Beneficial effects of high-intensity exercise on the attentive brain

Posted on by ebbadurietz

Physical exercise and the brain

Emerging evidence from research studies suggests that physical activity can improve attention, brain function and well-being. In an attempt to understand more about the beneficial effects of high-intensity exercise, we recently conducted a study on the effect of PHysical Activity on Brain function (PHAB study). We examined whether cycling at a high intensity for 20 minutes would improve brain-activity (electroencephalography; EEG) measures of attention and focus during computerised tasks. We also aimed to investigate whether some individuals, for example those who are physically fit, would benefit more or less from exercise.

PHAb setup2

Does high-intensity exercise improve attention?

Participants (young adult men) were invited to our research centre, where they completed computer tasks while we recorded their brain activity. In the first task, they were asked to respond to letter ‘X’ following an ‘O’, but not to respond if another letter was presented after an ‘O’. Participants performed the task both before and after exercise and rest, and so we were able to test if their brain activity changed after exercise.

Task

We found that an attention measure called the “P3” was enhanced after exercise but not after rest. This suggests that the intense exercise session led to improvements in their attention. These improvements in attention from exercise were equal across participants, regardless of how physically fit they were.

The participants also performed two subsequent computer tasks, but we did not find improvements after exercise in these tasks. We believe that the beneficial effects of exercise may have worn off by the time that they performed these tasks.

These results suggest that intense exercise may improve attention. Exercise may therefore be beneficial for individuals with impairing levels of inattentive and restless behaviours, such as ADHD. This is currently being tested in the clinical trial CoCA (https://mind-the-gap.live/2018/10/09/10-weeks-of-physical-exercise-or-light-therapy/) (https://mind-the-gap.live/2017/02/18/coca-proud-trial-ready-to-roll/).

Read more about our study results at:

If you have any questions

Please feel free to contact Professor Jonna Kuntsi (). The project was supported by a Medical Research Council studentship to Ebba Du Rietz.

Phelps

 

Ebba Du Rietz and Jonna Kuntsi

ADHD in ancient Greece?

Posted on by Tor-Arne Hegvik

One often hears that the first written description of ADHD stems from the book of the German physician Melchior Adam Weikard “Der Philosophische Arzt” (translated: “The philosophical doctor”) published in 1775. Other well-known old descriptions include for example George F. Still’s description from 1902 published in the Lancet, and Alexander Crichton’s description from 1798. However, this year a Brazilian research group published a report where they claim that the first know description of ADHD, or at least ADHD-like behavior, might be more than 2000 years old!*

The philosopher Theophrastus was a former pupil of Plato and Aristotle who lived in ancient Greece. In approximately 319 years BC he wrote “The Characters”, which essentially is a collection of texts that describes the behavior of 30 stereotypical characters where each character is devoted 10-15 phrases. One of these characters, “the obtuse man”, is an adult man who is described to have both inattention symptoms (forgets important appointments) and hyperactivity symptoms (tires out his children while playing). In addition, “the obtuse man” also has sleep problems and has problems with planning, which both are more common among individuals with ADHD than among those without.

Despite that it can be argued that the behavior of the “the obtuse man” is not a perfect description of typical ADHD, it is still interesting that the oldest known description of ADHD-like behavior describes these symptoms in an adult, in contrast to the later descriptions of ADHD-like behavior that are about children with these symptoms. Moreover, Theophrastus’ more than 2000-year-old text further supports that ADHD (and other psychiatric disorders) has been a part of human life as long as we have been humans.

*Victor MM, Bruna SdS, Kappel DB, Bau CH, Grevet EH. Attention-deficit hyperactivity disorder in ancient Greece: The Obtuse Man of Theophrastus. Aust N Z J Psychiatry. Jun 2018;52(6):509-513.

