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).

Is an ADHD mind a wandering mind?

This post follows on nicely from a previous one on the positive aspects of ADHD, and it is great to see that this area is receiving more attention. Research in this area is definitely sparse.

Throughout my PhD, I have been keen to conduct research that will be of benefit to those with ADHD, and I believe that finding different ways to look at and frame ADHD speaks to this. Yes, ADHD is associated with functional impairment in many aspects of life and poses a serious problem and difficulty for individuals, such as educational 1,2 and occupational problems 3–6, but I believe that there are also positives to ADHD. Recently our research group interviewed 6 adults with ADHD to try and understand more about the positive aspects of their ADHD, with reports of strengths and flourishing. Perhaps also appreciating and acknowledging the positive elements of ADHD traits could help reduce the stigma attached to mental health disorders.

In relation to occupational functioning, individuals with high levels of ADHD symptoms may excel in the workplace if they are in jobs that take advantage of some of the characteristic features of ADHD, such as the ability to hyper-focus on highly salient tasks or high levels of energy. It may be that individuals with ADHD or high traits of ADHD choose a specific type of job and career that is more suited to their ADHD symptoms. It is highly conceivable that creative professions would be appropriate, and an association between ADHD and creativity has also been described in the literature 7,8 (see Dr Martine Hoogman’s post ‘Is there a positive side to ADHD?’ for information about the association).

Such creativity could stem from the spontaneous generation of internal thoughts, also known as mind wandering, which is when our attention drifts away from our current external environment to internal thoughts and feelings that are unrelated to the current environment. This is something that we can all relate to (whether we have high traits of ADHD or not) – I know I can!! However, it seems that excessive and uncontrolled mind wandering is commonly experienced by adults with ADHD, and they often report symptoms that are very clearly descriptions of mind wandering.

My supervisor Philip Asherson is also a clinician and was noticing more and more that his patients with ADHD were using descriptions of mind wandering to characterise their symptom experience. This led to our research group looking more closely at this phenomenon and developing a new rating scale measure of excessive mind wandering; the Mind Excessively Wandering Scale (MEWS). Using this scale we found that excessive and uncontrolled mind wandering appears to be a common co-occurring feature of adult ADHD that has specific implications for the impairment experienced by individuals in their daily lives 9.

Currently, ADHD is characterised almost entirely at the behavioural level by reports of observed behaviours, but exploring mind wandering in ADHD encompasses a new way of thinking about the psychopathology based on mental phenomena rather than observable behavior. Also, if individuals experiencing ADHD symptoms find it easier to describe these subjective, internal experiences, and if these symptoms also separate those with and without ADHD then it is important to explore these alternative ways of evaluating symptoms. We are not saying get rid of current measures used to diagnose ADHD, but the MEWS could definitely complement these measures and may be more accessible for individuals. After all, the scale is based on actual patient reports of their experience.

wanderWe believe that excessive mind wandering has specific relevance for many outcomes associated with ADHD. However, we do not feel that it should only be viewed as having negative implications. It may confer functional benefit in some circumstances, and an association between mind wandering and creativity has also been described 10. This has led us to believe that it is important to enhance our knowledge and understanding of the role of mind wandering in the long term outcomes of ADHD. The area of mind wandering in ADHD also provides an opportunity to understand more about the positive aspects.

We decided to create an online survey that would help us understand more about how mind wandering and ADHD traits are associated, both the positive and negative aspects. More specifically, we want to learn more about how educational and occupational outcomes, as well as creativity, relate to mind wandering and other ADHD traits. We are collecting responses from both the general population (as ADHD traits are believed to lie on a continuum and are present in everyone to varying extents) and from individuals with a clinical diagnosis of ADHD.

Anyone over 16 years can complete our online survey.

