 400 children. Results are expected this year.

"We're getting closer and closer to a causal claim" between breathing problems during sleep and A.D.H.D. symptoms in children, said Dr. Ronald Chervin, a neurologist and director of University of Michigan Sleep Disorders Center in Ann Arbor.

In his view, behavioral problems linked to nighttime breathing difficulties are more likely a result of inadequate sleep than possible oxygen deprivation. "We see the same types of behavioral symptoms in children with other kinds of sleep disruptions," he said.

Posted by at 3:22 AM | Permalink | Comments (0) | TrackBacks (0)

My family has lived this reality for many years. We have a severely autistic son who has attended private schools which offer intensive behavioral therapy ("Applied Behavior Analysis" or "ABA," which is the only therapeutic methodology for which much evidence of effectiveness exists) with a student-teacher ratio of 1:1, and has also been receiving extensive ABA and other related services after school. Those schools and related services have enabled our son to make what progress he has been able to achieve. They are also necessarily and extremely expensive.

But every single year, we have to "sue" NYC (technically it's not a lawsuit in a court but an impartial hearing as provided under IDEA, but it functions in very similar fashion) to cover the costs of such a school and services when they invariably recommend services far below what is necessary for our son to achieve any educational benefit. We have never lost one of our "suits" yet against NYC, but in the meantime we are required to front the cost of our son's school and services every year and seek eventual reimbursement from NYC. Very, very few families have the financial resources to do so. (And while we have enough resources to front the costs pending reimbursement, we are not nearly rich enough to bear the full costs of our son's school and services - those can exceed $170K per year.) Those that do not either have to move or make do with whatever the system offers, which is often far, far below what is necessary.

It should also be noted that the very malfunctions of large school systems such as NYC make it easier for families such as mine, who have enough resources to go through the battles every year, to obtain eventual public reimbursement for special education services. First, the IEP process described above presupposes intensive consideration of the student's individual educational needs. Large educational bureaucracies, such as NYC's, are not well equipped for that type of individual consideration. This leads to a tendency for the bureaucracies to offer services based on what's convenient and typical rather than what's appropriate for the student. Second, large school bureaucracies are not, to put it mildly, well renowned for their general administrative competence, and the IDEA imposes various elaborate procedural requirements on school districts that are regularly violated. A family can often demonstrate these two facts when necessary to enforce the IDEA against the school district, if they have the time and resources to spare.

Continue reading "the Atlantic: Special ed system favors the rich and Romney has a plan to fix it. " »

Posted by at 6:01 AM | Permalink | Comments (0) | TrackBacks (0)

St. Augustine believed that "because God has made us for Himself, our hearts are restless until they rest in Him." We often think of restlessness as a malady.

Thus, we urgently need to reclaim the etymology of restlessness -- "stirring constantly, desirous of action" -- to signal our curiosity toward what isn't us, to explore outside the confines of our own environment. Getting lost isn't a curse. Not knowing where we are, what to eat, how to speak the language can certainly make us anxious and uneasy. But anxiety is part of any person's quest to find the parameters of life's possibilities.

Posted by at 6:14 PM | Permalink | Comments (0) | TrackBacks (0)

"Play is one of the most cognitively stimulating things a child can do," says Megan McClelland, an early-childhood-development researcher at Oregon State University who has led much of the research.

The key to games education is to start with a simple game and add increasingly complicated rules. For instance, Oregon researchers have developed a game called Head-to-Toes, which they use to assess preschool children's development. Initially, the child copies the teacher's movements, touching her head or toes. But later, the child is expected to do the opposite, touching her toes when the teacher touches her head.

While the game may sound simple, it actually requires a high level of cognitive function for a preschooler, including focus and attention, working memory to remember rules, mental flexibility (to do the opposite) and self-control.

Posted by at 10:01 PM | Permalink | Comments (0) | TrackBacks (0)

His wife's distractedness was particularly challenging when the children were young.

"She could be in the room but paying no attention to what was going on," he said. Traditional counseling didn't help. On the brink of the divorce, the wife found Ms. Orlov and Dr. Hallowell's Web site, adhdmarriage.com, and began consulting with Ms. Orlov. Although the couple have only just started therapy, they are finally hopeful about their future together.

"It's been a revelation," the wife said. "I didn't realize what a critical piece the A.D.H.D. has been in my marriage."

Posted by at 2:27 AM | Permalink | Comments (0) | TrackBacks (0)

Footsteps, sweat, caffeine, memories, stress, even sex and dating habits - it can all be calculated and scored like a baseball batting average. And if there isn't already an app or a device for tracking it, one will probably appear in the next few years.

Over the last weekend of May, in the upstairs of the Computer History Museum in Mountain View, California, in the heart of Silicon Valley, 400 "Quantified-Selfers" from around the globe have gathered to show off their Excel sheets, databases and gadgets.

-- April Dembosky, FT's San Francisco correspondent

Continue reading "Quantified-Self" »

Posted by at 1:20 AM | Permalink | Comments (0) | TrackBacks (0)