Wednesday, August 31, 2016

Unhealthy diet during pregnancy could be linked to ADHD

August 18, 2016
Source:King's College London

A high-fat, high-sugar diet during pregnancy may be linked to symptoms of ADHD in children who show conduct problems early in life, new research indicates.

Early onset conduct problems and attention-deficit/hyperactivity disorder (ADHD) are a leading causes of child mental health referral. These two disorders tend to occur in tandem and can also be traced back to very similar prenatal experiences such as maternal distress or poor nutrition.
Credit: © upyanose / Fotolia

New research led by scientists from King's College London and the University of Bristol has found that a high-fat, high-sugar diet during pregnancy may be linked to symptoms of ADHD in children who show conduct problems early in life.
Published in the Journal of Child Psychology and Psychiatry, this study is the first to indicate that epigenetic changes evident at birth may explain the link between unhealthy diet, conduct problems and ADHD.
Early onset conduct problems (e.g. lying, fighting) and attention-deficit/hyperactivity disorder (ADHD) are the leading causes of child mental health referral in the UK. These two disorders tend to occur in tandem (more than 40 per cent of children with a diagnosis of conduct disorder also have a diagnosis of ADHD) and can also be traced back to very similar prenatal experiences such as maternal distress or poor nutrition.
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Tuesday, August 30, 2016

One third of women with ADHD have anxiety disorders, almost half have considered suicide, study finds

July 20, 2016

University of Toronto


Women with ADHD are much more likely to have a wide range of mental and physical health problems in comparison to women without ADHD, according to a new study.

Women with ADHD are much more likely to have a wide range of mental and physical health problems in comparison to women without ADHD, according to a new study from researchers at the University of Toronto.
"The prevalence of mental illness among women with ADHD was disturbingly high with 46% having seriously considered suicide, 36% having generalized anxiety disorder, 31% having major depressive disorder and 39% having substance abuse problems at some point in their life," reported Esme Fuller-Thomson, Sandra Rotman Endowed Chair at University of Toronto's Factor-Inwentash Faculty of Social Work and Director of the Institute for Life Course & Aging.
"These rates are much higher than among women without ADHD, ranging from more than four times the odds of suicidal thoughts and generalized anxiety disorders to more than twice the odds of major depressive disorder and substance abuse" said Fuller-Thomson
Investigators examined a representative sample of 3,908 Canadian women aged 20 to 39 of whom 107 reported that they had been diagnosed with ADHD. Data was drawn from the 2012 Canadian Community Health Survey-Mental Health.
"We were surprised at the high levels of physical health problems that the women were experiencing" said Danielle A. Lewis, co-author of the study and a recent MSW graduate of the University of Toronto.

"More than one in four (28%) of these relatively young women said that physical pain prohibited some of their activities, which was much higher than the 9% of their peers without ADHD who had disabling pain. Insomnia was also more prevalent in the women with ADHD in comparison to those without ADHD (43.9% vs 12.2%) as was smoking (41% vs 22%)" stated Lewis.
"Unfortunately, our study does not provide insight into why women with ADHD are so vulnerable. It is possible that some of the mental health problems may be caused by and/or contributing to financial stress" Fuller-Thomson suggested. The study also found, one in three of the women (37%) with ADHD reported they had difficulty meeting basic expenses such as food, shelter and clothing due to their inadequate household income. For women without ADHD, only 13% had this shortfall."
"Many people think of ADHD as primarily a boys' disorder which has little relevance for girls and women. Our findings suggest, to the contrary, that a large portion of women with ADHD are struggling with mental illness, physical health concerns and poverty," said Fuller-Thomson.
"In light of these problems, it is important that primary health care providers are particularly vigilant in monitoring and treating their female patients with ADHD," suggested co-author Senyo Agbeyaka, a graduate student at the University of Toronto.
The results were in a study published online this week in the journal Child: Care, Health and Development.

Monday, August 29, 2016

Combining medications could offer better results for ADHD patients

August 1, 2016

Three studies report that combining two standard medications could lead to greater clinical improvements for children with attention-deficit/hyperactivity disorder (ADHD) than either ADHD therapy alone. At present, studies show that the use of several ADHD medications result in significant reductions in ADHD symptoms. However, so far there is no conclusive evidence that these standard drug treatments also improve long-term academic, social, and clinical outcomes.