To read the Information Sheet and complete the survey, go to:

tinyurl.com/mindwander

 

As an aside – but very related to this area – I believe it is important to acknowledge that ADHD traits were undoubtedly of benefit in our evolutionary past. For example, traits of risk taking, novelty seeking, and impulsivity were likely to be indicators of success back in the days of hunter gatherers. Yet, now we often view them as detrimental behaviours which I think speaks to current societal norms. The nature of our current culture and society is in many ways becoming more constrained. To give an example, the structure of the current education system, including the formal setting of the classroom and increased standardised testing, is not going to suit everyone and is likely to highlight and emphasise inattentive and hyperactive or impulsive traits which previously would not have been seen as so problematic.

Also, in schools the tendency is to not place as much emphasis on ‘creative’ subjects and professions as we do on ‘academic’ (in the narrow sense) subjects which can lead those who flourish in these areas feeling marginalised. Such subjects as art and sport are undoubtedly important and if individuals’ strengths lie within these domains this should be fostered and not discouraged or seen as less of an achievement. Especially if it enables those who may be functionally impaired due to a mental health condition experience reduced impairment and increased well-being.

Perhaps we can frame ADHD differently, not only viewing it as negative disorder associated with impairment, but recognising that is can also bring about positive traits such as creativity. It is important to understand more about the potential positive characteristics of ADHD and how individuals may use their symptoms to their advantage in some contexts. Our world would certainly be a very different place without the creative professions – artists, sportspeople, and musicians are an integral part of our society and everyone’s’ lives! (not to say they all have ADHD, but many do or have high ADHD traits).

 

Please feel free to share the survey with others, and tweeting would be greatly appreciated!!

@FloMowlem

Florence Mowlem, PhD student at the SGDP, King’s College London florence.d.mowlem@kcl.ac.uk

 

References:

  1. Frazier, T. W., Youngstrom, E. A., Glutting, J. J. & Watkins, M. W. ADHD and Achievement: 40, 49–65 (2007).
  2. Loe, I. M. & Feldman, H. M. Academic and Educational Outcomes of Children With ADHD. 32, 643–654 (2007).
  3. Biederman, J. et al. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J. Clin. Psychiatry 67, 524–540 (2006).
  4. Murphy, K. & Barkley, R. a. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr. Psychiatry 37, 393–401 (1996).
  5. Kuriyan, A. B. et al. Young adult educational and vocational outcomes of children diagnosed with ADHD. J. Abnorm. Child Psychol. 41, 27–41 (2013).
  6. Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P. & LaPadula, M. Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Arch. Gen. Psychiatry 50, 565–576 (1993).
  7. White, H. a. & Shah, P. Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Pers. Individ. Dif. 50, 673–677 (2011).
  8. White, H. a. & Shah, P. Uninhibited imaginations: Creativity in adults with Attention-Deficit/Hyperactivity Disorder. Pers. Individ. Dif. 40, 1121–1131 (2006).
  9. Mowlem, F. D. et al. Validation of the Mind Excessively Wandering Scale and the relationship of mind wandering to impairment in adult ADHD. Joural Atten. Disord. (2016). doi:10.1177/1087054716651927
  10. Baird, B. et al. Inspired by distraction: mind wandering facilitates creative incubation. Psychol. Sci. 23, 1117–22 (2012).

Second General Assembly meeting of the CoCA consortium was a great success – Some personal highlights

Enlightened, energised and slightly sunburned – that’s how I left the General Assembly (GA)-meeting of CoCA. This meeting took place from 19 – 22 March in Barcelona. After the kick-off meeting last year, this was the second time that all researchers came together and shared their findings, expertise and problems concerning the research on comorbid conditions of ADHD (CoCA). The meeting made clear that despite everyone’s different backgrounds, nationalities and expertise, we’re all working towards the same goal: reducing the burden of comorbid conditions in ADHD.

In 2 days I had listened to updates from researchers, talked about the latest findings and struggles in the various research groups, and informed the CoCA group about the progress we had made in the dissemination and valorisation workpackage. My ears were spinning, my throat was dry and my brain was tired, but the meeting had been a great success. Let me summarise my personal highlights from this meeting.

