The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina.  The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo --  A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing.  Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

Well, that’s what a  study published this month in Acta Paediatrica found.  That implies that nearly half of the serious cases of ADHD  in children are closely tied to social factors. The study reveals that factors like single parenting and poor maternal education were directly tied to ADHD medication use.

While we know that a genetic propensity likely exists, the human brain develops based on a complex interplay between nature and nurture; between genetic endowment (nature) and environment/social factors (nurture). Epigenetic theory tries to explain this relationship.

Curiously, few large-scale studies have tried to determine the impact of social and family influences on ADHD. Researchers at the Karolinska Institute in Stockholm, Sweden assessed data on 1.16 million school children and examined the health histories of nearly 8,000 Swedish-born kids, aged six to 19, who had taken ADHD medication.

"We tracked their record through other registers … to determine a number of other factors," said lead author Anders Hjern.

Here’s what the researchers found:

• Living in a single parent family increased the chances of being on ADHD medication by more than 50 percent.
• A family on welfare upped the odds of medication use by 135%.
• Boys were three times more likely to be on medication than girls.
• Social dynamics affected both sexes equally.

"Almost half of the cases could be explained by the socioeconomic factors included in our analysis, clearly demonstrating that these are potent predictors of ADHD-medication in Swedish school children," Hjern said.

It’s clear that this study found a link between socioeconomic factors and ADHD medication use/diagnosis. Other US studies have found that minority children and children of low socioeconomic status were more likely to receive ADHD medication.

Factors like low income and diminished quality time are more common in single-parent families. These typically lead to stressors like family conflict and a lack of social support, Hjern said.

While more research must be done, one has to ask, is medication the answer to social stressors like lack of time and money? Sounds too silly to ask, but it seems that our answer, ridiculously, is a resounding, YES!

We are the masters of our lives. We can make significant personal changes, but we must have the tools to do so. That’s why I began Play Attention (www.playattention.com) years ago.

Summer Brain Drain may even be worse for ADHD students already having trouble at school.

Going to school daily provides schedules and routines. The summer break means those routines aren’t there. Expectations are lowered or relaxed. Even sleep schedules are often totally abandoned.

Unfortunately, exercise is often replaced with computer time, watching movies, or playing video games with friends. That’s a bad idea. While there’s nothing wrong with playing video games or watching movies, sedentary activity must always be balanced with exercise. This is especially important for an ADHD student. 

I’ve included some specific articles that approach this topic from varying perspectives. Enjoy and gain the benefits this summer!

Children with ADHD benefit from time outdoors enjoying nature

(http://www.news.uiuc.edu/NEWS/04/0827adhd.html)

News Bureau at the University of Illinois at Urbana-Champaign from May 15 through June 8. — Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign.

The payoff for this “treatment” of children 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms. The study appears in the September issue of the American Journal of Public Health.

“The advantage for green outdoor activities was observed among children living in different regions of the United States and among children living in a range of settings, from rural to large city environments,” wrote co-authors Frances E. Kuo and Andrea Faber Taylor. “Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.”

ADHD is a neurological disorder that affects some 2 million school-aged children, as well as up to 2 to 4 percent of adults, in the United States. Those with ADHD often face serious consequences, such as problems in school and relationships, depression, substance abuse and on-the-job difficulties.

“These findings are exciting,” said Kuo, a professor in the departments of natural resources and environmental sciences and of psychology at Illinois.

“I think we’re on the track of something really important, something that could affect a lot of lives in a substantial way,” she said. “We’re on the trail of a potential treatment for a disorder that afflicts one of every 14 children – that’s one or two kids in every classroom.”

If clinical trials and additional research confirm the value of exposure to nature for ameliorating ADHD, daily doses of “green time” might supplement medications and behavioral approaches to ADHD, the authors suggest in their conclusion.

Kuo and Faber Taylor, a postdoctoral researcher who specializes in children’s environments and behavior, recruited the parents of 322 boys and 84 girls, all diagnosed with ADHD, through ads in major newspapers and the Web site of Children and Adults with Attention Deficit/Hyperactivity Disorder. Parents were interviewed by means of the Web and asked to report how their children performed after participating in a wide range of activities. Some activities were conducted inside, others in outdoor places without much greenery, such as parking lots and downtown areas, and others in relatively natural outdoor settings such as a tree-lined street, back yard or park.

