A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Dr. Russell Barkley has data to show why it’s a big deal!
A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Is there risk of not treating ADHD?
I have had the privilege of hearing Dr. Russell Barkley, an internationally acclaimed expert on ADHD, speak three times about his research results showing the long term impact of ADHD on our lifespan. He came to Kansas City to present at a Grand Rounds at Children’s Mercy Hospital and again at the Midwest ADHD Conference in April 2018. He presented the same information at the 2018 International ADHD Conference in St. Louis this past November. During each of the the three talks he made big impressions in audience members.
Unfortunately, not everyone outgrows ADHD and many people suffer from untreated problems, especially when they’re young and haven’t learned to adequately manage the frustrations that ADHD can cause.
Dr. Barkley’s long term study has shown some very distressing results. Children with ADHD have a shortened life expectancy of over 9 years. Adults with persistent ADHD symptoms have an even more significantly shortened life expectancy of nearly 13 years.
Dr. Barkley has found that many risks associated with ADHD can lead to life problems, including premature death.
We all know that kids with ADHD struggle in school without proper supports. This is linked to lower educational success, lower paying jobs, and more family stress.
Many people with ADHD get anxious and depressed due to circumstances created by their ADHD. This can lead to more problems in school, interpersonal relationships, self medicating with drugs and alcohol, legal problems, and even death by suicide.
Inattention and impulsivity increase the risk of accidental injury and death. Other risky behaviors can lead to unplanned pregnancies.
Problems with executive functioning can lead to problems at home with significant others and in parenting. Many adults with ADHD show problems at work and in maintaining a consistent job.
Impulsive eating can lead to obesity, and all the long term health consequences associated with that. These include diabetes, heart disease, orthopedic problems, and more.
A public health problem
Dr. Barkley asserts that we should approach ADHD as a public health problem.
During his talk in St. Louis, one of Dr. Barkley’s slides proposed that “ADHD is a serious public health problem; it accounts for greater reductions is ELE [expected life expectancy] than any single risk factor of concern to public health and medical professionals, such as smoking, excess alcohol use, obesity, or risky driving among other widely accepted health risks.”
The good news
The good news is that many of these risks can be minimized with proper management.
If we support our students to help them succeed in school, they are more likely to continue in their education. When people attain a higher education level, they are able to get more fulfilling jobs and earn better incomes.
Proper management of ADHD and executive function problems can help prevent and treat depression and anxiety. With less depression and anxiety, parents can be better parents, workers better workers, and partners better partners. Self medication with drugs and alcohol will be less, resulting in fewer problems that are linked to those issues: less crime, healthier bodies, less risky behaviors and fewer accidents.
Encouraging healthy habits, such as regular exercise and proper nutrition, helps everyone live a longer, healthier life. This is no different for those with ADHD, so it is important to help them overcome poor dietary habits and inadequate exercise to improve their overall lifespan.
What can be done?
We can use behavioral interventions, training for patients and parents of children with ADHD, educational support, and medication to optimize management of ADHD.
When properly diagnosed and treated, individuals with ADHD can be very successful in life. That’s why ADHDKC was started… to help those with ADHD learn to thrive!
What have others enjoyed reading on ADHDKCTeen that you may have missed?
I know it seems like I’m jumping on the bandwagon, but posting the top 10 blog posts at the end of the year serves several purposes. First, it might help someone find a post about a subject that’s important to them but they hadn’t seen yet. Second, it is a way for me to look at what people are reading, which can help me plan future group meeting topics as well as new posts. Third, it’s self-preservation. It’s a busy time of the year and I only have so much time like everyone else. This is an easy to write post!
10: Screen Time Limits
Setting Screen Time Limits is important to everyone. We all waste time on our screens, but we can’t simply get rid of them. They are a fantastic resource for information and a way to communicate with people we can’t talk to directly. Unfortunately, it’s all too easy to fall into the trap of checking one more app or playing one more game when we should be doing other things. People with ADHD are at risk due to their executive management issues with time management, impulsivity, and more. Learn some practical strategies on regulating your screen time so you have more time for other things!
9: What does brain imaging tell us about ADHD?
