ADHD at childhood and the risk of obesity later in life

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Really?

Having ADHD at childhood could increase the obesity risk later in life? Oddly enough, YES. There is increasing knowledge of scientific evidence about a positive link between this mental disorder and the risk of weight gain throughout life.

Is there any explanation for this relationship?

So, being hyperactive as a child can make that child to accumulate more body fat in the future? this is quite ambiguous. Let’s enlighten this matter. The ADHD is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. The factors contributing to the comorbidity between ADHD and obesity are supposed to be a genetic influence, fetal programming, executive dysfunctions, psychosocial stress, sleep patterns alterations, and factors directly related to energy balance (Hanć & Cortese, 2018). Among the last ones, it can be hypothesized that four inter-related mechanisms could partly explain why an ADHD brain is hard-wired for weight gain. These are low levels of physical activity, low physical fitness, sedentary behaviors, and overeating. Thus, individuals diagnosed with ADHD are more likely to do a less physical activity, to have a low fitness level, be more sedentary and eat more than they need than people without this disorder.

ADHD at childhood as a predictor of obesity across the life course

ADHD individuals have more complications to lead a healthy lifestyle in comparison with non-ADHD due to psychological dysfunctions. In addition, obesogenic factors are likely to accumulate over the life course of individuals. Collectively, children having ADHD and with an unhealthy lifestyle might become chronic, resulting in the development or maintenance of obesity later in life.

So, what can a child with ADHD do to avoid or reduce the risk of obesity in the future?

Youth aged between 6-17 years old can do a more physical activity, diminish sedentary behavior and eat healthier to avoid obesity later in life. Regarding physical activity guidelines, youth should perform 60 minutes or more of physical activity daily, as part of this they should do moderate-to-vigorous aerobic exercise, muscle strengthening activities and bone strengthening exercises at least 3 days per week. Also, sedentary behavior in youth should be limited <2 hours per day, and fruits and vegetables are recommended daily.

Take home message

Exercise your brain while your body!

References

Hanć, T., & Cortese, S. (2018). Attention deficit/hyperactivity-disorder and obesity: A review and model of current hypotheses explaining their comorbidity. Neuroscience & Biobehavioral Reviews, 92, 16–28.

Adrià Muntaner-Mas, Antonio Martinez-Nicolas and Francisco B. Ortega 

http://profith.ugr.es/

ADHD and obesity in adolescence and early adulthood

Have you ever heard of that people with ADHD are more likely to be obese than those without? This has been supported by two separately conducted meta-analyses in 2016,1,2 where the researchers combined results from previous independent studies using a statistical technique to provide more precise estimates.

In most studies to date, obesity was defined solely by body mass index (BMI) ≥30 kg/m2, based on the World Health Organization classification. In our recent study (published on Psychological Medicine),3 we attempted to revisit the association between ADHD and obesity in 2.5 million individuals identified from the Swedish national registers. Both ADHD and obesity were assessed via clinical diagnosis. We speculate that clinically diagnosed obesity may better reflect the pathological aspect of body fat deposition. Not surprisingly, we observed that people with ADHD were more likely than those without to receive a clinical diagnosis of ADHD during their adolescence and young adulthood.

ADHD_OBESITY

Genetic alterations common to both ADHD and obesity have been proposed as one of the plausible mechanisms underlying the association. To test this hypothesis, we conducted analysis in the relatives of the 2.5 million individuals. We compared the relatives of those affected by ADHD with the relatives of those unaffected. Here come the findings: first, relatives of individuals with ADHD were at higher risk for obesity diagnosis; second, the association was stronger in full siblings than in half siblings or full cousins; third, the association did not differ much between maternal half siblings and paternal half siblings. The first and the second findings just confirm that ADHD and obesity may run together in families, while the third one actually suggests that such familial co-aggregation is primarily due to the genetic sharing between family members. Here is the reason behind: the degree of genetic sharing between maternal half siblings is similar to that between paternal half siblings, whereas the maternal half siblings in our study were likely to share more of environmental factors than the paternal half siblings. This is because that children tend to live with their mothers following parental separation during the study period in Sweden. Nonetheless, the difference in environmental sharing did not seem to make the association stronger in maternal half siblings than in paternal half siblings.

More evidence for the genetic influence on the association is from our subsequent quantitative genetic analysis. The method is commonly applied to data from identical and fraternal twins to estimate the relative genetic and environmental contributions to the covariance between two traits. We applied the method to data from full and half siblings instead and found that the covariance between ADHD and obesity could be predominantly attributed to genetic factors. Environmental factors seem to play only a limited role in the covariance.

