ADHD: Not Just for Kids

Attention deficit disorder (ADD) and attention-deficit hyperactivity disorder (ADHD) aren’t just childhood problems. Many adults also struggle with attention deficit disorders even though they weren’t formally diagnosed as children. The same excessive inattentiveness, impulsiveness and hyperactivity that characterize ADD/ADHD in children are symptomatic of the condition in adults, although symptoms may present differently. The constant fidgeting displayed by children may translate into continual feelings of restlessness or agitation in adults. Disorganization, extreme procrastination, problems concentrating, irritability, trouble meeting deadlines, failure to remember appointments, problems keeping your house clean, constantly losing things, and impulsive behavior are common behaviors exhibited by adults with ADD/ADHD.

While we all periodically struggle to achieve an effective balance between work, family and personal activities; adults with ADD/ADHD constantly feel like their lives are spiraling out of control. The balance that gives life stability never comes for adults with attention deficit disorders. The problem isn’t lack of self control or willpower; it’s a chemical problem in the brain’s management system. ADD/ADHD can affect anyone, although sufferers are six times more likely to have another learning or psychiatric disorder like depression or anxiety. Multiple psychiatric disorders can make correct diagnosis difficult and complicate treatment. Many adults remain undiagnosed and struggle with ADD/ADHD all their lives, never receiving the help they need.

Not all repercussions of ADD/ADHD are negative, however. Symptoms may also manifest themselves  as creativity, flexibility, adaptability, commitment or tremendous drive. Sufferers are also capable of hyperfocus, the intense concentration on a single task or problem that often leads to major creative breakthroughs or discoveries.

Help is available for adults with ADD/ADHD. Cognitive-behavioral therapy can help adults make positive changes in their daily habits that can help them improve attentiveness, control impulsive behaviors, decrease stress, and better manage their personal and professional lives. Some medications like the stimulant Ritalin may also help some patients. Support groups can provide encouragement and practical solutions to common daily problems.

Fidgeting Helps ADHD Students Succeed

Children seem to be in constant motion. Parents are forever admonishing their children to sit still. But for children with attention-deficit hyperactivity disorder (ADHD) the constant fidgeting isn’t in their parents’ imagination. Even when other children are able to remain focused and quiet, children with ADHD are compelled to fidget and twitch and squirm. Parents and teachers often respond by trying to get them to stop moving, thinking that if they can just still their bodies, their minds will be able to focus and learn.

A recent study by Mark Rapport, a psychology professor at the University of Central Florida in Orlando, suggests that it might be more effective to encourage ADHD children to fidget as much as they need to. Rapport spent four years meticulously recruiting, screening, and testing 23 boys aged 8 to 12. In a lengthy analysis of the results, Rapport found that ADHD children use movement to stay focused. Fidgeting may actually facilitate learning in children with ADHD. Just like the caffeine in coffee helps adults stay focused, jiggling, bouncing at their desks, swiveling in their chairs, swinging their feet, etc. may help ADHD children concentrate and do better in the classroom.

Children with ADHD, which affects 3% to 5% of U.S. children, have problems with short-term, or working memory, the part of the brain that temporarily stores the information needed to carry out immediate tasks. ADHD children process information differently than those without the disorder. A child without ADHD can remember and follow a series of brief directions like opening a book, turning to a certain page, and doing specified exercises. Children with ADHD lose focus part way through the instructions. They may only catch one or two in the series of instructions and wind up lost in the classroom.

Stimulants like Ritalin can augment short-term memory, making it easier for ADHD children to focus on tasks. But not all children respond equally to Ritalin, and some parents would prefer a drug-free solution. Rapport’s study, though small in scope, offers new methods for helping ADHD children focus in the classroom and succeed at school.

More Sleep Can Improve ADHD Symptoms

A common behavior disorder that affects 8% to 10% of U.S. school-aged children, ADHD – attention deficit hyperactivity disorder — has been linked to children’s failure to get enough sleep. In a new study (see our April 29 post), researchers at the University of Helsinki in Finland found that children who typically received less than 7.7 hours of sleep per night were significantly more likely to develop ADHD than children who slept longer. The study is the first to pinpoint length of sleep alone as a source of behavioral symptoms.

Interestingly, the study found that parents regularly over-reported the amount of sleep their children received compared to objectively measured results, suggesting both that most parents are unaware of their children’s actual wake-sleep cycles or that a “social desirability bias” promotes over-reporting. Despite such discrepancies, study results clearly found a direct, measurable, causal link between short sleep cycles and increased symptoms of ADHD.