The researchers found that symptoms were reduced most in green outdoor settings, even when the same activities were compared across different settings.

“In each of 56 different comparisons, green outdoor activities received more positive ratings than did activities taking place in other settings, and this difference was significant or marginally significant in 54 of the 56 analyses,” Kuo said. “The findings are very consistent.”

The two researchers have been pursuing the ADHD issue as an extension of a long line of previous research they’ve conducted on the nature-attention connection among the general population in mostly urban settings.

“The medications for ADHD that are currently available work for most kids, but not all,” Kuo said. “They often have serious side effects. Who wants to give their growing child a drug that kills their appetite day after day and, night after night, makes it hard for them to get a decent night’s rest? Not to mention the stigma and expense of medication.”

Simply using nature, Kuo said, “may offer a way to help manage ADHD symptoms that is readily available, doesn’t have any stigma associated with it, doesn’t cost anything, and doesn’t have any side effects – except maybe splinters!”

There are a number of exciting possible ways in which “nature treatments” could supplement current treatments, she said.

Spending time in ordinary “urban nature” – a tree-lined street, a green yard or neighborhood park – may offer additional relief from ADHD symptoms when medications aren’t quite enough. Some kids might be able to substitute a “green dose” for their afternoon medication, allowing them to get a good night’s sleep.

“A green dose could be a lifesaver for the 10 percent of children whose symptoms don’t respond to medication, who are just stuck with the symptoms,” Kuo said. As Kuo and Faber Taylor wrote, a dose could be as simple as “a greener route for the walk to school, doing classwork or homework at a window with a relatively green view, or playing in a green yard or ball field at recess and after school.”

The National Urban and Community Forestry Advisory Council, U.S. Forest Service, and the U.S. Department of Agriculture’s Cooperative State Research, Education, and Extension Service supported the project.

Exercise Improves Learning and Memory
Chalk up another benefit for regular exercise. Investigators from the Howard Hughes Medical Institute (HHMI) have found that voluntary running boosts the growth of new nerve cells and improves learning and memory in adult mice.
"Until recently it was thought that the growth of new neurons, or neurogenesis, did not occur in the adult mammalian brain," said Terrence Sejnowski, an HHMI investigator at The Salk Institute for Biological Studies. "But we now have evidence for it, and it appears that exercise helps this happen."
USA Today (http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm)

ADHD treatment is getting a workout

http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm
Doctors haven’t done many definitive studies about exercise and ADHD, says David Goodman, an assistant professor of psychiatry at the Johns Hopkins University School of Medicine. But Goodman says it makes sense that working out would help people cope with the condition. Studies show that exercise increases levels of two key brain chemicals — dopamine and norepinephrine — that help people focus.

"Your cognitive function is probably better for one to three hours after exercise," Goodman says. "The difficulty is that by the next day, the effect has worn off."

If kids could exercise strenuously three to five times a day, they might not need medications at all, says John Ratey, an associate clinical professor of psychiatry at Harvard Medical School. Ratey is so intrigued by the question that he’s writing a book about how exercise can reduce symptoms of ADHD or at least help patients cope.

Team sports might help children with ADHD in several ways, says James Perrin, a professor of pediatrics at Boston’s MassGeneral Hospital for Children. Children with the condition benefit from following a regular schedule. Coaches who lead kids through structured exercises also might help build concentration and organizational skills.

“Our study suggests that both types of intervention [medicine and immediate reward/reinforcement] may have much in common in terms of their effect on the brain,” said Professor Chris Hollis, the lead investigator of  the study.

The research team used an EEG (electroencephalograph) to measure the brain activity of children as they played a computer game that provided extra points for less impulsive behavior.

The researchers devised a computer space game which rewarded the ADHD children when they caught aliens of specific colors  while avoiding aliens of designated colors. The game design actually tested the children’s ability to resist the impulse to grab the wrong colored aliens.

To test whether immediate reward/reinforcement made a difference, one iteration of the game rewarded the children fivefold for catching the right alien and penalized them fivefold for catching the wrong one.  All of this was done while activity in different parts of their brains was monitored with an EEG.