Since ADHD predicts obesity in adolescence and young adulthood, it might be a good idea to monitor children with ADHD for weight gain. Interventions, such as organized physical activity, tailored to those on a suboptimal trajectory might help prevent obesity later in life.  Hopefully, clinically actionable genetic variants can be discovered and benefit people suffering from both conditions.

Dr. Qi Chen is a research coordinator in the department of Medical Epidemiology and Biostatistics at Karolinska Institutet. Her research is supported by the CoCA project.

References

1          Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis. Am J Psychiatry 2016; 173: 34-43.

2          Nigg JT, Johnstone JM, Musser ED, Long HG, Willoughby M, Shannon J. Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: New data and meta-analysis. Clinical psychology review 2016; 43: 67-79.

3          Chen Q, Hartman CA, Kuja-Halkola R, Faraone SV, Almqvist C, Larsson H. Attention-deficit/hyperactivity disorder and clinically diagnosed obesity in adolescence and young adulthood: a register-based study in Sweden. Psychol Med 2018 Sep 17: 1-9.

ADHD Awareness month: Interview with a Participant

This month is the ADHD awareness month and we wanted to share with you an interview with one of the PROUD participants (CoCA project, Comorbid Conditions of ADHD).

The participant is a 21-year old male college student who is originally from Peru but has been living in Barcelona for a few years. He participated and did the exercise intervention of the PROUD Study.

backlit-city-cityscape-1466852

  1. What is it like to live with ADHD?

Please describe your main symptoms. Have your symptoms changed since childhood vs. adulthood?

When I was an adolescent, my main symptoms were low concentration capacity and hyperactivity (I could not sit for a long time). I was always bored and doing too many things at the same time. I was very impulsive as well and I had problems with my family and friends because I meddled in their activities and conversations.

Now I am 21 years old and I notice I have less hyperactivity and I can control more my impulsivity. On the other hand, my concentration is still bad and I need external help in order to improve it (pharmacology).

When were you diagnosed with ADHD? By whom? How did you feel about getting the diagnosis?

When I was 11 years old, I had very many academic difficulties and the school Psychologist noticed some ADHD symptoms in me. So, she sent me to a specialized psychology center and I was diagnosed with ADHD. This was in Perú, my country, but here in Spain I repeated some tests and I was diagnosed again and the psychologist confirmed the diagnosis.

At that time, I felt like the most weird kid in my class because I had to spend  some hours with the School psychologist and do some separate activities from the other children. My classmates asked me all the time where I was going and this bothered me.

How have you been treated (medication/ psychotherapy)? What are the effects?

When I was in Perú, I remember my parents gave me a syrup (I don’t remember the name) and my teachers were worried because they said I didn’t move from my chair in all day long, like I was sedated. My parents worried as well, and stopped giving it to me.

Then when I was older, in Spain, my brother told me I was very disorganized and I didn’t use the time well (referring to my studies). So I went to a different doctor and I started with ADHD medication.

The main effects I notice are irritability, low mood, less spontaneity and the fact that I prefer to be alone because I have a lot of concentration.

How does ADHD influence your life? (Work, friends/partnership, hobbies etc.)

When I was kid it was more difficult because I wanted to be like the other kids and be treated like a “normal” kid at school. I am competitive and I wanted to achieve the same goals as the other kids.

Regarding the friendships, it depends because there are times I want to be with friends and there are times I prefer to be alone. Some friends have been angry with me because I didn’t pay attention to them for a long time.

Do your friends/ colleagues know about your illness?

I mentioned the ADHD to a few friends and classmates because they didn’t understand some things about my behavior, my mood changes, etc. Sometimes I think people think I am dumb or something when I explain to them about the ADHD. That’s because it is difficult to me to talk about my disease.

What is the worst thing about having ADHD?

The worst thing about having ADHD is that people have a lot of prejudices about it and have a lot of incorrect thoughts about what it means. Some people told me that I will become a drug addict because I was taking pills for ADHD, they always think I don’t need the pharmacology. People usually treat me like a lazy person but I am not lazy, I just have low concentration capacity.

Sometimes, I believe that I won’t be able to achieve my objectives, I feel like I am not good for anything, and this is the saddest part about ADHD for me.

Do you think ADHD has any positive influences in your life?

I think so. I have had to be creative and follow my own strategies. I have been alone (without any friends) sometimes but this has made me stronger. And the most important thing, I know I have difficulties because of ADHD but I have learned to be a tenacious person and never give up.

  1. Study and Intervention

How did you learn about the study?

My psychiatrist from Vall d’Hebron told me about the study.

What motivated you to participate?

What motivated me the most is that if I participate in this kind of study, it could help the professionals to investigate and improve the ADHD treatments.

What were your expectations about the study before you started?

