New Findings on ADHD and Brain Development
November 14, 2007 6:32 AM   Subscribe

The BBC reports that new research ties ADHD to delayed cortical development.
posted by Fferret (57 comments total) 10 users marked this as a favorite

 
Interview with someone who worked on the study.
posted by brownpau at 6:43 AM on November 14, 2007


Um... ok... resumes rocking back and forth in desk chair...
posted by wfrgms at 6:44 AM on November 14, 2007


I wouldn't be surprised if there was a diet/nutrient connection, perhaps lack of certain fats like Omega3 ("the brain fat") or nutrients like Vitamin D (of which the modern diet is chronically short).
posted by stbalbach at 6:51 AM on November 14, 2007


I think we need stop giving small children rss readers.
posted by srboisvert at 6:55 AM on November 14, 2007 [6 favorites]


Does this belong in Metatalk?
posted by chillmost at 7:04 AM on November 14, 2007 [1 favorite]


Rather than reflecting deficiencies of any sort, this may represent normal variability in brain development. Some individuals are on slower trajectories than others to reach the same endpoint. The children at one end of the distribution are labelled ADHD because their behaviors are disruptive or dangerous to self or others given the environments they are in. But there is nothing intrinsically wrong with their brains. Many other aspects of development show the same variabiity; for example, children being learning language or learning to read at different ages, but eventually end up at the same level of performance. These different developmental patterns are all "within normal limits" as they say.

Then the question is: should the children who are on the slower but normal-range trajectories be medicated? I am not a professional in this area, but I would very much hesitate to do so unless the circumstances absolutely demanded it (like, there is risk of harm to the kid or others).

There are other ADHDs (about 1/4 acc to some estimates) who are different: the etiology is different, they aren't going to grow out of it, and they need the medication
posted by cogneuro at 7:09 AM on November 14, 2007 [3 favorites]


that should have been "children begin learning language," not "being".
posted by cogneuro at 7:10 AM on November 14, 2007


I am not a professional in this area...

And yet in the preceding paragraph you had no problem labeling ADHD kids as "within normal variability".
posted by DU at 7:12 AM on November 14, 2007 [3 favorites]


Well, I'm glad etiology is finally being established. Perhaps an MRI scan or something of that nature can be used to distinguish the impared from those looking to score some uppers.

As an aside, why is ADD classified as a learning impairment? It certainly makes some types of learning much more difficult, but it hardly seems learning specific. I'm just a likely to get distracted in a conversation with someone as I am in schoolwork (more so in the former case actually). Does that make it a language disorder? I know a guy paralyzed from the waist down, makes it hard for him to get to class, does he have a learning disorder?
posted by phrontist at 7:22 AM on November 14, 2007


I want cortical my development NOW!
posted by StickyCarpet at 7:32 AM on November 14, 2007


It certainly makes some types of learning much more difficult, but it hardly seems learning specific.

I don't think that is different from any other learning disability.
posted by Chuckles at 7:33 AM on November 14, 2007


And here's NPR's Diane Rehm on the article cited.
posted by Fferret at 7:33 AM on November 14, 2007


Interesting info. am a fan of EEG Spectrum's neurofeedback therapeutic treatment application for ADHD from the anecdotal info I've heard from friends with kids who used it.
posted by nickyskye at 7:36 AM on November 14, 2007


As an aside, why is ADD classified as a learning impairment?

Because it's impedes learning ?

Sorry for the snark, but people with ADD don't function as well as they could if they weren't ADD - particularly in learning situations.

That's not to say that they are worthless, or that certain ADD traits aren't useful sometimes - but there are definitely situations in which it provides an impediment neurotypical types don't have.

Whether it's normal part of human evolution or because I didn't feed my kid enough "brain fat" (wtf?) doesn't really matter so much as finding a treatment regime that mitigates the bad parts and improves the good parts.
posted by Pogo_Fuzzybutt at 7:40 AM on November 14, 2007


Hmmm. Medication seems the only option.

I think "Ritalin deficient" may be more accurate than "slower cortical development".

Bah.

The most dangerous thing is what Pogo says... "mitigates the bad parts."

Sometimes we are stuck with bad parts, and the best thing for us is to accept that the bad parts require that we live differently than everyone else.

