ADHD and neurocognition – Knowing what to remember

Kate Humphreys

ADHD In children and adults – Symptoms and tests

Children with attention deficit hyperactivity disorder (ADHD, formerly known also as ADD) are classically seen as the kids in class who have trouble staying in their seats and paying attention during long lessons. Underlying these problematic behaviors is a confluence of factors, with evidence pointing to genetics, neural function, and environmental factors (including parenting and lead exposure) that can all affect ADHD behavior. Many children diagnosed with ADHD seem to simply “grow out” of their symptoms. They may learn particularly effective strategies for managing inattention and disorganization (I myself am a notorious list maker), or learn to control some of the fidgeting and restlessness or channel that energy into sports or other activities. Continue reading “ADHD and neurocognition – Knowing what to remember”

ADD and ADHD medications: Lessons from a crystal meth experiment

I’ve recently completed a study that I presented at the Society For Neuroscience (SFN) meeting in DC. The study was actually aimed at looking at the usefulness of two medications in interfering with the rewarding qualities of methamphetamine. The thinking was the if we could figure out a way to interfere with crystal meth being perceived as rewarding by the brain, we may be able to help addicts from continued use after a relapse.

Two prescription stones but only one hits crystal meth

The two medications are atomoxetine and bupropion, though you may know them as Strattera and Wellbutrin or Zyban. Their mechanisms of action are similar, but distinct enough that we wanted to test them both. The results of the study, in one sentence, were that atomoxetine (or Strattera), but not bupropion (or Zyban) succeeded in eliminating animals’ preference for meth if given along with it. The implication is that in the future, these, or other, similar, medications, may be given to newly recovering addicts. The hope would be that by taking the drug, they may be somewhat protected in the case of a relapse. If they don’t enjoy the drug during the relapse, they may have a better chance of staying in treatment.

More to these medications than meets the eye

I learned some other interesting things while preparing, and then carrying out, the study. While Zyban could, by itself, be liked by the animals, Strattera did not seem to produce any sort of preference. Given the common use of these drugs in the treatment of ADHD, the difference may be very important. As you may recall, I’ve talked before about the connection between impulse control problems and being predisposed to developing addiction. Given this relationship, it would seem that we’d want to be especially careful about using drugs that can cause abuse with this population. Many of the stimulants used to treat ADD and ADHD can indeed lead to abuse, as their effects are very similar to speed, or crystal meth (Adderall and Ritalin come to mind). Zyban’s abuse liability is definitely lower, given the greatly reduced preference animals develop for it. Still, it seems that Strattera’s abuse potential is almost zero. In trial after trial, animals given atomoxetine fail to show a preference for the drug.

To my mind, this means that as long as it’s successful in treating the attention problems, atomoxetine is the better candidate. All in all, I’d think the first choice should be the one that helps the symptoms of ADHD while having a reduced likelihood of dependence. Obviously, if the drug is not able to treat the problem, other options should be selected, but it seems to me that given the known relationship between attention deficit problems and addiction, the question of abuse liability should play a significant role in the selection of medication.

Once again, this doesn’t mean that all users of Adderall, Ritalin, or the other stimulant ADHD medications will develop an addiction to their prescription. In fact, we know that rates of addiction to prescriptions are generally relatively low. Nevertheless, I’d consider ADHD patients a vulnerable population when it comes to substance abuse so I say better safe than sorry.

Thinking straight might help: Modafinil in early recovery from crystal meth addiction

I’ve mentioned before that I believe medications can be a very helpful tool in early recovery, especially for specific individuals who need help getting over the initial, most difficult, period (look here).

If you take a look at my first post about meth and its effects on the brain, you’ll read that crystal meth use can negatively affect the function of a neurotransmitter called dopamine. One of the dopamine’s important roles in the brain has to do with impulse inhibition and control over behavior.

The role of impulse control in early recovery trouble

With a reduced capacity for behavioral control, it’s no surprise that people in early recovery find it especially hard to resist urges to use again. When you consider that it’s already been shown that addicts are more likely to have impulse control problems, like ADD/ADHD, the role of impulsivity becomes even more important for understanding addictions. Having less control over a preoccupation that results in obsessive-thoughts and compulsive-actions means that slips, or relapses, are an almost expected outcome.