I wanted to learn more about this illness so I thought this study could help me too.

What intervention did you participate in? When?

I did the Exercise condition. I started 5 months ago more or less.

What did you like about the intervention? What did you dislike about the intervention?

I really liked the fact that I had a continuous monitoring and regular visits. Furthermore, the psychologist J.P. helped me a lot to understand all the devices I had to use and was very patient with me. She also helped me with more ADHD issues and gave me good advice.

On the other hand, what I didn’t like was the sensor I had to wear all the time because it was very big and uncomfortable.

Was the intervention helpful? (Any effects on ADHD core symptoms, mood, sleep, weight, fitness etc.?)  

I think the intervention was helpful for improving my physical condition and I was more tired so it helped me to sleep better. I also understood that my emotions and mood are important and that I have to take care of my mental health.

Was it difficult/easy to use the App?

It was easy to use the App but sometimes I had doubts about the sensor, because I didn’t know if it was synchronized with the smartphone or not.

Would you recommend other people with ADHD to participate in the study? Why?

Yes, I would recommend it, because it is important to investigate and you can learn more about the symptoms and adverse events of ADHD.

 Any suggestions/ways that the researchers could improve the experience for people in this study?

I would just change the sensor or the fact that you have to wear it all the time. I was embarrassed and it was very big.

 

 

Are you interested in participating, or do you want more information?

The trial will be continued until 2020. All outpatients with ADHD aged 14 to 45 years old living in and around Barcelona, Frankfurt, London or Nijmegen are invited to participate in the trial.

Contact:

Barcelona: judit.palacio@vhir.org

Frankfurt: Proud-Studie@kgu.de

London: adam.1.pawley@kcl.ac.uk

Nijmegen: proud@karakter.com

More information about the trial can be found on the CoCA website: http://coca-project.eu/coca-phase-iia-trial/study/

Exciting findings on ADHD comorbidities shared on 3rd meeting of CoCA researchers in Dublin

A few weeks ago, researches from all over Europe (and some even from the USA) gathered in Dublin to discuss the progress of the CoCA project. This project, investigating the prevalence and causal factors of ADHD comorbidities, is now almost half way. Time for an update on what’s happening. 

CoCA Dublin
All attendees of CoCA’s 3rd general assembly meeting in Dublin

ADHD is a risk factor for developing other (psychiatric) disorders

One of CoCA’s aims is to estimate the prevalence of comorbid disorders that occur together with ADHD. By using very large data registries from Norway, Sweden, Denmark and Estonia we can estimate the risk of developing a psychiatric comorbidity when a person has ADHD. For instance, last month a paper was published based on data from Norway, stating that the prevalence of anxiety, depression, bipolar and personality disorders, schizophrenia and substance use disorders is 4 to 9 times higher in adults with ADHD compared to adults without ADHD [1]. Interesting differences between men and women were also observed in this study. Such that depression is much more prevalent in women with ADHD, compared to women without, while in men substance use disorders are more common together with ADHD.

ADHD does not only co-occur with other psychiatric disorders, but also with obesity. Earlier last year, we published a study based on the Swedish national registry, where it was observed that ADHD and being overweight or having obesity share familial risk factors [2]. In other words, when you have a sibling who is overweight or has obesity, you are more likely to have ADHD compared to similar people who do not have overweight siblings.

The data from these registries can not only be used to estimate prevalence, but also to predict the risk someone has to develop other disorders. Our partners in the USA are using advanced machine learning tools to predict within the ADHD population who will develop comorbid disorders. Using the Swedish registry data they have found that having an ADHD diagnosis combined with a high number of injuries before the age of 12 predicts a comorbid substance use disorder at a later age. High risk taking behavior could mediate this association, and may therefore be a trait to investigate further and monitor in young people with ADHD. These data are now being further investigated and have not yet been published.

Publications on other registries and data will come out soon, so keep your eye on this blog for more information on the co-occurrence of (psychiatric) disorders in persons with ADHD.

ADHD and (psychiatric) comorbidities share genetic variants

When you know that ADHD often co-occurs with other disorders, the next question is to understand how and why. Our geneticists are trying to map the genetic overlap between the different disorders and identify shared genetic risks. Much of the work is still ongoing, but you can expect some exciting findings to be published very soon. What I can already share is the recent publication on how polygenic risk scores of ADHD overlap with other disorders and traits [3]. Polygenic risk scores (PRS) were calculated based on 12 genetic loci that are associated with ADHD based on earlier studies. In other words, the more risk variants you have on these loci, the higher your risk is for ADHD. Using the UK Biobank data, the researchers found that ADHD PRS were associated with higher body mass index, neuroticism, anxiety, depression, alcohol and nicotine use, risk taking and lower general cognitive ability (verbal-numerical reasoning). This suggests that the genes that contribute to ADHD are also involved in other traits and disorders that are often observed in people with ADHD. More knowledge on these genetic factors is expected from the studies that are now being conducted.