For everyone else, there is medication.
posted by ewkpates at 7:48 AM on November 14, 2007


This is very interesting stuff. The implications of this research are very important because...because....ohhhhh, shiny!
posted by never used baby shoes at 7:51 AM on November 14, 2007


Did they control for the effects of medications? (God, I hate "science reporting" (sic).)

Were the kids with ADHD on medication for the disorder? Could the speed have been effecting cortical development?
posted by OmieWise at 7:52 AM on November 14, 2007


My son has been through the rounds of assessment for ADHD. While I think he's fine in many ways, I have learned a few things about it. Many kids with ADHD are no more mentally ill than Andy Grove, who claimed to be "paranoid". Andy Grove paranoid is not the same as people who end up in mental hospitals paranoid. Some kids with ADHD have no zero impulse control. Some can literally not pay attentition to anything. These kids need real help, sometimes in the form of medication. However there are a lot of kids labelled as "ADD" who exhibit a few tendancies but aren't really held up by it.

(Also, nickyskye , we looked into neurofeedback therapy, but we weren't impressed by the long term results. Most kids revert to their prior level of attentiveness as soon as they stop the therapy.)

Anyway, this is interesting research, but the fact that different people's brains develop at different rates is about as suprising as finding that some kids are 6' tall in grade 8 while others go from 4'6 to 6' during grade 11.
posted by GuyZero at 7:52 AM on November 14, 2007


Medication seems the only option.

At the risk of sounding like a total hippie, we give our son B vitamin supplements and 5HTP, aka tryptophan, which is a seratonin percursor. One kid is not a scientific study, but it seems to have improved his mood, reduced impulsivity and increased attentitiveness. Many ADHD medications are pretty serious stimulants and my feeling is that there's probably something that will help that's not quite as severe as Ritalin, et al.
posted by GuyZero at 7:55 AM on November 14, 2007


I was in a workshop earlier this year where the presenter was talking abut a long term study the Canadian government was doing (not finished yet so nothing to point you to), which as of today (actually I guess 3 months ago) has not shown any ADD/ADHD rate of significance among the Inuit population/s. The rate is so small as to be virtually non-existent.
posted by edgeways at 8:05 AM on November 14, 2007


It's very strange how unusual conditions and diseases, like ADD and Asperger's and peanut allergies seem to be exploding in the industrialized world, particularly in California, but don't seem to be catching on anywhere else.

I remember in the documentary about the Plumpynut miracle peanut-based food they're using in Africa to fight the famines there, someone asks whether any kids have died because of peanut sensitivity, and the doctor turns to the camera and essentially says "we see no, as in zero, peanut sensitivities in developing countries period."

I'm not with the CDC, but it seems like reports of ADD and ADD prescription are similarly a developed country problem. I wonder how prevalent the diagnosis is in large semi-developed countries like China.
posted by felix at 8:16 AM on November 14, 2007 [1 favorite]


What it means is that we should quit trying to stuff all children into the same educational box, expecting the same 'benchmarks' at the same time ... allow a child's education to be emergent.
posted by lacus at 8:19 AM on November 14, 2007


God damn you, Cortext.
posted by Astro Zombie at 8:29 AM on November 14, 2007


Another recent study: Ritalin of no long-term benefit.
posted by the jam at 8:37 AM on November 14, 2007


People call omega-3's a "brain fat" because it gets incorporated into cell membranes in the brain. Some people think it can protect against developing ADHD, it's being studied. The jury's still out.
posted by selfmedicating at 8:45 AM on November 14, 2007


Here is the NMIH press release from which the article was written. I don't think the paper is online yet, or at least I couldn't find it at the PNAS website.

I still can't figure out if the ADHD kids were on meds. If they were I'd love to know how the researchers controlled for the effect of amphetamines on normal brain growth in kids this age.
posted by OmieWise at 9:02 AM on November 14, 2007


Oops, NIMH. Mrs. Frisby would be so pissed.
posted by OmieWise at 9:03 AM on November 14, 2007 [2 favorites]


It's very strange how unusual conditions and diseases, like ADD and Asperger's and peanut allergies seem to be exploding in the industrialized world, particularly in California, but don't seem to be catching on anywhere else.