Tor-Arne Hegvik is medical doctor who is doing research on ADHD and its co-morbidities as a part of the CoCA project:

Picture from https://pixabay.com

ADHD Is A Risk Factor For Type Two Diabetes And High Blood Pressure, As Well As Other Psychiatric Disorders

Posted on by Prof. Stephen Faraone

All Swedish residents have their health records tracked through unique personal identity numbers. That makes it possible to identify psychiatric and medical disorders with great accuracy across an entire population, in this case encompassing more than five and a half million adults aged 18 to 64. A subgroup of more than 1.6 million persons between the ages of 50 and 64 enabled a separate examination of disorders in older adults.

Slightly over one percent of the entire population (about 61,000) were diagnosed with ADHD at some point as an adult. Individuals with ADHD were nine times as likely to suffer from depression as were adults not diagnosed with ADHD. They were also more than nine times as likely to suffer from anxiety or a substance use disorder, and twenty times as likely to be diagnosed with bipolar disorder.  These findings are very consistent with reports from clinical samples in the USA and Europe.

Adults with ADHD also had elevated levels of metabolic disorders, being almost twice as likely to have high blood pressure, and more than twice as likely to have type 2 diabetes. Persons with ADHD but without psychiatric comorbidities were also almost twice as likely to have high blood pressure, and more than twice as likely to have type 2 diabetes.

Similar patterns were found in men and women with ADHD, although comorbid depression, bipolar disorder, and anxiety were moderately more prevalent in females than in males, whereas substance use disorder, type 2 diabetes, and hypertension were more prevalent in males than in females.

ADHD was less than a third as prevalent in the over-50 population as in the general adult population. Nevertheless, individuals in this older group with ADHD were twelve times as likely to suffer from depression, anxiety, or substance use disorders, and more than 23 times as likely to be diagnosed with bipolar disorder as their non-ADHD peers. They were also 63% more likely to have high blood pressure, and 72% more likely to have type 2 diabetes.

The authors noted, “Although the mechanisms underlying these associations are not well understood, we know from both epidemiologic and molecular genetic studies that a shared genetic predisposition might account for the co­existence of two or more psychiatric conditions. In addition, individuals with ADHD may experience increased difficulties as the demands of life increase, which may contribute to the development of depression and anxiety.” As for associations with hypertension and type 2 diabetes, these “might reflect health ­risk behaviors among adult patients with comorbid ADHD in addition to a shared biological substrate. As others have noted, inattention, disinhibition, and disorganization associated with ADHD could make it difficult for patients to adhere to treatment regimens for metabolic disorders.” They concluded that “Clinicians should remain vigilant for a wide range of psychiatric and metabolic problems in ADHD affected adults of all ages and both sexes.”

Stephen Faraone is distinguished Professor of Psychiatry and of Neuroscience and Physiology at SUNY Upstate Medical University and is working on the H2020-funded project CoCA. 

REFERENCES

Qi Chen, Catharina A. Hartman, Jan Haavik, Jaanus Harro, Kari Klungsøyr, Tor­Arne Hegvik, Rob Wanders, Cæcilie Ottosen, Søren Dalsgaard, Stephen V. Faraone, Henrik Larsson, “Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study,” PLoS ONE (2018), 13(9): e0204516. https://doi.org/10.1371/journal.pone.0204516.

Living day-to-day with ADHD and experience of the CoCA clinical trial

Posted on by adampawley

Below is a recent interview from a patient who took part in the PROUD study in London  I would like to thank him for taking the time to answer my questions, his articulate descriptions provide a fascinating insight into what it is like to live with ADHD on a daily basis and his reflections on the PROUD clinical trial, provide us, as researchers, a valuable insight into what it is like to participate from the perspective of a patient.

  1. What is it like to live with ADHD?

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

I find myself easily distracted. It is very difficult for me to carry out long tasks that require a lot of attention or very tedious tasks. I have racing thoughts going through my head 24/7 and it is very difficult for me to shut them off and focus on what I am doing. I also find myself experiencing mood swings very often. I have multiple highs and lows throughout the day and it is very difficult for me to maintain a stable mood. Also, when I read it is very difficult for me to retain the information and remember what I have just read. I also have trouble trying to organize my thoughts and speak in fluent sentences because my mind is thinking about so many things and I just want to get all of them out.