Searching for new treatment possibilities for ADHD and comorbid disorders

At the moment, there are no good treatments for obesity and substance use disorders, and there is little progress in the development of medication for ADHD in combination with depression. Within the CoCA project we are therefore investigating new treatment possibilities. In Frankfurt, Barcelona and London the first people with ADHD have received bright light therapy and physical exercise training to reduce symptoms of depression (the PROUD study). In Nijmegen this study will soon start as well. Meanwhile in Rostock (Germany), the circadian rhythm of participants with ADHD and other disorders is being measured. And in Frankfurt researchers are investigating the effects of dopamine agonists and antagonists on the reward system in the brain.

CoCA researchers in Norway have been searching the literature for new druggable targets for ADHD and comorbid disorders. A publication on many promising druggable genes can be expected soon. The first group of targets will be tested in an animal models.

Collaborations with patient organisations

Two representatives of ADHD patient organisations also joined our meeting: Andrea Bilbow from ADHD Europe, who is a partner in the CoCA project, and Ken Kilbride from ADHD Ireland. It was good to have these experts with us, and discuss with them how we can best translate our research findings to the people who should benefit from these findings. In Ireland for instance, there is very little knowledge about adult ADHD amongst health care professionals. It is therefore essential that our knowledge is also transferred to them, so that they can provide better care.

With the help of Andrea and Ken, we came up with a lot of new ideas for ADHD Awareness Month. During the entire month of October we aim to generate more awareness about. We will specifically target schools, such as universities and German Berufschule to inform both pupils and teachers about how to recognise ADHD and comorbidities, in adolescence and adulthood.

What’s next?

With the project being almost half way, we feel that we’re progressing very well (and our external advisor Jim Swanson – who attend the meeting as well – agrees!). In the coming year, we expect many exciting publications to appear and we will organise several symposia on international scientific conferences to share with you what we’ve found. By collaborating with patient organisations across Europe we will also share our knowledge with patients, family members, health care professionals and teachers. You can follow all of our progress on this blog!

This blog was written by Jeanette Mostert. Jeanette is dissemination manager of the CoCA project.

Further reading

1: Solberg, Halmøy, Engeland, Igland, HAavik & Kungsøyr (2018) Gender differences in psychiatric comorbidity: a population‐based study of 40 000 adults with attention deficit hyperactivity disorder. Acat Psychiatria Scandinavia, 137 (3): 176 – 186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838558/

2: Chen, Kuja-Halkola, Sjölander, Serlachius, Cortese, Farone, Almgvist & Larsson (2017) Shared familial risk factors between attention-deficit/hyperactivity disorder and overweight/obesity – a population-based familial coaggregation study in Sweden. Journal of child psychology and psychiatry, 58 (6): 711-718. https://www.ncbi.nlm.nih.gov/pubmed/28121008

3: Du Rietz, Coleman, Glanville, Wan Choi, O’Reilly & Kuntsi (2018) Association of Polygenic Risk for AttentionDeficit/Hyperactivity Disorder With Co-occurring Traits and Disorders. Biological Psychiary CNNI, in press. https://www.sciencedirect.com/science/article/pii/S2451902217302318?via%3Dihub

 

 

Are you an ADHD-friendly employer?

Do you have an ADHD-friendly work environment and management?
Yes
No
1.          Can you be trusted by your employee for the disclosure of his/her ADHD?
2.          Are you aware of the professional needs of your neurodiverse employees? – Boss: Is there anything that I’m doing or that anyone else is doing here at work that’s interfering with your success[1]?
3.          Are you incorporating reasonable accommodations (flexible work style/role innovation/closer supervision/reward systems[2]) to create a positive and productive work environment for your neurodiverse employees?
4.          If not, do you think the only solution would be to replace your neurodiverse employee with a neurotypical?
5.          Have you taken or are you willing to take professional trainings for tackling talented but sometimes difficult employees?
6.          Do you figure out your employees’ strengths and form a strength-based approach[3]?
7.          Do you foster a work culture of compliments more than that of complaints?
8.          Would you be open to personally work on the integration of diversity besides having personal sympathy and/or professionally capitalizing on the neuro-developmental disorders?
9.          Do you truly believe that organizational problems of your neurodiverse employees are the outcomes of ADHD and not the grounds for firing them?
10.       With neurodiverse people in your workplace, do you offer training/coaching to support their skills and for the organization to create an inclusive culture?
11.       Can you recognize ADHD (or other diversity) in your workplace?
12.       Most importantly, are you inclined towards being an ADHD-friendly employer and manager?
anx
Image Source
  • “I did see my job at risk but could not change anything”