We’re able to look at the brain in many novel ways that are helping us to better understand its function and development. Studies have shown that kids with ADHD have smaller brains than kids without ADHD. Learn what brain imaging can tell us about ADHD and what the limitations are in What does brain imaging tell us about ADHD?
8: Genetics of ADHD
If you know people who doubt that ADHD is a real condition, you can share new research that has located 12 specific areas in our genes that link directly to the symptoms of ADHD. Learn more in Genetics of ADHD.
7: Stimulants decrease brain function? Say what?
Yes, I was going for a click bait title with this one, but only in response to the headlines that made mainstream news about a study showing Adderall decreased brain function. The study was done in neurotypical (“normal”) people. There’s a big difference in what these drugs do in a brain that has imbalances of neurotransmitters (such as in those with ADHD) and in a brain that does not, so don’t freak out. Read Stimulants decrease brain function? Say What? to learn more!
One of the disappointing aspects of ADHD is that children are made to feel that they are bad and inferior. Most societies want children to do as they’re told in the way they’ve been shown. School in particular is difficult for kids with brains that work differently. The truth is that we should cultivate the characteristics that individuals have. If given the opportunity to learn in ways they learn best and to express their creativity and problem solving, people who think differently can excel. Many adults with ADHD finally find their purpose later in life when they can use the way their brains work to their advantage. Learn more in Celebrate ADHD.
4: 5 Self-Confidence Boosters Part 1: Stop Negativity
I’m surprised this is the most popular in the series of Self Confidence Boosters because it’s rather negative and the others are positive. I suppose it’s because if we recognize that we have a problem with negativity, we want to fix it.
3: How To Get A Growth Mindset
This is my personal favorite because I love this topic. A growth mindset is associated with success more than intelligence. Let that soak in… our perspective on life can help us be more successful. Learn How to Get A Growth Mindset.
2: Watch Out for Rejection Sensitivity
This is a topic that is a relatively new idea to me, but in hindsight I feel like I’ve always known of it. Kids with ADHD are particularly sensitive to criticism. They tend to have low self esteem and are often easily upset by things that wouldn’t bother others. Learn more about Rejection Sensitivity and what you can do to protect yourself against it.
1: What is ADHD? Why do some develop it?
The most read post is What is ADHD? Why do some develop it? It helps to introduce the basics of what causes ADHD and, sometimes more importantly, what does not cause it. If you know people who blame poor parenting or bad teachers, share this with them.
A new study shows 12 distinct areas in our DNA that link to ADHD.
I have recently written What is ADHD? Why do some develop it? and What does brain imaging tell us about ADHD? Both of these help to show that ADHD is NOT caused by bad parents, bad kids, or many of the other things that are blamed. It is a disorder of brain development that has a genetic basis. Today we’ll go into some of the genetics of ADHD. My hope is that by learning how and why ADHD develops, we can stop blaming people for acting the way they do and treat the symptoms to help individuals thrive.
It has been thought that a range of small and hard to identify differences in the sequence of nucleotides, which are components of DNA, combine to increase the likelihood of ADHD. These single nucleotide polymorphisms are referred to as SNPs. Environmental factors play a greater or lesser role (or sometimes none at all) depending on exactly which genetic variations are present.
What are SNPs?
SNPs are commonly pronounced like the word “snips”.
They are the most common type of genetic variation among people. Each SNP represents a difference in a single nucleotide in our DNA strands.
SNPs occur normally throughout a person’s DNA. They occur once in every 300 nucleotides on average. There are about 10 million SNPs in the human genome. They can act as biological markers, helping scientists locate genes that are associated with disease. When SNPs occur within a gene or in a regulatory region near a gene, they may play a more direct role in disease by affecting the gene’s function.
Does this cause a problem?
Most SNPs have no effect on health or development.
Some of these genetic differences have been shown to be very important in the study of human health. SNPs that may help predict an individual’s response to certain drugs, susceptibility to environmental factors, and risk of developing particular diseases. SNPs can also be used to track the inheritance of disease genes within families.
Twelve SNPs were identified that are linked to ADHD, but we must still learn what this means in terms of development of ADHD. Much like some people have a genetic predisposition to cancer but never develop cancer and others without a genetic risk still develop cancer, some people can have the SNPs without ADHD and some people without these SNPs can develop ADHD.