There's going to be some substance recently introduced to wide use, probably, in fact, several or many substances, that's massively fucking people up. Lead paint, asbestos insulation, ???????.

I'd lay my money on processed food and plastics, but we may never find out.
posted by TheOnlyCoolTim at 9:03 AM on November 14, 2007


Du: I am not a clinician who can recommend medications.

I am a cognitive neuroscientist who studies who child developing and learning.

There's a difference.
posted by cogneuro at 9:16 AM on November 14, 2007


not a good spelling day;

child development and learning
posted by cogneuro at 9:18 AM on November 14, 2007


And yet in the preceding paragraph you had no problem labeling ADHD kids as "within normal variability".

The only thing you need to be a psychologist is a working brain!
posted by delmoi at 9:30 AM on November 14, 2007


Medication seems the only option.

At the risk of sounding like a total hippie, we give our son B vitamin supplements and 5HTP, aka tryptophan, which is a seratonin percursor. One kid is not a scientific study, but it seems to have improved his mood, reduced impulsivity and increased attentitiveness. Many ADHD medications are pretty serious stimulants and my feeling is that there's probably something that will help that's not quite as severe as Ritalin, et al.
posted by GuyZero at 10:55 AM on November 14


What you're not telling us is that you hid the B vitamins and 5HTP in slices of pie to get your son to eat them.

In a proper study you'd control for the "I'm eating pie all the time! Life rules!" factor.
posted by Pastabagel at 9:44 AM on November 14, 2007


the fact that different people's brains develop at different rates is about as suprising as finding that some kids are 6' tall in grade 8 while others go from 4'6 to 6' during grade 11.

what was surprising--and obviously isn't trivial to grasp--is that normal variability in development may be responsible for what has been consider a form of abnormal behavior.
posted by cogneuro at 9:52 AM on November 14, 2007 [2 favorites]


MetaFilter: I'm eating pie all the time! Life rules!

Surprisingly, he takes liquid vitamin supplements mixed with juice which are pretty gross. We usually put a tablespoon of fish oil in there too. Luckily gross stuff is pretty appealing to 9 year old boys.

But like I said, one sample isn't science. Plus the measurement bias, etc.
posted by GuyZero at 10:25 AM on November 14, 2007


what was surprising--and obviously isn't trivial to grasp--is that normal variability in development may be responsible for what has been consider a form of abnormal behavior.

I really hope this turns out to be the case. But what will happen to all the adult "ADHD sufferers"?

Thanks for your contributions in this thread, cogneuro.
posted by fake at 10:30 AM on November 14, 2007


RITALIN IS TOTALLY OF LONG TERM BENEFIT I SHOULD KNOW I AM VERY FOCUSED I AM READING FINNEGANS WAKE RIGHT NOW AND COOKING AN OMELET WITH GREEN PEPPER HAM MUSHROOMS AND CHEESE CHEDDAR NOT AMERICAN AND ALSO I AM LEARNING THE LYRICS TO ALL OF BARON SCARPIA'S PARTS IN TOSCA THE PROBLEM IS THAT YOU NEED TO TAKE IT INTRANASALLY AND NOT GENERIC METHYLPHENIDATE IT HAS TO BE REAL RITALIN THE PROBLEM IS HOW TO KEEP THE TWENTY DOLLAR BILLS FROM UNROLLING WHEN YOU PUT THEM DOWN (PROJECT--FIGURE OUT HOW TO KEEP TWENTY DOLLAR BILLS FROM UNROLLING WHEN YOU PUT THEM DOWN) I'M UP TO "'TIS GONE INFAROVER. SO FORE NOW, DAYLEASH. POUR DEDAY. TO TRANCEFIXUREASHONE. FEIST OF TABORNECCLES, SCENOPEGIA, COME! SHAMWORK, BE IN OUR SCHEINING! AND LET EVERY CRISSCOUPLE BE SO CROSSCOMPLIMENTARY, LITTLE EGGONS, YOULK AND MEELK, IN A FARBIGER PANCOSMOS. WITH A HOTTYHAMMYUM ALL ROUND. GUDSTRUCE! YET IS NO BODY PRESENT HERE WHICH WAS NOT THERE BEFORE. ONLY IS ORDER OTHERED. NOUGHT IS NULLED. FUITFIAT!" JAMES JOYCE IS HARD ALSO I HAVE TO BREW COFFEE (DECAF ONLY) TO HAVE WITH MY OMELET (ALSO VACUUMING A LITTLE) BUT I DON'T KNOW I'M PRETTY ON TOP OF THINGS AND I COULDN'T DO IT WITHOUT RITALIN OH I KNOW HOW TO FIX THE TWENTY DOLLAR BILL THING I COULD USE TAPE TAPE IS WHAT I WILL USE JUST A LITTLE PIECE ON THE SIDE THAT WILL FIX IT THREE QUARKS FOR MUSTER MARK OMELET'S READY TALK YOU YOU GUYS LATER
posted by exlotuseater at 10:36 AM on November 14, 2007 [16 favorites]