– A freelancer (late thirties), worked for an e-commerce and cloud computing company, double Master’s degrees holder and with ADHD

“I don’t remember failing the deadlines. How? I had to work overtime and give up on my personal interests. The projects I was allocated did not fit my strengths. I wouldn’t say dealing with customers is my biggest strength. Further adding to my misery, I was made responsible for overseas clients which played havoc with my sleep cycle. My continuous requests for switching the duties and departments were never well received. Instead, I came across as a demanding, an arrogant and inflexible person.

I thought I had made a few friends at work but nobody wants to hang out with the boss’ not-so-favorite person. I was given a three-month termination period; I could not utilize it to find myself another job, as I was looping within the company’s projects. It was followed by a stretch of depression, and multiple but feeble psychotherapy sessions.

This was not my first job. I indeed have a 7 year experience (starting in my late twenties) in one of the richest and best known Information Technology multinationals. Looking back, I spent most of my professional life stuck in the office for hours with my laptop, could never actually build networks, and had the uncountable guilt trips of cancelling on friends and family.

How do people with ADHD even get closer to managing both personal and professional life? I am now trying to make a living as a freelancer. It has been two years since that full-time job, but the downers don’t let me re-enter the corporate sector or raise a family of my own. I feel I had wrongly prioritized my entire life by putting the professional part first. I have lost a lifetime.”

  •  “I did not even see it coming!”

– A dietitian (late thirties), parent, worked in academia and with ADHD.

“As an independent professional, I had been doing well. Why I switched to an academic position? I think of myself as a cheerful and people’s person. The idea of working in academic teams was quite fulfilling. I am so intrigued by nearly everything I am a part of.

With a mind full of too many and rational ideas, I can sometimes be challenging for others to work with. I finish the assignments, but with delays; thanks to the perfectionist within me. I spend too much time on perfecting things that at the end everybody is just relieved to get it submitted rather than appreciating the quality. I wish I could “just do it” rather than “doing it right”, and direct my creativity and research habits into the truly rewarding tasks.

At first, everyone seemed to like my company but things suddenly changed one day! My job dismissal – with an immediate effect jolted me. I had naively thought the boss would probably be more supportive after knowing my ADHD and where I was struggling. I loved my work that I was originally hired for but the unsaid overwhelming paperwork!

I have always been a bit clumsy, or much clumsier than the average person. People notice my ineptness, but not the frustration I internalize in those situations, like re-doing documents just because I lost track of originals, or re-booking flights that incur me hefty losses.

Struggling professionally, financially to support myself and kids, I now feel like a juggler.”

What-does-it-feel-like-to-have-adhd

And what do the employers come up with for firing the ADHD employees?

Their same old EXCUSES – Late for meetings! Late for handing in submissions! Unrealistic ideas! “Off track”! Does not sync with the team members! Impulsive! Continue reading Are you an ADHD-friendly employer?

Poor sleep quality in adult ADHD

We don’t realize how important sleep is. In a recent review of a new popular science book “Why We Sleep” by Matthew Walker (and you should really check it out) [1] a commentator wrote that our attitude towards sleep reminds her of what ancient Egyptians did just before they mummified a body: they always dumped the brain because they had no idea what it is, so why bother with the mushy pudding inside the skull? (www.tinyurl.com/y85pbmck) It seems that the way we treat sleep today has similar negative consequences for our physical and mental health as if we were thrashing our brains. It certainly doesn’t help to mummify our bodies as lack of sleep can considerably shorten our lifespan [1].

Poor sleep quality disturbs all aspects of cognition and emotion [2] resulting in poor concentration and high sleepiness during the day [3]. If you suffer from ADHD you are very likely know what I’m talking about, regardless how old you are [4, 5].

Sleep problems have long been a part of daily (or rather nightly) struggles of people with ADHD [6]. In fact, it is estimated that more than 50% of adults with ADHD experience sleep concerns [7] and suffer from low sleep quality [8-11]. This makes the burden of ADHD even higher by further lowering the quality of life. Imagine being exhausted by ADHD by day and then not being able to get any rest at night… No wonder poor sleep quality in ADHD results in poor academic performance, negative relations with significant others and higher chances for obesity [12]!

Interestingly, sleep disorders would often produce symptoms mimicking ADHD, so doctors should be extra careful not to confuse ADHD with consequences of these sleep problems [13, 14].

