ARTICLES ARCHIVE
Tarnow's Takes
Dr. Jay Tarnow
 ADHD linked to increased risk for overweight:
A 2008 study (Waring & Lapane, 2008) examined the potential connection between ADHD and overweight/obese children. The authors analyzed parental responses to the 2003–2004 National Survey of Children's Health. Presence of ADHD was determined by a positive response to the question "Has a doctor or health professional ever told you that your child has attention-deficit disorder or attention-deficit/hyperactive disorder, that is, ADD or ADHD?" Children were also classified as underweight, normal weight, at risk of overweight, or overweight based on body mass index. ADHD children who were medicated and who were not medicated were analyzed separately.
The results of the study suggest that ADHD children who are not medicated are at 1.5 times greater risk of being overweight, while ADHD children who are medicated are more likely to present as underweight. The authors explain that the risk for overweight may be due to impulsivity, poor self-control, and time spent playing video games as opposed to playing outside. The medicated ADHD child's tendency to be underweight was linked with common medication side effects such as appetite suppression and weight loss.
Tarnow's Take: While the determining criteria for presence or absence of ADHD is vague, this study makes an interesting argument for the connection between untreated ADHD and poor self-care. With school starting back up, plan activities to keep your children active on the weekends!
Stimulant treatment effects on executive functions:
Given the known effectiveness of stimulant medications on behavioral symptoms and certain executive functions that are critical to academic performance, why is it that ADHD children treated with stimulant medications continue to have academic struggles? A 2008 research study (Biederman et al., 2008) examined exactly which executive functions are affected by stimulant medications.
26 adolescents and young adults (age: 15 – 25) who were being treated with medications for their ADHD were compared to 94 youths with ADHD who had not received medication for a month prior to testing. These two ADHD groups were then compared to 133 non-ADHD control subjects on a series of executive functioning measures.
Results of this study found that non-medicated ADHD subjects performed more poorly than the controls on nearly all measures, and performed more poorly than the medicated ADHD subjects on measures of sustained attention and verbal memory. Medicated ADHD subjects performed more poorly than controls on measures of interference control and processing speed.
The authors conclude that medications do not impact all executive functions equally, and that sustained attention is the area of functioning most improved by stimulants. Therefore, they argue for additional interventions to address the areas of functioning that are not as positively impacted by stimulant medication.
Tarnow's Take: One of the more difficult realities for parents with an ADHD child is that there is no "miracle drug". Stimulant medications are helpful in improving the child's ability to remain focused, but the trick is applying that focus in order to learn appropriate self-management skills.
The thrill of the chase: Search for stimulation more rewarding than reward:
Slate Magazine's Emily Yoffe has written an article suggesting that "seeking" stimulation, or anticipation of a payoff, is more rewarding than the reward itself. In 1954, James Olds attached electrodes to the lateral hypothalamus of rats and allowed rats to activate the electrode by pushing a small lever. He noticed that the rats would push on the lever repeatedly until they collapsed from exhaustion. Similar experiments done on humans (Heath, 1972; Portenoy et al., 1986) found that subjects elected to self-stimulation over other responsibilities, such as family commitments and hygiene.
While this area of the brain was then referred to as the "pleasure center", later research has found that stimulation of the lateral hypothalamus actually produces the anticipation of pleasure, rather than pleasure itself. Kent Berridge makes the point that the brain is wired more for stimulation than satisfaction. Yoffe argues that this makes sense from an evolutionary standpoint. Those who are motivated to forage and find have a better shot at survival than do those who are easily satisfied.
Yoffe's article goes on to share that the driving force behind this anticipation is the neurotransmitter dopamine. "Rats whose dopamine levels have been destroyed retain the ability to walk, chew, and swallow, but will starve to death even if food is right under their noses because they have lost the will to go get it." Conversely, rats whose brains are flooded with dopamine are highly motivated to find the food, but do not find the food any more rewarding than rats with normal dopamine levels.
Tarnow's Take: Given what we know about the connection between ADHD and decreased dopamine levels, this article presents three points that are highly relevant in regards to ADHD.
- Motivational difficulty with ADHD children and adolescents may in fact be due to the role that dopamine plays in anticipation of reward. If a child is not stimulated by the anticipation of a good grade, he is less likely to work for that grade.
- Anticipation of pleasure is no less stimulating for the ADHD child than the non-ADHD child, but it is harder to come by due to diminished dopamine levels. Therefore the ADHD child will be that much more drawn to activities that activate this arousal. This can result in the restlessness, impulsivity and impatience commonly seen in ADHD children. "This isn't working, maybe that will..."
- Arguing is an example of an activity that does provide this high level of stimulation. Therefore, I encourage parents of ADHD children (or Bipolar, Oppositional, Tourette's) to avoid arguing with the child. This doesn't mean giving in; it means setting firm, clear boundaries that leave no room for argument.
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