Hollis found that the immediate rewards helped the children perform better at the game. This was verified by the EEG which  revealed that both medication and immediate reward/reinforcement were "normalizing" brain activity in the same regions.

Many parents of ADHD children are aware that giving a reward to an ADHD child a week after their good behavior is insignificant to that child. ADHD children respond better to immediate reward, not delayed reward.

"Although medication and behavior therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalize similar components of brain function and improve performance,"  said Hollis.

"We know that children with ADHD respond disproportionately less well to delayed rewards – this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioral approaches using reinforcement and rewards may be less effective."

It’s obvious that providing immediate rewards/reinforcement 24 hours a day and 7 days a week would be impractical and impossible. But what does this research tell us? It tells us that if we are to train an ADHD student, feedback, reward, and reinforcement need to be immediate if we are to get their brain to rewire.

We at Play Attention have known this for many years. This is why we integrated immediate feedback/reinforcement for attention training, cognitive training, memory training, and behavioral shaping by using feedback technology. We patented this method years ago because of its inherent strength. While we knew this was the best way to achieve success, we feel research like this rather reinforces our approach. It’s about time the world caught up!

This blog is partially based on material I presented to the International Atomic Energy Agency of the United Nations in Vienna, Austria.

Playing vs. learning
What’s the difference between playing and learning? Sometimes there is no difference. People can learn through play. Educators have known this for years. Grade school teachers often try to teach using games. Games engage, excite, and motivate students. However, there is a significant difference between games that simply entertain and games that facilitate learning.

When learning through games or other modalities, three fundamental catalysts are necessary for the brain to create and grow a neural pathway facilitating long-term retention. These catalysts are attention, challenge, and deliberate practice.

Attention 
A student must pay enough attention to incoming stimuli to even begin the learning process. Too little attention causes the student to constantly redirect attention to other stimuli.  Picture your ADHD child trying to learn multiplication tables. While the teacher is teaching 2 x 2, he’s paying attention to the bird outside the window. Little chance that multiplication tables will be learned soon. So, attention is crucial, in fact, it’s the core to all learning. For an ADHD person, the ability to direct attention and sustain it without distraction is impaired.

Challenge
If the teacher can get a student to pay enough attention to multiplication tables, the student must then be challenged. Challenge arrives when the brain confronts something it doesn’t quite understand. The brain attempts to place the information into a tenuous relationship with information it already possesses. If the brain already knows the information, it simply retrieves the data from its storage bank. So, if the teacher presents 2 x 1, and the student knows immediately the answer is 2, then there’s no challenge and little is learned. However, if the teacher presents 2 x 7561, then the student is challenged and must use all of his pre-existing knowledge to find a solution. Attention and challenge spark creation and growth of new neural pathways for long-term retention. However, long-term retention is not guaranteed until we practice.

Deliberate practice
Educationalists have known that haphazard studying or practice results in haphazard learning. Deliberate practice is a term coined by Dr. Anders Eriksson, a professor at Florida State University (http://www.psy.fsu.edu/faculty/ericsson.dp.html). He studied how people become experts in their fields and found that the length of time they practiced and their use of deliberate practice greatly influenced their expertise. 

Let’s use multiplication tables again to describe deliberate practice.  Chances are that you learned your multiplication tables by practicing one group at a time; multiplying by 1, by 2, by 3, etc. In many years of teaching, I never saw a student learn multiplication tables by learning 2 x 3, then 7 x 9, then 6 x7. We learned in a sequence that was deliberately practiced until mastered.

When I was learning to multiply by 6, I had difficulty with 6 x 7, 6  x 8, and 6 x 9. So, my teacher made special flashcards for me with these specific problems written on the cards. I used these cards, blocks, and other devices to practice these difficult sequences. If I didn’t get the right answer, I got immediate feedback that I was incorrect. I used this feedback to make changes to my strategy in attempting to find the correct solution. That’s deliberate practice; sorting out the difficult elements that we have not learned, developing strategies to learn them, getting feedback regarding correctness or incorrectness of these strategies, and practicing them correctly and  long enough to attain long-term retention.