  1. Comorbid conditions in ADHD are prevalent, and costly

The first epidemiological findings of CoCA are currently being written up. Very large databases from Sweden, Germany and Estonia have been studied to investigate the prevalence and costs of comorbid conditions in ADHD. The results will likely make a strong case that comorbid conditions in ADHD are very common, and that better treatment of these conditions is expected to reduce societal costs. You can expect some interesting and important papers to appear this or next year.

What has already been published in the past year is for instance this paper on the genetic overlap between ADHD and bipolar disorder (Van Hulzen et al. 2016).

  1. The first intervention studies with patients have started

Other CoCA researchers have been working hard to get the first intervention studies up and running. In Frankfurt am Main, the first participants have started in the PROUD-trials (see this recent blog post). Using both bright-light therapy and regular physical exercises, we hope that symptoms of depression and obesity in adolescents and adults with ADHD will decrease. This same study will also run in Nijmegen (NL), London (UK) and Barcelona (SP). So no results yet, but exciting things are coming up!

  1. CoCA researchers are actively disseminating and communicating the project

On the dissemination and communication side, which I’m personally involved in, things are moving forward as well. I was very happy to hear from many different researchers how they are informing children, adults, patients, health care professionals and other parties about the work that we are doing. In Spain for instance, researchers go to schools to inform pupils about ADHD and comorbid conditions. And in Germany, health care professionals are informed about the co-occurrence of depression, substance abuse and obesity with ADHD. We are also closely collaborating with the ADHD patient organisation ADHD-Europe, who are a great help in disseminating our messages to ADHD patients and their families.

Additionally, this blog is receiving an increasing number of visitors and followers. Although still somewhat hesitant, the CoCA researchers themselves start to get excited about writing posts for this blog. And after I gave a workshop on ‘how to write a blogpost’ at this meeting, I expect that many more posts will appear in the next months.

  1. Philips is interested in our project and gave us useful advice

Besides the research findings and publications that CoCA will generate, we want the project to have additional societal impact. For instance, that the tools of our intervention study that we are now testing could be further developed by a company. We had therefore invited someone from Philips to join our meeting, listen to what we’re doing and give feedback from an industrial perspective. I learned for instance that when at Philips a new product is developed, they always first ask what problem they are solving, and for whom. Seems pretty obvious, right? But it’s a good thing to keep in mind also when designing studies.

  1. The weather was perfect

Let’s be honest, the weather in Barcelona was another highlight. Although most of the meetings were indoors, lunch and tea breaks allowed us to enjoy the Spanish sun. And if you’re coming from Northern Europe, this is a welcome treat after a long and dark winter. I would vote to have next year’s meeting in a sunny place again!

 

So now the real work starts. With the first results coming out, dissemination activities can really start taking place. We have also come up with the idea to make tip-sheets about CoCA that every member can use for dissemination. This way, our activities will be more coordinated and combined.

Keep following this blog for updates on CoCA (and the other consortia), as well as our new Twitter account @mindgap_psy

 

Towards a diagnosis of autism based on biochemical markers?

An interesting piece of work on the diagnosis of autism has recently been published in the scientific journal PLOS Computational Biology. The authors work at the Rensselaer Polytechnic Institute in New York.

Autistic patients have limited social interaction skills and show restricted repetitive behaviors. Although important progress has been made in recent years to understand the underlying pathophysiology of this disorder, its causes remain largely unknown. This lack of biological knowledge restricts diagnoses to be made based on behavioral observations and psychometric tools.

This study tackles a new approach that uses biochemical measures taken from blood samples in the diagnosis of the disorder. The idea behind this method is that certain metabolic pathways are frequently altered in autism. The authors have developed an algorithm that combines data from a number of blood metabolites and is able to predict the outcome of the disorder with high accuracy at least in a subset of the cases. The authors, who are system biologists, have used big data analytical tools. According to one of them, Juergen Hahn, “instead of looking at individual metabolites, we investigated patterns of several metabolites and found significant differences between metabolites of children with ASD and those that are neurotypical“. And he added that “by measuring 24 metabolites from a blood sample, this algorithm can tell whether or not an individual is on the Autism spectrum, and even to some degree where on the spectrum they land.”