I would say my symptoms have gotten worse as I transition into adulthood, but it could be because I am more aware of what is going on and the science behind it. I always had anxiety when I was a kid but never really depression. I notice that as I get older I find I get down into slumps and feel really unmotivated. That is the main difference from my childhood and adulthood experiences.

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

I was diagnosed when I was roughly 12 years old. I went to see a Doctor to get tested because my reading comprehension was very low and my test taking ability was terrible as well. They discovered that I had ADHD as well as Performance Anxiety.

As a kid, you never want to be told that there is something wrong with you, but it was good to know why I was having the thoughts I had and what exactly was going on. This led me to do extensive research on these mental illnesses and get a better understanding of what was going on and how to better handle my symptoms.

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

I was treated for my anxiety with Anti-depressants as a kid but came off of them due to them making me emotionally numb. I was never treated for my ADHD as a kid because the doctors thought that Anxiety was the main culprit of my problems, but I have actually discovered that ADHD is the main issue.

I did have a psychiatrist for a while as a kid, but I can’t remember much from the sessions and I don’t think they were very helpful. I did do CBT towards the end of 2017 and that did prove to be quite helpful. I just recently decided to get treated for my ADHD with medication just after I finished the Trial at Kings College because I felt that my symptoms were really beginning to affect my life. So I am currently on 40 mg Elvanse and I am on the waiting list for CBT to try and give psychotherapy another shot.

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

I am an Actor, so remembering lines and understanding things thoroughly is absolutely crucial! My ADHD comes in the way a bit because sometimes I zone out and don’t completely listen to instructions or other actors. Also, reading scripts can be a bit difficult in trying to retain the information and focus on what I am reading.

I find that it hinders my relationships because I am a bit all over the place sometimes and do not give my friends or family the time or attention they deserve. I have also found that my ADHD causes regular mood swings so sometimes I am feeling depressed and do not feel like doing anything. This affects my work and relationships as well as my hobbies.

Do your friends/ colleagues know about your illness?

Yes, they do. I find it extremely important that everyone understands why I may act strange sometimes and also, they will understand me better. It is not something that I am ashamed of. It is just the way my brain works.

What is the worst thing about having ADHD?

The biggest issues are not being able to focus or getting easily distracted. Another of the big issues I have is the depression side of things. It also drains all of my energy and I end up not feeling like doing anything.

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

One of the big benefits of having ADHD is always planning everything! I have to always be very prepared, but it is also a bad thing because it causes me anxiety sometimes. But then again, I don’t believe I would be the same person I am now if I didn’t have these issues.

  1. Study and Intervention

How did you learn about the study?

I believe I learned about the study from the Clinicaltrials.org website.

What motivated you to participate?

I absolutely love psychology and I am always interested in learning about the things that affect me personally. I am always doing research on mental health because it allows me to get a better understanding of what is happening on a more scientific level. It gives me more insight and allows me to better deal with my symptoms.

What were your expectations about the study before you started?

I expected to get a better understanding of ADHD and even finding a new strategy on coping with my symptoms.

Which intervention did you participate in, when?

Exercise intervention.

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

I liked the fact that it kept me busy and it also forced me to be proactive and accountable because I couldn’t lose the phone or the wrist band tracker. It made me work on that aspect of my ADHD because I do tend to forget to do things and I am always losing things. I also found that my depression is onset when I am not doing anything so having to be accountable for this exercise and doing what I was supposed to do kept my mind busy.

The only thing I didn’t like was the wrist band and having the wear it all the time because it is quite unattractive, and I do travel a lot so having to keep it while traveling it abroad and charging everything was just a bit overwhelming.

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

I am already a very active person, so it didn’t really change anything as far as fitness goes. It helped my sleep patterns because I was more aware of how much I was sleeping because I had to write it down. I feel like it helped my mood a bit because I was focused on phone ringing and answering the questions, so my mind was wandering off and causing me depression.

Was it difficult/easy to use the App?

The app was extremely easy to use but it was a bit tedious when it would go off every hour or so and was a bit annoying when I was busy or working. Not to mention that I couldn’t cover up the tracker with a sleeve or a jacket because of the light sensor.