In our recent study involving adults with ADHD (data not yet published) we found that sleep quality is closely related to symptoms of inattention, hyperactivity/ impulsivity and emotional instability and that people with poor sleep quality make a lot of errors and respond much slower in a cognitive task which required concentration.

This means that if you have ADHD and you don’t sleep well, it’s as if you’d have more severe symptoms. And if you don’t have ADHD, lack of quality sleep could essentially make you a bit ADHD.

That’s why, regardless of whether you suffer from ADHD or not, you should do all in your power to make sure you sleep well at night (for useful tips check www.sleepfoundation.org). After all, we will all spend 20-30 years of our lives journeying into slumberland, so let’s make the best of these long and frequent trips – for the sake of our bodies and minds.

 

  1. Walker, M.P., Why we sleep : unlocking the power of sleep and dreams. First Scribner hardcover edition. ed. 2017, New York: Scribner. pages cm.
  2. Krause, A.J., et al., The sleep-deprived human brain. Nat Rev Neurosci, 2017. 18(7): p. 404-418.
  3. Durmer, J.S. and D.F. Dinges, Neurocognitive consequences of sleep deprivation. Semin Neurol, 2005. 25(1): p. 117-29.
  4. Hvolby, A., Associations of sleep disturbance with ADHD: implications for treatment. Attention Deficit and Hyperactivity Disorders, 2015. 7(1): p. 1-18.
  5. Cortese, S., et al., Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry, 2009. 48(9): p. 894-908.
  6. Konofal, E., M. Lecendreux, and S. Cortese, Sleep and ADHD. Sleep Med, 2010. 11(7): p. 652-8.
  7. Yoon, S.Y., U. Jain, and C. Shapiro, Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev, 2012. 16(4): p. 371-88.
  8. Sobanski, E., et al., Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep, 2008. 31(3): p. 375-81.
  9. Boonstra, A.M., et al., Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep, 2007. 30(4): p. 433-42.
  10. Schredl, M., B. Alm, and E. Sobanski, Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci, 2007. 257(3): p. 164-8.
  11. Surman, C.B., et al., Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. J Clin Psychiatry, 2009. 70(11): p. 1523-9.
  12. Um, Y.H., S.C. Hong, and J.H. Jeong, Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. Clin Psychopharmacol Neurosci, 2017. 15(1): p. 9-18.
  13. Bioulac, S., J.A. Micoulaud-Franchi, and P. Philip, Excessive daytime sleepiness in patients with ADHD–diagnostic and management strategies. Curr Psychiatry Rep, 2015. 17(8): p. 608.
  14. Oosterloo, M., et al., Possible confusion between primary hypersomnia and adult attention-deficit/hyperactivity disorder. Psychiatry Res, 2006. 143(2-3): p. 293-7.

Come sit on a mat with an artist and a psychiatrist to have a chat about mind wandering, gingerbread men, shark baits, and the interface of normal/abnormal behaviour

By Dr Kai Syng Tan (Leeds College of Art and University College London) and Professor Philip Asherson (Kings College London)

How far is too far?

Does your mind wander? What do you picture when you daydream? Where do you go? How far is too far? How often is too often? When does mental restlessness become impairment? What are the boundaries between pathology and normalcy, a healthy brain versus one that is ill, disordered and disorderly? What can a science-art collaborative exploration of mind wandering contribute to, challenge and extend our understanding of wellbeing?

Above: Left: Art invades science, science invades art: Phil and Kai at Monologue Dialogue IV exhibition inside Kai’s installation entitled ‘Crossed wor(l)ds (un-floored) (brain drawing) (2019 itinerary) (after Brexit, Chagall, Billingham, Wes, Savage, 2017)’, The Koppel Project, London (Photography by Richard Wright). Right: Memory Lane, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.

