DOES ADHD MEDICATION CHANGE THE DEVELOPING BRAIN?

Treating children with ADHD medication is hotly debated. It’s shown to be effective in reducing ADHD symptoms, but what are the long-term effects on developing brains? We asked an expert.

How ADHD medication influences the brain in the short-term has been widely studied, but many children with ADHD take medication over several years. The effects of long-term ADHD medication treatment on the developing brain have been less researched. Lizanne Schweren conducted her PhD research on this very topic, with a focus on stimulants, the most commonly prescribed ADHD medication. We sat down with Lizanne and asked her a few questions:

Photo by en:User:Sponge

What are stimulants?

Stimulants are drugs that activate the body, including the brain. Stimulants are sometimes referred to as “uppers”, as their effects tend to be energizing and pleasant. The best-known prescribed stimulant to treat ADHD is methylphenidate. For 70-80% of children, as well as adults, methylphenidate reduces their ADHD symptoms and helps them concentrate.

What happens in the brain directly after taking stimulants?

Methylphenidate blocks the reuptake of dopamine within the synaptic cleft, the gap between pre- and postsynaptic cells. Dopamine transmits neural signals from one cell to the next, and does so until the presynaptic cell transports dopamine back for recycling. By blocking presynaptic reuptake, more dopamine is left in the synapse and more signal is transmitted.

Children with ADHD often take stimulants for several years. What effect does this have on their brains?

People with ADHD, their brains look subtly different from people without ADHD. Previous studies had suggested that after long-term stimulant treatment, these differences may become smaller or even disappear. However, in my own research we found subtle differences in brain structurebetween those with and those without ADHD, regardless of treatment history. This suggests that the treatment does not in fact change the way the brain develops structurally.

Photo by amenclinicsphoto ac 

As opposed to structural differences, we did find differences in brain activation patterns when comparing children who differed in the age of onset of ADHD as well as stimulant dosage. During an fMRI experiment, the group who began taking stimulants at a young age and at a higher dose, was more likely to show activation in brain regions important for cognitive control (dorsal anterior cingulate cortex, and supplementary motor area), compared to children who took stimulants at an older age and at a lower dose. All children were off their medication during the experiment. We think that people with ADHD, who often act impulsively, may benefit from activations in these brain regions.

What do these long-term effects of stimulants on the brain mean for children with ADHD? And for clinicians prescribing stimulants?

While neuroscientists were hoping for positive – normalizing – long-term effects of stimulant treatment on the brain, parents and clinicians have mostly been concerned about potential negative consequences. For them, the fact that we found no evidence of structural brain changes associated with stimulant treatment is probably a relief. Moreover, we showed that long-term stimulant treatment does not result in better clinical outcomes. Most often symptoms of ADHD decrease during adolescence, and these improvements happen whether the child took stimulants or not. For clinicians working with patients and their parents, it is important to communicate that stimulants may temporarily improve symptoms of ADHD but they do not alter outcomes in the long-term.

 

Lizanne’s research is based on data linked to the Donders Institute: the NeuroIMAGE sample.

We want to thank Lizanne for the interview with the Donders Wonders.

Her thesis can be found here.

 

Interview conducted by Corina Greven.

Blog written by Corina Greven.

Blog edited by: Marisha Manahova.

Featured image by Jonathan Rolande.

 

This blog was originally published on www.blog.donders.ru.nl. This is the official blog of the Donders Institute on brains and science.

donders_banner_bilingual

Mindfulness for children with ADHD – is that possible?!

International research shows that mindfulness can improve attention and self-control. This has already been shown for people without ADHD, and the initial results from research in children with ADHD are promising.

Many parents of children with attention-deficit hyperactivity disorder (ADHD) are looking for alternative treatments that do not involve ADHD medication. Mindfulness (paying attention without judgement) is becoming an increasingly popular training in Western societies, and is already successfully used in the treatment of depression and anxiety in adults. But may mindfulness also work as an intervention for ADHD? Especially in the case of children with ADHD who have difficulties with concentration, you may wonder whether they are able to pay enough attention for mindfulness training.

6035280806_b70fc7e2e0_bImage from: Sebastien Wiertz

What is mindfulness precisely?

Mindfulness involves paying attention in a particular way:

  • On purpose (meaning it involves effort)
  • To the present moment
  • Without judgement

With mindfulness you can learn to become aware of your body, emotions and thoughts. You learn to notice impulses, but to not immediately react to them.

An example: A boy sits in the classroom. His mind starts to wander away from the teacher towards his weekend activities which he is excited to share with his classmate. He deliberately notices feeling excited (awareness) and the urge to turn around to speak to his friend (impulse). He lets the sensation pass through him without judgement (non-judgement/ non-reactivity). He purposefully brings his attention back to the teacher.

Mindfulness for children with ADHD – is that possible?!

In many ways, mindfulness training seems an ideal intervention for ADHD. Children with ADHD have difficulties with paying attention, hyperactivity and regulating their impulses. In short, they experience problems around self-control. Research from non-ADHD populations shows that mindfulness training improves people’s self-control by increasing attention control, emotion regulation and self-awareness.

In addition, evidence suggests that mindfulness training alters the structure and function of brain areas involved in self-control, such as the anterior cingulate cortex, prefrontal cortex, posterior cingulate cortex, striatum, insula and amygdala. Several of the brain areas implicated in mindfulness overlap with those for ADHD. However, is mindfulness training feasible in children with ADHD?