Three studies to be published in the August 2016 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) report that combining two standard medications could lead to greater clinical improvements for children with attention-deficit/hyperactivity disorder (ADHD) than either ADHD therapy alone.

At present, studies show that the use of several ADHD medications result in significant reductions in ADHD symptoms. However, so far there is no conclusive evidence that these standard drug treatments also improve long-term academic, social, and clinical outcomes. Research suggests that both the severity of ADHD symptoms and the degree of cognitive dysfunction that remain despite treatment contribute to poorer outcomes. As a result, more effective treatments need to be identified. One method for identifying more effective treatments is by including objective measures of the effect of ADHD treatments on brain function, which most clinical studies do not do. Using objective biological markers (or biomarkers) of patients' response to ADHD treatments could substantially advance knowledge of the neural mechanisms underlying treatment effects, helping researchers understand why there are differences in individual response.
By recruiting a sample of children and adolescents 7-14 years of age with and without ADHD, a group of researchers led by Drs. James McCracken, Sandra Loo, and Robert Bilder of the UCLA Semel Institute performed three interlocking studies examining the effects of combining standard medications on clinical, cognitive, and brain activity measures. Combined treatment was hypothesized to be superior to the two standard medications, d-methylphenidate and guanfacine, on both clinical and cognitive outcomes, and was expected to show a distinct profile of effects on brain wave activity (EEG). Participants with ADHD were randomly assigned to eight weeks of double-blinded treatment with either d-methylphenidate, guanfacine, or a combination of the two.

Clinical results showed consistent added benefits for the combined therapy over the two single treatments, especially for symptoms of inattention, and more global response indices. The rate of good clinical response went up from 62-63% in the single drug therapy to 75% in the combined therapy.
The authors argue that the modest but consistently better treatment effects of the combined treatment may have long-term significance, as less severe symptoms may lead to better outcomes. Cognitive functioning showed a slightly different pattern. Working memory improved with both combination and stimulant treatment showing roughly equal positive effects. Guanfacine, however, showed no change in working memory function despite improvement in ADHD symptomatology. Finally, the EEG study showed that only the combination therapy resulted in improved brain activity patterns that were associated with reduced ADHD symptoms and improved cognitive functions. Taken together, the results from the three studies suggest that combination therapy resulted in the best outcomes across several different domains of function, including ADHD symptom change, working memory performance, and brain activity patterns.
"ADHD is the most commonly diagnosed neuropsychiatric disorder in children, and we know full well the risks it poses for children's future success in every area of functioning. Our current treatments clearly benefit most children in the short-term, but we've yet to find ways to protect those with ADHD from suffering many of the long-term risks," McCracken said. "While we are encouraged by some of the advantages we observed of the combined treatment, we have a long way to go still in improving interventions for ADHD, as seen by the more limited cognitive effects."

"These data highlight the importance of considering cognition as a major outcome," said Bilder. "In the future, we may be able to utilize multiple objective methods such as cognitive testing and EEG to individually optimize treatments, but more work is needed, including long-term studies of treatments with proven clinical and cognitive benefits." Dr. Loo added, "The use of objective biological measures in diagnosis and treatment can also help to reduce stigma, increase acceptance of the disorder, and more accurately track treatment response to yield better outcomes."
Based on these findings, the authors conclude that combining stimulants with medications like guanfacine warrants more consideration even in children with ADHD who benefit from monotherapies. Combination treatment, with appropriate monitoring, was equally well tolerated and safe in this and prior studies. Greater consideration of the cognitive effects of treatments is necessary to improve clinical outcomes. Moreover, other treatment strategies that may yield more robust benefits are needed. As technology advances, the authors hope that more objective measures of response can make their way into routine practice. Even with such improvements, the source of individual differences in ADHD treatment response remain largely unknown. Additional long-term research on the benefits of combination treatments in large samples is necessary to confirm these findings and to further advance clinical care. If validated, combined treatments of these or potentially other compounds have the potential to dramatically improve the lives of many individuals with ADHD.