what was surprising--and obviously isn't trivial to grasp--is that normal variability in development may be responsible for what has been consider a form of abnormal behavior.

Good point. While I don't disagree with you, the range of behaviours that are labeled as ADHD has grown broader over time and I'm not sure if this study quantifies the delay in brain development for kids who have really debilitating, autism-type levels of ADHD versus kids who just don't like sitting sitting still.

Plus, as the parent of a kid who fits the ADHD profile I would object to describing my child's behaviour as abnormal. His behaviour is perfectly normal for someone with his level of brain development.

Measuring brain development is hard but redefining normal is comparatively easy.
posted by GuyZero at 10:43 AM on November 14, 2007


I take Ritalin regularly. One thing that continuously surprises me is the fact that people are so quick to make sweeping judgements, to the tune of "THIS IS MEDICATION RUN AMOK!" or "WE MUST MEDICATE THE KRAZY KIDS!" The reality on the ground for parents-- and, moreover, the growing number of adults like me who are living with ADD-- is more complex.

felix: "It's very strange how unusual conditions and diseases, like ADD and Asperger's and peanut allergies seem to be exploding in the industrialized world, particularly in California, but don't seem to be catching on anywhere else."

That's something that I've wondered about, too. Moreover, not only geographical variation, but historical variation seems strange to me; ADD wasn't a problem, or wasn't seen as a problem, even fifty years ago.

In the case of ADD, I feel as though at least a good proportion of the variance can be accounted for by the simple fact that life is a hell of a lot more complicated than it was fifty years ago, or is now in developing countries. Several psychiatrists have echoed this sentiment to me. The science isn't in, but I think it's a good wager.
posted by koeselitz at 11:04 AM on November 14, 2007


Also, GuyZero, thanks for some very good comments here.
posted by koeselitz at 11:05 AM on November 14, 2007


life is a hell of a lot more complicated than it was fifty years ago

My memory may be faulty, but I'm pretty sure my son in grade four does more than I did in grade 12. The pressure on kids to be well-rounded and accomplished is pretty high these days, even with laid-back parents (me!).

My son has classmates who run in open 5k races. 9 year olds. Kids not much older than that are running marathons. And there are kids who are doing the academic equivalent thereof. Not to mention the school curriculum has run amok.

Let me trot out my favourite homework story: last year there was an "extra" question in the section on area and perimeter. The normal questions have kids draw shapes on graph paper and count the squares (grade 3). The extra question was "What is the area of a shape with a perimeter of 12?" Now, a square with sides length of 3 meets the criteria, so the easy answer is 9. But there are actually an infinite number of answers. And I asked a co-worker who dropped out of a physics doctorate how he would express the question in a closed-form equation. He couldn't do it. Really. You're basically being asked to prove that circles have the lowest perimeter to area ratio. In grade 3.

I could go on about the increased level of interaction between kids and adults and how very precocious children who speak like adults are considered by many adults to be "normal" (or at least pleasant and desirable to interact with) when in fact they're extreme outliers in terms of development. The days of children being sen and not heard are long gone - you children will be heard and they better be well-spoken too. Or how teaching resources are oddly biased towards reading difficulties, but if you have writing problems you're considered to be uncooperative or lazy. Or how teachers are pressured to do more and how, again, parents view the best teachers as "normal" leaving a poorly organized teacher to face the wrath of angry bourgeois parents (me!) when the kids don't solve global warming for their science project.