Most people do not  use deliberate practice. We just practice, i.e. we just repeat the same thing over and over without taking the time or making the effort to work on the elements that are most difficult for us. We often only practice things that are easy or that we’re already good at performing. We avoid the difficult elements that don’t provide immediate reward, and that seems to be the line that clearly distinguishes expert from amateur.

Coming soon, part two: Entertainment vs. Learning

As a matter of fact, the term ‘attention deficit’ is actually a misnomer of sorts. ADHD people have diffused attention, not a deficit or lack of attention. Ask them. I often asked ADHD students what was happening in my classroom. They could tell me about the bird outside the window, the cobwebs in the corner of the room, a little about my lesson, a little about the whispering around them, and a little about when the air conditioner was turning on and off. That’s actually a great amount of attention. It’s just scattered or diffused over a wide area all day long.

A true hallmark of ADHD is the brain’s inability to direct attention for long periods without becoming distracted. So, it’s not a deficit at all; ADHD is an inability to direct attention. But there’s more.

ADHD is also a matter of difficulty in multiple domains of cognition. These domains are also labeled “Executive Functions.” Aside from diffused attention, ADHD also encompasses difficulty in organization of thought and tasks; sustaining effort while filtering out distractions; memory (both short-term and working memory); managing behavior/emotion; and visually directing attention and actions.

How does one cope with all these areas? It seems a monumental task. Of course, the primary medical intervention is medication. Does medication actually address all of these cognitive domains? No, it does not. Medication has limitations. That’s a fact. That’s why many parents do not see academic, behavioral, or social improvements [see the MTA study] over time. Another fact is that many of these cognitive domains can be strengthened by direct instruction.

Several small and large software companies have introduced themselves recently into the brain fitness category. Each company tends to address a specific domain like memory or focus. So, to satisfy the cognitive and behavioral needs of an ADHD person, one would need to purchase many of these games.

As the original pioneer and developer back in the late 1980s,  I saw that there was a vast gap in the needs of the ADHD person and what was being delivered. By 1994, I developed Play Attention to teach sustained attention, visual tracking with attention (like watching a teacher move about the classroom), organizing and finishing tasks, memory, filtering out distractions, and motor skills. I even included behavioral shaping. Later this year we’ll deliver social skills, more working memory & short-term memory modules, and more.  We’ve received 3 patents for this pioneering effort.

Play Attention is a careful collaboration between you, the Play Attention software, and the Play Attention professional support staff. It’s provided us with a 92% satisfaction rating.

Of course, to get results, you need to use it. Next week I’ll address how Play Attention transcends being useful to being compelling.

Obviously, being pregnant can be stressful in itself, but current research shows that stress can affect fetal development which may lead to long-term problems including ADHD.

Dr. Vivette Glover of Imperial College London, surveyed pregnant women at her hospital. Of these, nearly one quarter felt anxious and depressed due to stressors including work, money, arguing with spouse, and moving to accommodate a larger family. When compared to their non-stressed counterparts in this research, the babies of the stressed mother had lower birth weight, lower IQ, slower cognitive development, and more anxiety. Lower birth weight has been an indicator for coronary heart disease in later life.

In 2007, research in the Journal of the American Academy of Child and Adolescent Psychiatry indicated that being stressed during pregnancy is as detrimental for the baby’s development as smoking or being obese. Glover’s research reveals why and how this happens: stress produces the hormone cortisol. An abundance of stress can actually diminish the barrier enzyme that inhibits cortisol from reaching the fetus. Costisol impacts fetal brain development.

According to Glover, “People used to think that if something was congenital, apparent at birth, it had to be genetic. In fact it can be an in-vitro reaction of genes and environment.”

Glover also contends that her research shows stress greatly increases the likelihood of a child having ADHD (attention-deficit hyperactivity disorder), cognitive delay, autism , anxiety and depression. 

Glover’s research reinforces previous data from the UK where stress was shown to increase the risk for development of ADHD. In that research, the women who experienced the most stress doubled the chances of developing ADHD.

“The organs are forming during the first trimester of pregnancy, but the brain is developing all the way through,” Glover explains. “The organs are sensitive while they are forming and, once formed, they are harder to change.”