Wednesday, August 24, 2016

Five Ways to Help Misbehaving Kids

By Stuart Shanker | August 22, 2016 | 0 Comments
Bad behavior is often a sign that children are stressed—and punishment isn’t the best solution.
“For a man to conquer himself is the first and noblest of all victories.” Thus wrote the philosopher Plato in the 4th century BC, thereby instilling the idea that character is built 

upon self-control.
This assumption about the importance of self-control has profoundly shaped how we think about behavior, including that of our children. If only they had willpower and good character, they would be able to behave well and resist temptation, right?

Wrong. Many years of research and experience as a psychologist have shown me how misleading this notion is, even as experiments like the famous “marshmallow test” seemed to confirm it. Rather than needing more self-control, our children need better self-regulation—a way to understand and manage their stress and energy—to succeed in life.
What exactly is different about self-regulation? As I explain in my new book, Self-Reg: How to Help Your Child Break the Stress Cycle and Successfully Engage with Life, self-regulation is about recognizing when we are over-stressed, identifying our sources of stress, reducing their intensity, finding places of calm, and learning ways to rest and recover. Understanding the distinction between self-regulation and self-control is essential to understanding how to help our children.
I’ve seen hundreds of children and their parents in my professional capacity and have never once seen a “bad” kid. Every single child, when met with understanding and patience, can be guided along a trajectory that leads to a rich and meaningful life. But stereotypes of the “difficult child” too often color our views, as do the dreams, frustrations, and anxieties we suffer as parents. When we impart negative judgments on children, we are just mistakenly shifting blame for our own emotions and insecurities onto our children’s “nature.” 
Instead, we need to understand the science of stress. New advances in neuroscience are unlocking the secrets of why we behave the way we do and, more to the point, why it is so hard at times to behave the way we want. The limbic system plays an important role here, as it is the source of our strong emotions and urges; it also plays a critical role in memory formation, as well as the emotional associations we have with our memories. This system contributes to how we respond to threats and worries, but it is largely out of our conscious control, including the control of children.
Children who are in a heightened state of emotional arousal can have very sensitive limbic systems, where their brains are primed to respond to threats even when none exist. For example, experiments have shown that children who are chronically over-aroused will label neutral faces as hostile. 
This means that children who react with hostility or by shutting down are likely showing the outward signs of an inward experience of stress overload. If we don’t recognize the signs, figure out what is stressing them, and help them to cope—instead of using blame, threats, or punishments—we will continue to make matters worse for them, rather than better.
A parent’s reaction to a child’s stress is important to their later ability to self-regulate, starting in the first years of their life. Nature intends for human parents to play a close, nurturing role with their offspring and to take advantage of the “interbrain”—the shared intuitive channel of communication between a parent and child that is maintained by touch, shared gaze, voice, and, most of all, shared emotion. This is what helps a stressed child develop a way of self-soothing that will stay with them and allow them to cope with stressors in their lives. 
Providing warm, nurturing care early in life can go a long way toward stress management. But that doesn’t mean that parents are solely responsible for their child’s ability to adapt. Even kids who have enjoyed warm, nurturing parenting can have trouble with self-regulation. That’s why it’s important to understand how it works and how we parents can help.
Here are the steps I outline in my book that can help parents deal with problematic behavior or anxiety in their children more effectively:

1. Recognize when your children are over-stressed

A lot of your work as a parent involves learning how to understand the meaning of behaviors that you would otherwise find troubling or irritating. If you learn to read the signs and recognize them for what they are—a signal of a system on overload—you will be able to resist assigning blame or labels to your children. Reframing your children’s behavior as a reaction to stress rather than willful misbehavior, and learning to listen to your children and to observe them with curiosity, is the first and perhaps most important step in self-regulation.