The human brain hasn't changed in 50 years but sheesh, being a kid sure has.

Of course, this doesn't explain peanut allergies.
posted by GuyZero at 11:36 AM on November 14, 2007


Also, don't encourage me. blah blah blah.
posted by GuyZero at 11:38 AM on November 14, 2007 [1 favorite]


what was surprising--and obviously isn't trivial to grasp--is that normal variability in development may be responsible for what has been consider a form of abnormal behavior.

Interesting, certainly, but surprising? We call theft and murder abnormal too, but surely that is because of inconvenience rather than actual abnormality.
Which isn't to say there is no such thing as sociopathy, or whatever.. The question is inherently about semantics, but I'm trying not to be too pedantic.
posted by Chuckles at 12:09 PM on November 14, 2007


High fructose corn syrup, and excessive multiple source, short burst electronic interaction.

Those are my two completely unscientific stab-in-the-dark guesses at sources.
posted by edgeways at 2:11 PM on November 14, 2007 [1 favorite]


It's very strange how unusual conditions and diseases, like ADD and Asperger's and peanut allergies seem to be exploding in the industrialized world, particularly in California, but don't seem to be catching on anywhere else.

No. People just can't get used to the idea that their children are average or worse. People haven't changed, but standards have risen. People just don't give up on kids, and there are whole industries based around getting your kid ahead, getting them to achieve.
posted by phrontist at 4:02 PM on November 14, 2007


People just can't get used to the idea that their children are average or worse.

Surely this kind of statement is a reflection of the problem. Average or worse at what? IQ tests?
posted by Chuckles at 4:27 PM on November 14, 2007


Chuckles, are you really contesting the fact that half of all people are average or worse? I think you need to have a good think.
posted by tehloki at 1:30 AM on November 15, 2007


The question is inherently about semantics, but I'm trying not to be too pedantic.

The question isn't about semantics at all. The NIMH press release makes it clear that 1) it was necessary to study a large group of individuals to identify this difference in the average development; and 2) this information is not applicable (as a test, say) to single individuals. What this clearly means is that for any one person with ADHD their scans will be within the range of normal development, while their behavior, by virtue (at least) of their diagnosis, has been determined to be outside of what we consider the norm. Setting aside for the moment the unanswered question of whether or not these differences in average development are iatrogenic, they only pertain as statistical descriptions of large groups, and not of individual people.
posted by OmieWise at 5:32 AM on November 15, 2007


That's something that I've wondered about, too. Moreover, not only geographical variation, but historical variation seems strange to me; ADD wasn't a problem, or wasn't seen as a problem, even fifty years ago.

The historical and geographical variability of mental illnesses isn't really surprising, unless, like in discussions like the one here, one subscribes to a strictly biological account of human behavior. Such accounts always surprise me because they seem so reductionist, determinist and lacking in imagination. We can certainly preserve materialism while also recognizing that human behavior occurs within human society, and, therefore, is frequently a response to and an elaboration of expectations and pressures inherent in the time and place in which the behavior occurs. GuyZero has provided a great description of one set of such pressures and expectations.

Ian Hacking has a great book called "Mad Travelers: Reflections on transient mental illness" in which he talks about the rise and fall of historically bound mental illnesses. No strict constructionist, he argues that transient mental illnesses need a particular set of circumstances to thrive, he refers to a niche which is akin to, but not reducible to, an ecological niche. Essentially, the mental illness needs to occur within the interstices between a good and a bad, to express the cultural concerns about a given aspect of society. With Mad Travelers it was between the liberation of travel and the concept of the evil vagrant; with Multiple Personality Disorder it was the liberating idea of self-described and determines "selves" and child abuse. He talks about other constituents, too, but his idea is that things can be both real and historically bounded. People diagnosed with such illnesses may or may not be better understood to have other issues now: traumatic brain injury, some other form of dissociation.