 

3238035260_06613cf1c3_o

Image from: Todd Fahrner

The MindChamp project

A handful of Dutch studies have shown that mindfulness training clearly is feasible for children with ADHD. For this work, children with ADHD and their parents underwent the MYmind programme: 8 weekly mindfulness sessions of 1.5 hours. The training is adapted to the needs of families of ADHD, for example using shorter and more playful exercises. The studies showed that mindfulness training reduces ADHD symptoms, improves self-control and reduces parenting stress. However, the studies were small and used a less rigorous (non-randomised) design.

Research linked to the Donders Institute is taking this to the next level with the MindChamp project: Mindfulness for Children with ADHD and Mindful Parenting. This larger, randomised-controlled trial uses the MYmind mindfulness programme, and is based at Karakter Child and Adolescent Psychiatry, in collaboration with the Radboud Centre for Mindfulness and UvA Minds. Recruitment for the project is ongoing (children with ADHD aged 8-16 years), and the first results can be expected in 2018. The hope is that positive research results will allow more families with ADHD access to the intervention.

Links:

More information about MindChamp here

Questions about MindChamp? Email mindchamp@karakter.com

MindChamp is part of the MiND project. It is funded by a Marie Sklodowska-Curie grant and the Netherlands Foundation for Mental Health.

Blog written by Corina Greven.

Editor: Marisha Manahova.

Featured image by: papermoons

This blog was originally published on www.blog.donders.ru.nl. This is the official blog of the Donders Institute on brains and science.

donders_banner_bilingual

The other side of ADHD

In children, it is common to observe traits of ADHD such as being easily distracted, blurting out answers in the classroom, being always ‘on the go’, or fidgeting. However, there are also children on the other extreme, those who have excellent attention, sit quietly in class, and are well-organized with their homework. Are they a mirror-image of ADHD or are they expressing overly controlled and inflexible behaviours?

corinaillustration-1024x426

© image by Roselyn Chauvin

Scientists believe that attention-deficit hyperactivity disorder (ADHD) does not exist in an all-or-nothing fashion – where you either have the disorder or not – but on a continuum. Just as we differ in height (from short to tall) or weight (under- to overweight), we differ in attentiveness, impulsiveness and activity levels. This is why many of us recognize ADHD traits in ourselves, even though ADHD as a diagnosis only affects around 6% of youth. High extreme ADHD traits at one end of the continuum are well-studied (those with a diagnosis) but what about those at the other end of the spectrum – those with “low extreme ADHD traits”?

Mirror image of high ADHD traits?
Low extreme ADHD traits might simply be a mirror image of what we see for high ADHD traits. So instead of the inattention and impulse control problems that we commonly observe, those at the low extreme may be perfectly self-controlled individuals, with excellent attention and impulse control skills. For example, we might expect these to be children who are well-adjusted because they are able to pay attention to the teacher, are very organized in their homework, and able to regulate negative emotions such as anger, allowing them to build a positive family and friendship circle.

Too much of a good thing?
On the other hand, excellent attention skills and impulse control may become maladaptive when one has ‘too much of a good thing’, reflecting hyperfocus at the cost of being unable to switch attention when needed, or being overly controlling of one’s behaviour. Hence, we might expect children at the low extreme to also have problems at school or home, due to being less spontaneous or flexible, overly rigid or inhibited, or inactive.

Twins with low ADHD traits
To investigate whether these extremely low ADHD traits reflect a mirror image of ADHD, or instead too much of a good thing, my colleagues and I examined data from over 2000 16-year old British twins drawn from the so-called Twins Early Development Study. The twins rated individual differences in their own ADHD traits from low to high on a rating scale.

We found that children with the lowest ADHD traits had the lowest levels of depression and conduct problems. They were also the happiest and most satisfied with their lives, did the best at school, showed the most prosocial behavior, and had the least chaotic home environments. Hence, low extreme ADHD traits appear to be highly positive, adaptive traits, consistent with a mirror image of high extreme ADHD traits.

Nature and nurture
What’s interesting about twin studies is that we can address how heritable certain traits are. We know that ADHD is one of the most highly heritable childhood psychiatric disorders. That is, high ADHD traits are mainly attributable to genes (nature). How does this fare for children with extremely low ADHD traits? We were surprised to find that low ADHD traits were not significantly heritable. Instead, low ADHD traits were strongly influenced by the environment (nurture). For example, the shared environment between family members influences siblings in the family to have similar low ADHD traits.

Importantly, just because high ADHD traits are heritable does not mean that environmental interventions are not effective for ADHD. Both medication and behavioural interventions such as parent management training are evidence-based treatment options for ADHD. In this light, our results are very interesting. If we can identify positive or protective environments influencing low ADHD traits, this could possibly provide clues for interventions for those with high ADHD traits or to prevent individuals from developing ADHD.

More information
The article about low ADHD traits

The article is winner of the 2016 Kramer-Pollnow Young Investigator Award

More on the Twins Early Development Study

This blog is written by Corina Greven.  Edited by Lieneke.

This blog was originally published on www.blog.donders.ru.nl. This is the official blog of the Donders Institute on brains and science.

donders_banner_bilingual