If we could only figure out how to give people better control over their impulses, we’d possibly better equip them to prevent their own relapses.

ADHD medication for crystal meth addiction help

Well, a number of drugs used for ADHD have been researched as possible aids for addicts, and it seems like Modafinil (marketed as Provigil) may help with exactly the cognitive deficits that seem to trip meth (and cocaine) addicts in early recovery up. In fact, the results seem to be strong enough to warrant the initiation of some larger scale investigations. This, along with previous findings that reported relatively low abuse-potential for modafinil suggest that this may indeed prove to be a useful medication.

No one is saying that this is the pill that will cure addiction, or even that a pill like that is going to be found. But hopefully, along with other medications (like Bupropion), the number of tools in the proverbial toolbox of addiction specialists will continue to increase, allowing them to better treat a larger proportion of those suffering from addiction.

Citations:

Jasinski, D. R & Kovacevic-Ristanovic, R. (2000). Evaluation of the Abuse Liability of Modafinil and Other Drugs for Excessive Daytime Sleepiness Associated with Narcolepsy. Clinical Neuropharmacology, 23, 149-156.

Ling, W., Rawson R., & Shoptaw, S. (2007). Management of methamphetamine abuse and dependence. Current Psychiatry Reports, 8, 345-354.

Addiction causes – Learned self regulation and its possible benefits for drug use problems

In the first part of this little series on addiction cause and self-regulation I talked about some of the genetic influence on impulsivity that have been shown to also be related to drug use.

In this next part, I want to drive home some recent ideas regarding learning related to self-regulation.

It’s no secret that diagnoses like ADD and ADHD have been seen with much greater frequency in the last decade or so. Slight variations on the same theme, both of these disorders have to do with a person’s (usually a child) inability to appropriately control their impulses and behave appropriately.

The debate about the sources of the large increase in these diagnoses is still ongoing. Some think that they are nothing but an inflated push for pharmaceutical treatment by those who stand to profit from the sale of Adderall, Ritalin, and the likes.

However, if you talk to the parents of the children being diagnosed with these disorders, they’ll be the first to tell you that even though they can’t put their fingers on it, something’s up with their kids…

Tin Can PhoneA recent educational program in New Jersey (at the Geraldyn O. Foster Early Childhood Center) tries to instill in children the concept of internal regulation by making pretend play rules explicit. Children talk to their teachers before embarking on their next imaginary adventure in order to lay out everybody’s role. The idea is that by the generation of internal rules, the children become more aware of how social rules regarding behavior are dependent on their specific role in a given environment.

The creators of the program believe that children’s play in the recent past has become more and more structured. They believe that video-games, explicit toys, and constant oversight have reduced children’s ability to take on roles and depend on their own mind for the rules of behavior.

Adele Diamond, a researcher at the University of British Columbia, has found that children in the program performed much better (up to 35% better) than other children in tests of executive function. It should be noted that the program doesn’t claim, and hasn’t been shown to, get rid of attention-deficit problems in kids that have been diagnosed. Rather overall cognitive function for kids in the program seems improved.

More research on this program is ongoing, but the initial results seem to indicate that educational and developmental aspects of a child’s life can impact their ability to have internal oversight. This is obviously promising and upsetting all at once.

No parent intentionally places their child at a disadvantage, but it seems that the most recent trends of “electronic babysitting” we’ve become so accustomed to may in fact be impacting children in unintended, discouraging ways.

The connection to addiction again has to do with general impulse control problems. Less executive control leaves children generally more vulnerable to behaviors that can be detrimental to their future. As I’d mentioned in one of my earlier posts, most of the negative impact of drug use on the lives of users is not related to long term addictive use. Instead, it is the acute (as in quick and short lasting) negative impact of things like unintended pregnancy, motor accidents, and legal troubles and arrest, that end up impacting adolescent drug users.

Maybe by making our children better able to control their actions, we can protect them from a host of possible problems, including drug use…

Question of the day:
How much of your childhood was spent in relatively free play and how much of it was structured?
How, if at all, do you feel that these different activities have affected the kind of self-control you can, or can’t exert?

Addiction causes – Genetic variability related to attention, impulsivity, and drug use.