A roving art installation

Drawing on emerging research on how mind wandering relates to Attention Deficit/Hyperactivity Disorder[i], channelling the exuberance of artist Grayson Perry’s legendary tapestries as well as an artist’s lived experience as a mind wandering extraordinaire, We sat on a mat and had a chat and made maps! #MagicCarpet is a new collaboration between artist Dr Kai Syng Tan and molecular psychiatrist Professor Philip Asherson that aims to generate a critical and creative space to explore the boundaries between normal and abnormal behaviour, social and medical models of disability, imagination and pathology, art practice and scientific research, clinician and patient. Under the mentorship of Professor Asherson at the MRC Social, Genetic & Developmental Psychiatry (MRC SGDP) at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), a key aspect of the practice-led research project is how Kai will gate-crash/invade/intrude/immerse herself within the environment of leading researchers in ADHD at King’s College London as a Visiting Researcher. Apart from observing/participating in seminars, Kai will also volunteer for scientific experiments and trials. She will then embed knowledge, questions and interpretations gained in the design of a tapestry. The tapestry will be weaved in Flanders Tapestries in Belgium, which has produced tapestry art by Perry and other contemporary artists. The work ‘takes off’ when people sit on the tapestry, and chat about their mind wandering. Because words may be inadequate or challenging, they also capture their discussions/disagreements/discoveries in the form of maps and drawings (and the point is not how well you draw) that they will co-create. Co-riders of this ‘magic carpet’ include clinicians and researchers from UK Adult ADHD Network (UKAAN), self-taught artists from Submit to Love Studios, of Headway East London, a charity for people affected by brain injury, and as well as students and staff at King’s and elsewhere. Selected maps, as well as commissioned text and developmental sketches, will be documented in a limited-edition publication. A one-day seminar, exhibition and book launch will take place at the iconic Art Workers Guild. Other possible exhibition venues may include the Southbank Centre and IoPPN. Those who cannot experience #MagicCarpet live may enjoy photographs and a short film published on social media.

A space to problematise, debate and make magic 

As Flo Mowlem (April 11) and Dr Martine Hoogman (March 20) pointed out in previous blog posts, while mind wandering – in which attention switches from a current task to unrelated thoughts and feelings[ii] – is a universal human experience, excessive mind-wandering can be unproductive, and could be a key feature of ADHD; while ADHD can pose serious problems, there can be positives, and this is hitherto an under-explored area of research. Indeed, as one of the best example of a continuous trait found in both impaired and excelling individuals, ADHD is an ideal springboard to spark a discourse about the line(s) separating wellness and illness. BBC Horizon’s recent ADHD and me with Rory Bremner did a wonderful job in sparking mainstream interest in ADHD (not least in its controversial analogy of people with ADHD as half-baked gingerbread cakes and hapless victims of shark attacks). The ‘magic’ that #MagicCarpet as a project aims for is not to provide answers but to raise more questions. This is not just during the workshops, but publication, exhibition (if the tapestry and maps are portraitures of the makers’ neurodiversity, they present an interesting counterpoint to the hung portraits of able-bodied males that deck the Edwardian Hall of the Art Workers’ Guild), and beyond. While there are no shortage of melting clocks, cupboards that lead to other worlds and grand pronouncements about human beings’ primal desire for ‘journeys of the mind and body’, without which we ‘rot’ [iii] in the so-called ‘art world’, that mind wandering as a subject area, creative process or tool in the arts seems to be an unchallenged ‘given’ makes it an appealing area of research for Kai as a researcher and practitioner. Her own diagnosis of ADHD, dyslexia and dyspraxia in Autumn 2015 generated questions, not clarity. Where and when does the ADHD/art/personality begin, end or smash into each other? What are the problems and opportunities afforded by conceptualising and making ‘neurodiverse art’? Is this discussion a rehash of the tiresome myth of the ‘mad artist/genius’ (which artists themselves may corroborate, intentionally or inadvertently)? Is neuroscience society’s new tool to ‘otherpeople who do not conform, or does it enlighten and clarify? What can art bring to this conversation? #MagicCarpet is Kai’s process of inquiry/discovery as a woman/artist/curator/researcher. It is also her way to interrogate existing representation of ADHD which she has found to depict as largely only affecting children or adult male criminals, and only as an aberration to be corrected, cured, ironed out, medicated.

#MagicCarpet may also present a template of how art and science can clash and/or create sparks. As an ‘experiment’ which ‘invites us into the epistemological space of the laboratory’ while pointing to ‘ethical and aesthetic territories of novelty, invention, and play’[iv], it contributes to discourses on interdisciplinarity. Research in and with the arts and sciences tends to be siloed, but grand (and not-so-grand) challenges often require crossovers and the pushing of boundaries. The work creates a platform for clinical communities to dialogue with the arts about ADHD. As a leading artist working in the art-science interface argues, ‘not only is medicine capable of providing new material for the gallery space’, art can bring ‘new knowledge into the consulting space’ [v]. Equally important is the opportunity for artists to engineer forays out of comfort zones, in order to learn unfamiliar tools, languages and processes. A mind that does not seek new frontiers is one that is closed and stuck. Kai is thrilled as she is terrified by the extent to which her trespass into the medical world disrupts her assumptions and habits as an artist. Which was why she approached Philip in March 2016. The ensuing cultural clashes, collisions and antagonisms would, hopefully, be jarring, surprising, productive [vi].