The model developed by this team seem to have much stronger predictability than any existing approaches from the scientific literature and paves the way towards a diagnosis based on biomarkers for the first time.

More information can be found at     http://dx.doi.org/10.1371/journal.pcbi.1005385

Is there a positive side to having ADHD?

If you are searching for positive aspects of ADHD on the web, you will find a lot of websites claiming all kinds of positive sides to having ADHD, such as being more creative, able to hyperfocus, or being more spontaneous. However, if you try to back up this information by scientific evidence, you will be disappointed. Up to now, research in ADHD has almost exclusively focused on cognitive and behavioral deficits in people with the disorder. With ADHD being a disabling disorder, this may not be surprising on the one side. On the other, however, scientific research in several other target groups, shows there is indeed evidence pointing in the direction of a positive side of neurodevelopmental disorders and traits associated with ADHD. Take for example creativity: for disorders such as bipolar disorder and schizophrenia, strong links with creativity have been observed in large samples1, and these disorders overlap phenotypically (e.g. through impulsivity) and genetically with ADHD. Also, creative people are often risk-takers and novelty seekers, as are people with ADHD20. From genetic studies, we can also derive suggestive evidence for a possible link between ADHD and creativity. groenebrainlampwebsiteMHThe dopamine receptor D4 gene (DRD4), also sometimes called the ‘adventure gene’, is a candidate ADHD risk gene identified by meta-analysis2 but has also been associated with increased divergent thinking3. Further evidence comes from brain imaging studies, showing brain regions involved in creative thinking, temporal and frontal lobe4, 5, to overlap regions implicated in ADHD (Hoogman et al. in prep & e.g.6).

What is already known about creativity and ADHD?

Creativity tests can be divided into tasks that measure divergent thinking (such as the alternative or unusual uses task and the Torrance test of creative thinking), and tasks that measure convergent thinking (e.g. the remote associations task). Also, questionnaires that relate to creative achievement are used to acquire information about ones creative abilities (e.g. the creative achievement questionnaire). A handful of studies has linked ADHD (symptoms) with creative performance. These studies had a maximum sample size of 90. Healey and colleagues showed that among creative children, ADHD symptoms were higher than in less creative children7. Another study, by White and Shah, found increased divergent thinking in ADHD college students as compared with non-ADHD college students8. And also higher creative achievement was found in ADHD9. Additional studies did not find a relationship between ADHD (symptoms) and creativity. For example, in a study by Aliabadi and colleagues, there was no difference on a figural Torrance test of creative thinking, and patients performed worse on fluency and flexibility11.

Another way of looking at potential links between creativity and ADHD is by using possible proxies of creativity, e.g. having a creative profession. Investigating the Swedish population registries in this way did not result in evidence for more creative professions among people with ADHD than among others12. This might be due to the categorization of creative professions (writers, painter, dancers, scientists), as this might be too broad. Also, people with ADHD are often unemployed, which would lead to an underrepresentation of people with ADHD in these studies.

So (what now)…?

Patients consistently claim a link between creativity in ADHD, but this link has not been the subject of large-scaled studies that are indispensable to define such a potential link scientifically. The one large, proxy-based study of creativity and ADHD, did not find a link between both12. Should we stop there? I don’t think so. Following the demand of patients to know more about creativity in ADHD as well as the promising findings of several small-sampled studies, I think that it does deserve our attention to not only focus on the deficits of ADHD. Finding answers on this subject might reduce stigma in ADHD, as we know from previous work that more knowledge about a disorder will create understanding and lessen prejudice13. In addition, it also has the potential to help patients cope with their disorder and support them in making choices education- and career-wise.