How can this help us?
ADHD is real
One important thing that genetic studies can do is to help people understand that ADHD is a real condition. It is not made up. Yes, it can be over diagnosed in some people and missed in others, but it is real either way.
Learning about symptoms
Comparing this study with similar ones of related conditions can lead to new understandings of relationships of the conditions.
For example, one SNP pattern found overlaps with those discovered in a similar study of insomnia. Many people with ADHD suffer from sleep problems, so this might lead to specific treatments of sleep disturbances.
Limitations of the study
This is not a study that will help us diagnose ADHD.
Specific ways that the genes lead to symptoms are not yet known.
How other factors, such as prematurity, nutrition, and life experiences, interact with the genetic predisposition must be further investigated.
How is ADHD diagnosed?
Diagnosis of ADHD requires that symptoms exist in at least two settings, such as home and school.
Standardized assessment scales should be used to assess risk of ADHD. These scales are commonly done by parents, teachers, and others close to a child. Adult rating scales are available for adults with suspected ADHD.
Evaluation to assess for other disorders and conditions that can mimic ADHD, such as learning disorders, sleep deprivation and anxiety, should be completed.
Blood tests and brain imaging are not required to diagnose or treat ADHD.
Future research may help us learn to manage the symptoms of ADHD in new ways.
My hope is that learning the causes of ADHD will not only help us manage the non-desired symptoms, but also cultivate the beneficial attributes and decrease the stigma and misunderstanding so we can help people with ADHD learn to thrive.
We now are able to look at the brain in ways that show its development and function. Studies have shown that kids with ADHD have smaller brains than kids without ADHD. This does not correlate with the head size your doctor measures in infancy, and head size does not help physicians predict ADHD.
Last week’s post What is ADHD? Why do some develop it? introduced the concept that ADHD is a brain disorder, not a problem with parenting or other common misbeliefs. Today we’ll go more in depth into how brain imaging has shown differences when people have ADHD. Next week we’ll go further into the genetics of it.
There are many ways we can image the brain for different reasons. Single-photon emission computer tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI) are all being studied to show different aspects of brain function and development.
Some of the studies look at blood flow to various parts of the brain during different tasks to show which parts of the brain are triggered and how that differences among different groups of people. Others look at subtle changes in brain growth.
With vs without ADHD
Brain imaging comparing large groups of kids with ADHD to those without ADHD show significant differences. These are very subtle differences and are still considered investigational. The changes are too subtle to diagnose ADHD in any one person.
There are several areas of the brain that have been shown to be smaller in children with ADHD. At this time the specific areas of delayed growth do not correlate with specific treatments.
ADHD is a brain condition
It is not recommended to do imaging studies to diagnose ADHD, but the fact that large groups of people show differences highlights the fact that ADHD is a real disorder of the brain.
Hopefully as this information is recognized, the stigma of ADHD and other brain disorders will be lost. People will be able to understand that it is a real brain dysfunction.
The case for a clinical diagnosis
Studying brain differences helps us to understand ADHD, but imaging is less useful to any individual for diagnosis. We have a good track record for diagnosing ADHD with standardized questions and a clinical history.
Images capture a moment in time, but they don’t necessarily tell the whole story.
What happens to a brain in different circumstances? It can be very insightful to ask what happens when a child is doing a favorite activity versus when he’s stressed.
Clinical history can cover different situations over time. This cannot be captured in any brain image.
To be useful for diagnosis and management of a medical condition, a test must first:
Be reliable: The changes seen are very subtle, and results must be shown to be accessible and identifiable in individuals to be useful for diagnosis. If only a few trained people can identify the subtle differences, it will not be available or helpful to most people.
Show safety: Everything we do in healthcare must be shown to be safe and effective before it’s used. Risks and benefits must be weighed. Risks of imaging must be considered.
Show benefit: If a clinical diagnosis can be made, what benefit would be attained by doing an expensive test? If it does not add to the treatment, it should not be done. Since the large majority of people with ADHD can be diagnosed clinically, we should not need to do studies that add risk and cost.
Studies have shown that the prefrontal cortex develops more slowly in children and teens with ADHD. This means that the areas of the brain that control executive functioning are thinner in children with ADHD versus those without ADHD.