“In evolutionary terms, stress perhaps prepares the child for survival in a stressful environment. If a child is anxious and has attention deficiency, it will be very alert to danger. This may once have been adaptive, beneficial for the child, but it isn’t any more,” Glover says.

Significantly, Glover’s research implies that the changes may be on a genetic level so that it may be passed on generation to generation.

Therefore, it’s important to realize that taking care of ourselves during pregnancy is more important now than ever. Small efforts like seeking health services early, meditating, eating a balanced diet, taking pre-natal vitamins, and laughing are good practices.

Minimizing stress by maintaining a consistent schedule both at work and at home is a good idea.

“This is the chance to study the ultimate form of animal communication – language,” said Thomas A. Christensen of UA’s department of speech, language and hearing sciences (SLHS). “Humans have evolved a very sophisticated symbolic form of communication. Language affects how we think, what we believe, how we interact with each other. I’d even go so far as to say that our future as a species depends on understanding how we communicate. But very little is known about what’s going on in the brain when we’re having a simple conversation.”

Christensen will use UA’s magnetic resonance imaging (MRI) facilities to map the areas and networks within the brain linked to language, attention and memory. While this has been done before, Christensen’s techniques are slightly different – inside the scanner volunteers will perform simple language discrimination tasks.

“You read in the text books is that if you’re right handed, then language is localized to the left hemisphere of your brain,” Christensen said. “I found out right away – that’s just not true. Analyzing a human voice also involves the right hemisphere and even parts of the cerebellum.” Nothing new here either, unfortunately.

It’s interesting that Christensen “found out right away [that language is localized to the left brain hemisphere]– that’s just not true,” because as long as 30 years ago, examinations of patients who had their corpus callosums split by accident or by surgery demonstrated language wasn’t localized in the left hemisphere of the brain.

“These MRI images destroy the myth that you’re only using about 10 percent of your brain for any particular task,” Christensen said. “The crux of this grant is to learn more about the language, attention and memory centers in the brain, and also about the complex interactions between them.”

The MRI scanner reveals the brain’s activity. As UA’s press release states, the MRI scanner shows networks that scientists didn’t suspect were involved when the brain listens.

“We’re getting a snapshot of what that activity is across the population. What’s so striking is how clearly we see that certain areas of the brain are strongly engaged in attentional control while other areas are not. As we scan more volunteers, we’re definitely beginning to see a pattern here.”

“ADHD (Attention Deficit Hyperactivity Disorder) is probably one of the most over-diagnosed disorders of our time,” Christensen said. “The reason for that, I think, is that we really don’t know very much about the biological basis of this syndrome. There’s a lot of research on it, but there’s still a lot of disagreement about what the root cause is, and about whether drugs like Ritalin that are being prescribed to children as young as 2 years old are doing any good, and if we have any business exposing our children to drugs at such a very early age,” he added.

ata that show the connections among areas of the brain that are strongly engaged in language tasks, he plans to collaborate with computer modeling experts. “We could develop a mathematical model that would allow us to generate hypotheses about what we expect if we deliver a certain type of stimulus. We’d see what effect it would produce in our model.”

Simulating brain activity in the mathematical model “would take the whole question of language processing beyond ‘blobology’ – where you’re just looking at blobs of activation in the brain. That’s what I hope to do,” Christensen said.

So in answer to my title question, Can we map attention, memory and language links in the human brain? No. However, we do need good research in this area. MRI does demonstrate activation in areas of the brain. Christensen will have to determine the relationships between the active networks – that’s more art than science currently since current MRI and fMRI don’t depict anything more than activation. The basic tangent Christensen is examining will likely move ‘blobology’ forward a little, but we are still a long way from understanding the brain – the most complicated piece of matter that we know of. Quite a paradox, isn’t it? – the most complicated piece of matter that we know of, the brain, which is essentially a super computer, cannot understand itself. Yet.

According to a study published in the January 2007 issue of the American Psychological Association’s journal, Developmental Psychology, a mother’s depression predicts whether children with ADHD will develop behavioral problems.

• Maternal Depression and Early Positive Parenting Predict Future Conduct Problems in Young Children With Attention-Deficit/Hyperactivity Disorder.