Unlimited commission, unlimited possibilities

#MagicCarpet is one of 6 works commissioned by Unlimited in its Main Commissions strand for its 2017 round of awards. Unlimited is an arts commissioning programme that celebrates the work of disabled artists, with funding from Arts Council England, and is delivered by Shape Arts and Artsadmin. While the project is expected to run between Summer 2017 – Autumn 2018, there are possibilities to extend #MagicCarpet intellectually, artistically, pedagogically. An example is to tour the tapestry at various universities and working with the respective disability offices to help raise awareness of ADHD, mindfulness and neurodiversity in its staff and student populations. Another is to incorporate the tapestry as an object-based learning activity for students at MRC SGDP. Evidence relating ADHD with exercise as a preventative treatment is emerging[vii]. This is an area that could be developed into a research project, and relates to Kai’s existing body of work on running as a creative and critical toolkit. A related strand is to work with mobile EEG devices to enable the ADHD brain to create ‘brain drawings’ as the body runs through different places in various parts of the world, which could fit under the Science in Culture flagship of the Arts and Humanities Research Council.

Come ride the magic carpet with us. Share your thoughts, experiments, explorations, recommendations and counterarguments. Let’s see how far we can go (together).


Dr Kai Syng Tan FRSA SFHEA is an artist and curator. Through installation, performance, film, and text, she explores the body and mind in (com)motion. Sitting/slipping between/beyond discipline/form/conceptual frameworks/spaces/places/allegiances, her work is turbocharged by a day-glo palette, hyperactive layering and over-the-top vocabulary. They have appeared at Documenta, Royal Geographical Society, Biennale of Sydney, MOMA, BBC and the Guardian, and are collected by the Museum of London and Fukuoka Art Museum. Currently a Research Fellow at Leeds College of Art, Visiting Fellow at University College London’s Institute of Advanced Studies, Peer Review College Member of the Arts and Humanities Research Council and Director of RUN! RUN! RUN! International Body for Research, Kai completed her PhD at the Slade School of Fine Art, University College London. From Summer 2017 she will also be a Visiting Researcher at SGDP. @kaisyngtan
Professor Philip Asherson, MB,BS, MRCPsych, PhD is Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry (SGDP) centre at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London in the United Kingdom. Since 1996 when he moved to the IoPPN he has worked closely with Professor Jonna Kuntsi to develop a program of research on clinical, quantitative and molecular genetics of ADHD. In his own work, he has a particular focus on adults with ADHD. Current research projects include investigations of the neural basis of mind wandering in ADHD, clinical trials of prisoners with ADHD, and the impact of ADHD on learning in University students. He is the author and co-author of more than 300 articles and book chapters on ADHD and other neurodevelopmental disorders and traits. @ukaan_org

[i] See for instance Franklin, Michael S., Michael D. Mrazek, Craig L. Anderson, Charlotte Johnston, Jonathan Smallwood, Alan Kingstone, and Jonathan W. Schooler. “Tracking Distraction.” Journal of Attention Disorders 21 (6): 475–86. doi:10.1177/1087054714543494 (2014) and Mowlem, Florence D., Caroline Skirrow, Peter Reid, Stefanos Maltezos, Simrit K. Nijjar, Andrew Merwood, Edward Barker, Ruth Cooper, Jonna Kuntsi, and Philip Asherson. “Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD.” Journal of Attention Disorders, June, 1087054716651927. doi:10.1177/1087054716651927. (2016).

[ii] Smallwood, Jonathan, and Jonathan W. Schooler. “The Science of Mind Wandering: Empirically Navigating the Stream of Consciousness.” Annual Review of Psychology 66 (January): 487–518. doi:10.1146/annurev-psych-010814-015331. (2015).

[iii] Chatwin, B. Anatomy of Restlessness: Selected Writings 1969-1989. Viking Pr. 100-106 (1996).

[iv] Callard, F, and Fitzgerald, D. “Medical Humanities.” Where Does It Hurt, 16–17 (2014).

[v] Padfield, D. MASK: MIRROR: MEMBRANE The photograph as a mediating space in clinical and creative pain encounters. University College London. 3 (2013).

[vi] Elsewhere Kai has talked about interdisciplinary collaborations. See Latham, Alan, and Kai Syng Tan. “Running into Each Other: Run! Run! Run! A Festival and a Collaboration.” Cultural Geographies, Cultural Geographies (Sage), doi:10.1177/1474474017702511 (2016).

[vii] Rommel, Anna-Sophie, Jeffrey M. Halperin, Jonathan Mill, Philip Asherson, and Jonna Kuntsi. “Protection from Genetic Diathesis in Attention-Deficit/hyperactivity Disorder: Possible Complementary Roles of Exercise.” Journal of the American Academy of Child and Adolescent Psychiatry 52 (9): 900–910. doi:10.1016/j.jaac.2013.05.018. (2013).