It will probably come as no surprise to at least most of you that addiction is closely linked to problems of self-regulation (like ADD and ADHD). This is one of the main reasons that professionals view addiction as a disease, and not a choice.

This post is pretty advanced, but it should leave you knowing a lot more about the relationship between attention, self-regulation, impulsivity, and addiction. Also, when I use the term “Addiction causes” I have to stress that the link to date has been one of association, NOT causation. We don’t truly know what causes addiction.

What is self-regulation?

Self-regulation is the ability to control one’s actions in ways that are appropriate to specific situations. Having to do with the most advanced aspects of cognition, self-regulation is considered to be the prime example of human executive functioning. It’s this aspect of thought and brain function that is thought to truly separate humans from other animals.

Being this important for our functioning, you can probably imagine how complex and interactive the brain systems that control executive functioning are. You’d be right.

These systems, centered in the Prefrontal Cortex (PFC), the part of the brain nestled right behind your forehead, are connected to essentially every other brain system, including vision, hearing, motor control, emotion, etc. It’s the PFC that controls these systems and tells the brain what brain impulses should actually be acted on.

And impulses is a great word for it. Given how complex the system is, there are many things that can affect its function. There are genetic factors, some that have to do with early development, and others that are affected by behavior, including the ingestion of drugs.

In this post, I would like to focus on the genetic influences, later on, I’ll talk about the developmental influences and the effects of drugs and other behavior on these systems.

Genetic influences on executive function:

There are a host of genes that affect different aspects of executive function. Some of these, like those impacting genes related to DAT, DRD4, and COMT functioning, have an effect on dopamine function that has been correlated with personality traits like sensation seeking and impulsivity.

Hyperactivity

As I’d mentioned earlier, these personality traits themselves, and the genes that affect them, have been found to be associated with addiction as well as several other conditions and syndromes that are related (such as ADD and ADHD).

Just to be clear, we all have these genes, but there are different version of them (called alleles). Some of these versions are more common than others, and some are associated with the conditions I mentioned earlier.

For instance: There are 2 versions of the COMT gene. This gene codes for a chemical in the brain that breaks down DA (this breakdown is important for brain function as I’d mentioned in an earlier post). One of these versions (named MET) breaks dopamine more slowly while the other (VAL) breaks it down quickly. The VAL allele actually breaks the dopamine down so fast that it interferes with dopamine’s ability to properly get its message across. That’s why this allele has been linked to attention and impulsivity issues. Each of these alleles has a 50% prevalence in society, which means that 1 out of 2 people have the VAL allele. Obviously its effect is not enormous, but along with many other factors, it has a significant impact on dopamine functioning.

Similar issues come up with one of the versions of the DRD4 gene, which codes for a specific type of dopamine receptor; and with the DAT gene, which codes for the DAT transporter I talked about in the cocaine post mentioned earlier.

Again, while the effects of each of these genetic variants is small, these can add up along with other genetic influences and environmental factors (especially during early development) to overall affect a person’s ability to control impulses.

Obviously, those who have a more difficult time controlling their impulses would have a more difficult time making appropriate choices. These difficulties can lead some to be more likely to start behaviors that are detrimental, including the use of drugs. The drugs themselves can then further exacerbate the problem (as we’ll see in a future post), and can do other things to make users more likely to keep using them.

In short, while genes don’t make people use drugs, they can definitely make it more likely for certain people to engage in risky behavior, including trying drugs in the first place…

Question of the day:
Did any of the people you know who have developed drug use/abuse problem show problems with impulsivity before their drug use?

About addiction: Meth, pregnancy, codependency, and ADD

Here’s a new set of articles about addiction that are worth taking the time to read. As usual, don’t forget that if you click the title of this post, you’ll get a list of posts on our site that are related to this week’s links (below the post).

Breaking The Cycles: To Talk or Not To talk – A great post about a topic we’ve already mentioned on here

PhysOrg: Crystal Meth during pregnancy

Addiction Today: Families and marijuana use

Science Blogs Select: Poppy tea can kill you

ADD ADHD Blog – Nascar and ADD – I’ve long thought that there was a relationship between impulse control problems and other conditions that are more acceptable than drug addiction…

That’s it for now, enjoy!