Psychology professor Andrea Chronis, director of the University of Maryland ADHD Program and lead author on the paper said, “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

As I’ve discussed in many previous blogs, the brain is quite plastic almost to a flaw; negative stimulation, will affect the brain negatively while positive stimulation will affect the brain positively. This study seems to reflect that fact as well. The researchers found that positive parenting during preschool years predicted fewer behavioral problems as the children reached early adolescence. Children presented fewer conduct problems such as lying, fighting, bullying and stealing. Conversely, maternal depression predicted more conduct problems during adolescence.

The researchers estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says [see ADHD and Alcohol Abuse]. Chronis’ team has found in earlier research that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids. Focus was place on mothers as they are frequently the primary caregivers and are therefore subject to more stress and depression. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Chronis’ research is part of an ongoing longitudinal study funded by the NIH that follows ADHD children through their 18th birthdays. Collaborating with research teams at the Universities of Chicago and Pittsburgh, the study evaluated the behavior and development of 108 children whose ages ranged from four to seven at the study’s beginning. Parenting techniques were assessed by observation, and data on the mother’s mental health were analyzed annually.

Neuroplasticity at work: the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time while children of previously depressed mothers had significantly higher levels of conduct problems over time.

As I mentioned in ADHD and Alcohol Abuse, the problems of depression and alcohol abuse may be parental coping mechanisms in response to an ADHD child. They are also quite likely cyclic; the child is more likely to be depressed or abuse alcohol later in life.

This does give us a background to develop a methodology to prevent the cycle from recurring.

For ADHD Children, Mother’s Depression, Early Parenting Predict Conduct Problems

COLLEGE PARK, Md., March 22 (AScribe Newswire) – A mother’s depression predicts whether children with ADHD (Attention Deficit Hyperactivity Disorder) will develop conduct problems such as lying, fighting, bullying and stealing, according to a new study from a University of Maryland researcher.

The study, published in the January 2007 issue of the American Psychological Association’s journal, “Developmental Psychology,” also found that early positive parenting during the preschool years predicted fewer conduct problems as the children grew to early adolescence. The strength of the findings led the researchers to conclude that maternal depression may be a risk factor, whereas positive parenting may be a protective factor.

“This research gives us clear targets for early intervention to prevent conduct problems in children with ADHD,” says Andrea Chronis, director of the University of Maryland ADHD Program and professor of psychology who served as lead author on the paper. “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

The researchers say their study is the first to focus directly on the role of parent mental health and early parenting in the development of conduct problems among children with ADHD. Moreover, they point to previous research that shows the development of conduct problems to be quite common in children with ADHD. By one estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Findings and Method

Specifically, the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time, when other possible contributing factors were controlled. Also, children of previously depressed mothers had significantly higher levels of conduct problems over time compared to children whose mothers had never been depressed.

This research is part of an ongoing longitudinal study funded by the National Institutes of Health that follows ADHD children through their 18th birthday. Conducted by members of the research team at the Universities of Chicago and Pittsburgh, it consisted of a series of annual assessments of 108 children’s behavior and development. Children ranged in age from four to seven at the start of the research. The parenting techniques were assessed using observational methodology during the first year of the study. Information on the mother’s mental health was also collected annually.

The study focused on the mothers’ health and parenting since they are most often the primary caretakers and are more likely to be depressed than men. Also, an earlier study by Chronis and the research team found that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids.

With a grant from the National Institute of Mental Health, Chronis and her research team at the University of Maryland are now developing and evaluating a 14-week behavioral intervention for depressed mothers of children with ADHD that targets effective parenting and reducing maternal depression.

An electronic copy of the research paper is available to journalists. Please email Neil Tickner: ntickner@umd.edu.

The Maryland ADHD Program is a clinical research program with a strong commitment to conducting clinical research that advances knowledge of the assessment and treatment of ADHD, provides comprehensive, empirically-based assessment and treatment of ADHD and associated behavior problems, trains the next generation of child clinical psychologists in these practices and educates parents and schools in this form of assessment and treatment. More information is available online: http://www.bsos.umd.edu/psyc/clinicalpsyc/training/adhd.htm.