Functional imaging shows that the frontal lobes in children function less during activities involving concentration, memory, decision-making and problem solving.
It’s even more than that. Those with worse outcomes as they mature have fixed thinning (it doesn’t ever normalize) but those who ultimately develop a normal thickness have a better outcome.
A thinner brain cortex is not a damaged brain. It is an alteration in development.
Other parts of the brain are affected too
Our cerebellum helps us with movement and memory. Children with ADHD show slower growth of cerebellar white matter in early childhood, but faster growth in late childhood.
The amygdala and hippocampus are also smaller in the brains of people with ADHD. These areas are responsible for emotional processing and impulsivity, problem areas for many with ADHD.
What does all of this mean?
You guessed it: it’s still being studied.
Studies continue to help us learn more about brain structure and function. We also continue to learn about the chemical interactions that happen while our brain is working.
What all this information means and how we can use it to best manage the troubling symptoms of ADHD is yet to be fully uncovered.
It may be possible one day to predict which children will develop ADHD and change something in the early years to alter that development. But we’re not there yet…
Does a slower development of certain brain areas have an advantage? Maybe the slower development of the cerebellum is why kids with ADHD learn better when they fidget.
ADHD was first recognized as a behavior problem, but now we know it’s a developmental disorder. Don’t worry though. Having a developmental disorder doesn’t make you stupid or damaged. It simply means that brain development is a bit different. We’ll tackle details here.
Typical Brain Development
Our brains have billions of nerve cells called neurons that start developing a few weeks after conception. Within 6 months after conception, there are even more neurons than are found in an adult brain. As we develop, neurons grow and make connections with one another. The number of brain cells decrease as unneeded neurons are pruned away.
A network of fibers develops to connect the brain cells in order to interact with other parts of the brain and to perform complex functions. Neurotransmitters help send messages between nerve cells.
We’ll tackle neurotransmitters more in future posts. They’re important!
How long does it take for the brain to fully develop?
We might look pretty mature by our teen years, but our brain is still growing!
The first 3-4 years of life is a time of rapid brain development, but it continues for more than 20 years.
The prefrontal cortex is especially interesting. It helps us plan, organize, make decisions, and maintain self control. These are considered executive functions and are often problematic for those with ADHD.
The prefrontal cortex typically doesn’t finish full development until mid-20s. That means our brains are still developing key areas into our early adult years!
How does ADHD develop?
There are many things that affect our brain development that can lead to symptoms of ADHD.
At this point we don’t diagnose the cause of the ADHD since treatment is geared toward addressing the symptoms, but it can be helpful to know that there are many reasons a person develops ADHD.
Like many things, brain development is affected by our genetics. Genetics affects how we look, how tall we should grow, our intelligence, and risks of certain health problems – such as cancer or heart disease. Of course our genetics are only the blueprint. Our environment, nutrition, experiences, and much more also affect how we grow and develop.
If one parent has ADHD, a child is more likely to have ADHD. If both parents have ADHD, their child is much more likely to have ADHD.
While a baby is still in its mother’s womb, it is considered a fetus. This is considered the prenatal time of development.
Many things can affect development during the prenatal time. Drugs and alcohol, illness, and other stressors affecting the mother can affect the baby.
Prematurity (being born before the due date) and being small at birth can increase the risk of developmental disorders, including ADHD.
Illness, injury, toxins and more… oh, my!
The first few years of a child’s life can be complicated by illness, injury, nutritional deficiencies, and toxins. These can all affect brain development.
Even after the critical developmental years, injuries and toxins to the brain can change our brain function. Think of a teen or adult who has had a concussion. Their brain function can be severely altered. They might suffer from mental fogginess, fatigue, irritability, and more after the injury. In fact, sometimes people will be treated with medications commonly used for ADHD temporarily after a concussion.
What it’s NOT:
ADHD is not due to bad parenting, poor discipline, or bad schools.
Yes, those things can worsen a child’s behavior, but they don’t cause ADHD.
What about sugar?
ADHD also isn’t from too much sugar.
Studies have even shown that even when a parent perceives worsening of behavior after sugar, independent observers see no real change. For more on that and how diets affect ADHD, see Special Diets for ADHD.