“Even though we hypothesized that sleep duration would affect behavioral symptoms, we were somewhat surprised that the effect was so very, very clear,” principal researcher Dr. E. Juulia Paavonen told Medscape Psychiatry in an April 28, 2009, online article about the study.

The study found the lowest risk of developing ADHD symptoms among children who regularly received an average night’s sleep characterized by at least 7.7 to 9.4 hours of uninterrupted sleep per night. Parents who are able to help their children establish and maintain adequate sleep cycles of 8 to 10 hours of uninterrupted sleep per night may be able to significantly reduce their children’s risk of developing ADHD. In children who already exhibit symptoms of the disorder, maintaining adequate sleep patterns may help to control and/or alleviate symptoms, researchers believe. In an independent European study, lengthening children’s sleep cycles by just 30 minutes per night was found to significantly improve cognitive and attention behavior with observable improvement exhibited in less than one week.

Here are some things parents can do to help their children get the sleep they need:

• Establish a regular bedtime.
• Decrease activity about 30 minutes before bedtime.
• Ban TVs, video games and other over-stimulating activities from the bedroom.
• The bedroom should be comfortable — well ventilated and slightly cool with a nightlight.
• Establish a soothing bedtime routine — bath, brushing teeth, toileting, story time, prayers.

ADHD Linked to Lack of Sleep in Kids

Lack of sleep in children increases their risk of developing attention deficit hyperactivity disorder (ADHD), according to new research published in the April 27, 2009 online edition of Pediatrics. In a study of 7- and 8-year-olds conducted by researchers at the University of Helsinki in Finland, children who received less than 7.7 hours of sleep per night were at significantly increased risk of developing hyperactive/inattentive disorders compared to children who slept longer. The Finish study is the first to identify length of sleep alone as a source of behavioral difficulties.

“There is a large amount of literature linking sleeping difficulties to behavioral symptoms,” principal researcher E. Juulia Paavonen, M.D., Ph.D. told Medscape Psychiatry in an April 28, 2009, online article about the study. “However, this study shows short sleep duration itself is related to behavioral symptoms, independent of sleeping difficulties.”

The study provides a potential key for the treatment of rising attention and cognitive performance issues among U.S. children. As many as one-third of American children do not receive an adequate amount of sleep.  While previous studies have indicated a probable link between sleep disorders, such as sleep apnea, and the behavioral symptoms associated with ADHD, none of those studies included behavioral assessments. The Finish study is the first to specifically assess the effects of sleep length on behavioral issues in children and show a definite causal effect between lack of sleep and decreased attention span and cognitive performance.

The study evaluated the sleep habits and duration of 280 boys and girls with a mean age of 8.1 years. Assisted by the children’s parents, sleep journals logged when children went to bed, woke up and were allowed to leave their beds over seven-day intervals. Problems such as illness that could affect sleep quality were also recorded. Hyperactivity, impulsivity and inattention symptoms were evaluated using the maternal ratings from the ADHD Rating Scale. Socioeconomic status, parental education and other demographic data were also considered. The majority of the test group (80.7%) were categorized as average sleepers, getting 7.7 to 9.4 hours of sleep per night. Short sleepers (9.3%) received less than 7.7 hours of sleep, while long sleepers (10%) got more than 9.4 hours of sleep.

Next time: Study recommendations: What parents can do.

Ritalin Helps Drivers with ADHD

Dr. Joris C. Verster at University of Utrecht in the Netherlands conducted a study and discovered that Ritalin significantly improved the driving skills of patients with Attention Deficit Hyperactivity Disorder (ADHD). They used a pool of 18 people ages 21-30 and compared their driving skills on and off of their medication. Off medication, they were able to maintain a steady speed, but they weaved more. The weaving was even more pronounced during the latter part of their trip.

This finding was not surprising because ADHD causes problems with sustained attention, or sticking to a task for a sustained period. The driving test in this study took 1 hour so the patients off their medication had more trouble staying focused on the road and not being distracted by things on the side of the road.

I’m not sure how the weaving (also called standard deviation from lateral position in the study) was measured. That is, are we talking weaving like a driver under the influence, or minor deviations from the center of the lane? I doubt that skipping medication means automatic driving into oncoming traffic, but these findings do illustrate the importance of knowing one’s limitations if you have ADHD.

I’m frequently asked if someone will have to remain on medication for ADHD forever. I tell some people that usually over time the impact of attention problems lessen in adulthood. Many people have attendtion deficit problems, but learn to adapt by staying away from activities or responsibilities that stress their attention capacity. So in this example of driving, rather than concluding that a person with ADHD is a dangerous driver off medication, one could say that the same person should not be considered the anchor driver for a long road trip.