2. Identify the stressors in your children’s lives

This essay is adapted from <a href=“”><em>Self-Reg: How to Help Your Child Break the Stress Cycle and Successfully Engage with Life</em></a> (Penguin Press, 2016, 320 pages)This essay is adapted from Self-Reg: How to Help Your Child Break the Stress Cycle and Successfully Engage with Life (Penguin Press, 2016, 320 pages)
Stress in children often involves disappointments in their relationships, schoolwork, and other purposeful activities, or having too much to do in too little time. But stress can also be hidden and have biological sources. For example, some children are highly distressed by too much noise, light, or odor, and this can cause ongoing problems in their lives that may be hidden from you. They may also find boredom, waiting, or sitting still extremely stressful. Stressors can come from many sources—biological, emotional, cognitive, and social domains—so it’s important to consider all of these. 
Though our environment may be highly stressful to our children, we often overlook information that could alert us to this fact. We—or they—may carry on as if it doesn’t matter. That doesn’t mean that their unconscious mind isn’t registering the stress and responding with stress, though, which can in turn create a fight, flight, or freeze response. 
Parents can look for patterns of behavior—such as children always breaking down around 5:30 pm—to help figure out what their children’s stressors are—perhaps they are hungry at that hour. Or, if it’s less obvious, try reviewing in your head the different domains of their lives and what might be causing stress. Whatever you do, don’t become a further drain on them by reacting in anger or judgment. Instead, try to listen and calmly affirm what seems to be going on for your children. 

3. Reduce those stressors

It’s amazing how simply reducing sources of stress can change a child’s behavior quickly. I once saw a child who was sensitive to noise, light, and textures labeled as a “problem child” by his teacher, only to have that opinion completely reversed when she realized that dimming the classroom lights changed his demeanor drastically. Sadly, the child had had to endure her judgment, communicated through raised voices and hardened facial expressions, for some time prior. In fact, she’d also labeled his father and grandfather as difficult.
The same thing can happen to parents who don’t pay attention to what stresses their children and bring it into their conscious awareness. Once sources of stress have been identified, it’s much easier to either help our kids avoid them or to mitigate them, as best we can—perhaps by moving our dinner hour earlier or dimming the lights or giving them a hug after they’ve failed a test. 
Sometimes, reducing our children’s stress involves understanding what stresses us out and how it impacts our behavior. Learning how to soothe our own stress can help us self-regulate our emotions and lead to less reactivity toward our kids when they are suffering, as well as provide important role modeling for them.

4. Help your children find calming strategies that work for them

We all need strategies for reducing tension and replenishing our energy. No one size fits all, so it’s important to read the signs in your children, recognize their unique sources of stress, and make sure their self-regulation strategies fit their needs. 
Mindfulness has been touted as a way to instill calm energy and to make our children more aware. But sometimes our children can get so used to feeling excessive stress that a state of hyper-alertness becomes “normal,” so much so that sitting still and focusing on their breathing—a typical mindfulness exercise—can be a thousand times more distressing than being manic. 
Helping your children to slowly develop an awareness of their inner states and to find relaxation techniques that help them calm down can be incredibly empowering. Teaching your children mindful breathing—if done slowly and with supports in place—can be one technique to help them increase awareness of their need for calm. 
But it’s important that calming techniques are experienced by your children as enjoyable, too, and don’t add to their stress inadvertently. There are many relaxation exercises that produce calm, such as practicing yoga, taking a walk, or working on art projects, for example. Encourage your children to experiment with what helps them most and support them in finding relief.

5. Take a long-term perspective

When you help your children find self-regulation strategies, be careful to consider the distinction between “quiet” and “calm.” For example, a child may be quiet when playing video games, but no one would mistake that for calm, and you shouldn’t either. Their brains are producing stress hormones galore when they are engaged and quiet playing video games. The point of finding strategies is not to make your life easier in the short run (by having your kids remain quiet), but to make their life easier and more productive in the long run (by helping them handle stress in a calming manner). 
Of course, following my advice doesn’t mean that your children will never misbehave, or that all of their problematic behaviors are a response to stress. But, so much of the time, misbehavior is a cry for help—a cry that we, as parents and adults, need to answer with compassion and understanding, not punishment. 
Following the steps of self-regulation does not guarantee your child will suddenly stop irritating or frustrating you, but it may help prevent some unnecessary suffering. Our research has shown that following these steps is a powerful way for children to change their behavior. When your children see that you truly understand them and that you are committed to doing what you can to help, it will go a long way toward improving your relationship with them, as well as their ability to cope with life’s challenges.