Anyone who pays any attention to psychiatric fads can see that not only do they exist, but they drive diagnosis all over the place. Sometimes there may be concrete and measurable reasons for the rise in diagnosis (Hacking wrote a good recent review of autism research in the London Review, arguing that the "epidemic" is simply better diagnosis), but other times we may just be in the middle of a fashion: multiple personality in the 80s, depression in the late 80s, ADHD in the 90s, bipolar disorder now. Of course all of these things exist and can be hard to live with for people suffering from them, but they are also all diagnostic fads, in which the diagnosis is applied far beyond its usefulness.

The problem now, at this moment in history, is that emerging technologies may allow us to reify an illness that is being diagnosed in a faddish way, as this research may be doing with ADHD. It isn't that problems with concentration and attention don't exist, but research like that presented here seems to answer the question of what those problems mean and how we should address them. In addition, the wide availability of, and serious pressure to expand the uses of, psychiatric medications suggests that there may be serious consequences if your kid is caught up in one of these fads. Toddlers, who by definition cannot be responsibly diagnosed with bipolar disorder (because the diagnostic criteria essentially ask if an adult is acting like a toddler) are being so labeled and are being put on harsh psychotropic medications. There certainly isn't research that has explored the potential long term consequences of those prescriptions, and nor will there be, which essentially makes it a grand experiment.
posted by OmieWise at 6:22 AM on November 15, 2007


Toddlers...are being put on harsh psychotropic medications.

We may still have a copy of a book - I wish I could remember the title - about mental illness in children. Primarily depression but also ADHD and some other issues. It was more of a self-help book for parents of such children rather than a clinical type of book. But there are definitely some mentally ill kids out there.

If the societal view of mental illness has improved anywhere, it's in the recognition of mental illness in children. I'm sure that even 30 years ago these children would have been treated harshly and put in the worst kind of institutional care. Anyway, it was certainly an eye-opener and puts one's own child's behaviour in an entirely different light.
posted by GuyZero at 6:43 AM on November 15, 2007


tehloki: are you really contesting the fact that half of all people are average or worse?

Once you have a metric, like IQ, you can say "half of people are worse than average on IQ tests". Without a metric, the statement is without meaning.



Regarding semantics.. This conversation at least, and I think the study too, are working to define (or understand, if you like) what ADHD is - semantics. Of course there is a current accepted clinical definition, but surely that is mutable.
posted by Chuckles at 6:49 AM on November 15, 2007


But there are definitely some mentally ill kids out there.

Did you honestly read my whole comment and somehow think that I was disputing that? I have no doubts about there being mentally ill kids out there (sometime we'll have a beer and I'll tell you about working as a clinician on the child & adolescent unit of a psych hospital), but recognizing that fact does not preclude pointing out that there are consequences to our current psychiatric diagnostic (and prescribing) fads.
posted by OmieWise at 6:59 AM on November 15, 2007


Did you...think that I was disputing that?

No. I was agreeing with you?

My ancedote isn't really much good without the title of the book, but the first-hand account written by the mother the kids of kids you describe (essentially, babies on the harshest psychtropic drugs available) is a scary story. I'll go dig up the book when I get home.
posted by GuyZero at 7:09 AM on November 15, 2007


Oh, sorry. I guess I get kneejerky about responses to some of this stuff.
posted by OmieWise at 8:02 AM on November 15, 2007


No. People just can't get used to the idea that their children are average or worse. People haven't changed, but standards have risen. People just don't give up on kids, and there are whole industries based around getting your kid ahead, getting them to achieve.

ADD is happening to 6 year olds who aren't being driven to achieve; and your theory doesn't account for, e.g., peanut allergies.
posted by felix at 10:59 AM on November 15, 2007


From USA Today: Girls get extra school help while boys get Ritalin.

I wonder if the UK researchers have data controlled for gender.
posted by GuyZero at 1:45 PM on November 15, 2007


Because I know you've all been waiting desperately for the name of the book I mentioned, it's The Elephant in the Playroom.
posted by GuyZero at 5:46 AM on November 16, 2007


Here is the abstract for the paper, which appears to require a subscription in order to see the full text. Not answered in the abstract is what seems to me to be the crucial methodological question of whether or not the controlled for amphetamine use in the ADHD kids.
posted by OmieWise at 9:16 AM on November 27, 2007


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