Therefore, we are currently making a first attempt to study creativity in our adult ADHD clinical study (IMPACT2-NL) by testing creative performance on divergent and convergent thinking tasks and by administering a creative achievement questionnaire. To be able to relate creative performance to the known cognitive deficits of ADHD, we will also assess those. In addition, we will also collect brain imaging and genetic data to gain knowledge on the underlying neural mechanisms. We are also working on reaching out to other ongoing studies to add creativity tasks to their testing batteries.

It goes without saying that ADHD is a debilitating disorder. However, we feel that if there is a chance that some positive sides of ADHD exist, they deserve to be studied.

 

Dr. Martine Hoogman, senior postdoc and PI of IMpACT2-NL

impactlogo

 

 

References

  1. Thys, E., Sabbe, B. & De Hert, M. Creativity and psychopathology: a systematic review. Psychopathology 47, 141-147 (2014).
  2. Gizer, I., Ficks, C. & Waldman, I. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126, 51-90 (2009).
  3. Mayseless, N., Uzefovsky, F., Shalev, I., Ebstein, R.P. & Shamay-Tsoory, S.G. The association between creativity and 7R polymorphism in the dopamine receptor D4 gene (DRD4). Front Hum Neurosci 7, 502 (2013).
  4. Cousijn, J., Koolschijn, P.C., Zanolie, K., Kleibeuker, S.W. & Crone, E.A. The relation between gray matter morphology and divergent thinking in adolescents and young adults. PLoS One 9, e114619 (2014).
  5. Dietrich, A. & Kanso, R. A review of EEG, ERP, and neuroimaging studies of creativity and insight. Psychol Bull 136, 822-848 (2010).
  6. Shaw, P., et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A 104, 19649-19654 (2007).
  7. Healey, D. & Rucklidge, J.J. An investigation into the relationship among ADHD symptomatology, creativity, and neuropsychological functioning in children. Child Neuropsychol 12, 421-438 (2006).
  8. White, H. & Shah, P. Uninhibited imaginations: Creativity in adults with Attention-Deficit/Hyperactivity Disorder. Personality and individual differences 40, 1121-1131 (2006).
  9. White, H.A. & Shah, P. Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Personality and Individual Differences 50, 673-677 (2011).
  10. Healey, D. & Rucklidge, J.J. An exploration into the creative abilities of children with ADHD. J Atten Disord 8, 88-95 (2005).
  11. Aliabadi, B., Davari-Ashtiani, R., Khademi, M. & Arabgol, F. Comparison of Creativity between Children with and without Attention Deficit Hyperactivity Disorder: A Case-Control Study. Iran J Psychiatry 11, 99-103 (2016).
  12. Kyaga, S., et al. Mental illness, suicide and creativity: 40-year prospective total population study. J Psychiatr Res 47, 83-90 (2013).
  13. Mueller, A.K., Fuermaier, A.B., Koerts, J. & Tucha, L. Stigma in attention deficit hyperactivity disorder. Atten Defic Hyperact Disord 4, 101-114 (2012).

Nutrition and ADHD

 There is a well-documented relationship between dietary factors, health and human behavior. Severe malnutrition produces neurological and psychiatric symptoms. It is also assumed that dietary factors play a role in common mental disorders, such as ADHD, but this is less established and more difficult to investigate. A few studies have documented a beneficial effect of dietary interventions and vitamin supplements in ADHD in children and adults.

To examine the nutritional status in ADHD, Landaas et al. recently compared blood vitamin levels in 133 adult ADHD patients and 131 healthy controls. In the ADHD group there was a clear overrepresentation in the group with low levels of vitamins B2, B6 and B9.

It is yet unclear whether these vitamin levels are associated with ADHD symptoms, or whether they are the result of altered dietary intake or metabolism in ADHD patients. However, it is possible that the differences reflect dietary habits that are different in a subgroup of ADHD patients and controls. Dietary habits are established early during life and may last into adulthood. It is possible that suboptimal dietary habits may precipitate, exacerbate or maintain symptoms of ADHD. More research in larger samples is obviously needed to clarify these issues.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153567/

 

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.

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