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

Yes I would because I feel like it gives people a better understanding of their mental health and gives them some helpful things that they can take away from the study to implement into their life. Having a mental illness does not mean you are less of a person or less capable, but it is just important to understand what is going on. If you understand what is causing the symptoms, then it is easier to find ways to overcome these issues.

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

I would recommend updating the technology and having a more advanced wrist band sensor that looks more like a watch like apple watches or fitbits. It is an amazing study and I am very happy with how it was conducted. I wish I could offer more ways that you could improve the study, but my experience has been extremely satisfying.

Adam Pawley is a clinical neuroscientist at King’s College London. He is running the CoCA PROUD trial in London.

Validation of DIVA 2.0: a new interview for diagnosis ADHD in adults

Posted on by ramosquiroga

Despite the high prevalence of ADHD in adults, until recently, only the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) was the validated semi-structured interview available for the accurate diagnostic assessment of ADHD based on the DSM-IV criteria in the adult population. However, an important limitation of the CAADID that needs to be highlighted are the costs that come with its administration.

On the other hand, the DIVA 2.0 interview (Diagnostic Interview for ADHD in adults, DIVA 2.0, for its acronym in Dutch) is a semi-structured instrument which is freely available as a PDF on the website of the DIVA Foundation (www.divacenter.eu) and via a small one-off charge as a downloadable app. This semi-structured interview allows a thorough evaluation of the diagnostic criteria of DSM-IV-TR for ADHD in adulthood, as well as in childhood. It is divided into two domains, each applicable for childhood (before age 12) and for adulthood: the DSM-IV criteria for inattention, and for hyperactivity/impulsivity. The third part deals with the impairment caused by the ADHD symptoms in five areas of functioning (including work and education; relationships and family life; social contacts; free time and hobbies; self-confidence and self-image). For each criterion and age period, the DIVA 2.0 provides a list of specific and realistic examples of current or retrospective behaviors throughout life, that simplify the assessment of each of the 18 DSM-IV criteria required for the diagnosis of ADHD. The examples are based on common descriptions provided by the patients themselves. DIVA 2.0 also provides examples of the types of impairment commonly associated with the symptoms in five areas of daily life mentioned above. Whenever possible, the adult is interviewed in the presence of the partner or close relative who is familiar with the patient’s childhood, in order to evaluate simultaneously collateral and retrospective information (hetero-anamnesis).

This study investigates criterion and concurrent validity of the DIVA 2.0, a diagnostic semi-structured interview for ADHD in adults, based on the DSM-IV-TR criteria. Given that only one other study has investigated the validity of this interview, this is one of the first studies to carry forward the appropriate statistical analysis to explore the psychometric properties of the diagnostic tool in Spanish (Pettersson et al., 2015). Nevertheless, the study of Pettersson et al. compared DIVA 2.0 with an open clinical interview and in this study DIVA 2.0 was correlated with a semi-structured interview (CAADID).

The validation of this diagnostic interview provides us with an accurate and free diagnostic tool for assessing ADHD in the adult population, which can be useful in daily clinical practice and research settings. Findings from this piece of research provide support for the good reliability of this interview for the diagnosis of ADHD within the adult population. The findings demonstrate that DIVA 2.0 has a diagnostic accuracy for ADHD in adults of 100% when compared with the diagnosis obtained using the current gold standard diagnostic interview, the CAADID. Moreover, DIVA 2.0 appears to have similar psychometric properties as the CAADID as a diagnostic tool for adult ADHD. Regarding the validity of the interview, the results show a good correlation with the WURS scale when assessing ADHD symptoms for inattention, hyperactivity/impulsivity, and total symptoms during childhood. Along the same lines, fair results for concurrent validity were obtained for the assessment of symptoms during adulthood using the ADHD-Rating Scale and DIVA 2.0. Finally, a new updated DSM-5 version of DIVA is coming soon.

Complete abstract with link to pubmed and reference:

https://www.ncbi.nlm.nih.gov/pubmed/27125994