attention-problems

Six guidelines to navigate the Aduhelm controversy and (hopefully) help patients with Mild Cognitive Impairment and early-stage Alzheimer’s Disease

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The approval of a con­tro­ver­sial new drug for Alzheimer’s dis­ease, Aduhelm, is shin­ing a spot­light on mild cog­ni­tive impair­ment — prob­lems with mem­o­ry, atten­tion, lan­guage or oth­er cog­ni­tive tasks that exceed changes expect­ed with nor­mal aging.

After ini­tial­ly indi­cat­ing that Aduhelm could be pre­scribed to any­one with demen­tia, the Food and Drug Admin­is­tra­tion now spec­i­fies that the pre­scrip­tion drug be giv­en to indi­vid­u­als with mild cog­ni­tive impair­ment or ear­ly-stage Alzheimer’s, the groups in which the med­ica­tion was studied.

Yet this nar­row­er rec­om­men­da­tion rais­es ques­tions. What does a diag­no­sis of mild cog­ni­tive impair­ment mean? Is Aduhelm appro­pri­ate for all peo­ple with mild cog­ni­tive impair­ment, or only some? And who should decide which patients qual­i­fy for treat­ment: demen­tia spe­cial­ists or pri­ma­ry care physi­cians? [Read more…] about Six guide­lines to nav­i­gate the Aduhelm con­tro­ver­sy and (hope­ful­ly) help patients with Mild Cog­ni­tive Impair­ment and ear­ly-stage Alzheimer’s Disease

Study shows why children with ADHD should be reevaluated each year: Attention problems perceived by teachers are far less stable than we imagine

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While the study below was pub­lished a few years ago, it makes an impor­tant point that I think is worth revisiting.

In the study, pub­lished in the Jour­nal of Devel­op­men­tal and Behav­ioral Pedi­atrics, my col­leagues and I looked at how fre­quent­ly teacher rat­ings of inat­ten­tive symp­toms per­sist in chil­dren from one grade to the next. We felt this was an impor­tant issue to exam­ine because recog­ni­tion that ADHD is often a chron­ic con­di­tion can obscure the fact that atten­tion prob­lems do not always reflect an endur­ing child char­ac­ter­is­tic, and that impor­tant changes are pos­si­ble when chil­dren move to a new classroom.

As you will see below, clin­i­cal­ly-ele­vat­ed atten­tion prob­lems as per­ceived by teach­ers are less sta­ble than you may have imag­ined. [Read more…] about Study shows why chil­dren with ADHD should be reeval­u­at­ed each year: Atten­tion prob­lems per­ceived by teach­ers are far less sta­ble than we imagine

Working Memory Training can Influence Brain Biochemistry

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I want­ed to alert you to a very inter­est­ing find­ing pub­lished in a recent issue of Sci­ence, one of the world’s lead­ing sci­en­tif­ic journals.

The study was led by Dr. Torkel Kling­berg and his col­leagues from the Karolin­s­ka Insti­tute Torkel Klingbergin Swe­den. The goal was to learn whether Work­ing Mem­o­ry Train­ing is asso­ci­at­ed with changes in brain bio­chem­istry, thus sug­gest­ing a mech­a­nism by which train­ing may lead to enhanced work­ing mem­o­ry capac­i­ty and a reduc­tion in atten­tion prob­lems. Thus, although Work­ing Mem­o­ry Train­ing has pre­vi­ous­ly shown promis­ing results as a treat­ment for work­ing mem­o­ry and atten­tion dif­fi­cul­ties, this was a basic sci­ence study rather than a treat­ment study.

The major find­ing was that increased work­ing mem­o­ry capac­i­ty fol­low­ing train­ing was asso­ci­at­ed with changes in brain bio­chem­istry. Specif­i­cal­ly, the researchers found changes in the den­si­ty and bind­ing poten­tial of cor­ti­cal D1 dopamine recep­tors in brain regions that are acti­vat­ed dur­ing work­ing mem­o­ry tasks.

Results from this study sug­gest a bio­log­i­cal basis for the improve­ment in work­ing mem­o­ry capac­i­ty and reduc­tions i [Read more…] about Work­ing Mem­o­ry Train­ing can Influ­ence Brain Biochemistry

Self-Regulation and Barkley’s Theory of ADHD

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A CDC report esti­mat­ed that, in 2003, 4.4 mil­lion youth ages 4–17 lived with diag­nosed ADHD, and 2.5 mil­lion of them were receiv­ing med­ica­tion treat­ment. Now, which is the core deficit under­ly­ing ADHD-so that treat­ments real­ly address it? and how are ADHD and brain devel­op­ment relat­ed? Keep reading…

ADHD & the Nature of Self-Con­trol — Revis­it­ing Barkley’s The­o­ry of ADHD

— By David Rabin­er, Ph.D

As implied in the title of his book, ADHD and the Nature of Self-Con­trol, Dr. Barkley argues that the fun­da­men­tal deficit in indi­vid­u­als with ADHD is one of self-con­trol, and that prob­lems with atten­tion are a sec­ondary char­ac­ter­is­tic of the disorder.

Dr. Barkley empha­sizes that dur­ing the course of devel­op­ment, con­trol over a child’s behav­ior grad­u­al­ly shifts from exter­nal sources to being increas­ing­ly gov­erned by inter­nal rules and stan­dards. Con­trol­ling one’s behav­ior by inter­nal rules and stan­dards is what is meant by the term “self-con­trol”.

[Read more…] about Self-Reg­u­la­tion and Barkley’s The­o­ry of ADHD

How Strong is the Research Support for Neurofeedback in Attention Deficits?

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(Edi­tor’s Note: Neu­ro­feed­back is one of the tech­nolo­gies that peo­ple often ask us about.  It is a promis­ing inter­ven­tion in a vari­ety of areas, and has got sig­nif­i­cant trac­tion in help­ing kids with ADD/ ADHD. Now, giv­en the sig­nif­i­cant cost it pos­es for par­ents, we need to ask the ques­tion: “How Strong is the Research Sup­port for Neu­ro­feed­back Treat­ment of Chil­dren with ADHD”? We are hon­ored to present the thoughts of Duke Uni­ver­si­ty’s Dr. David Rabin­er, a lead­ing author­i­ty on the field, on that impor­tant issue. As a bonus, you will enjoy his detailed descrip­tion and sug­ges­tions of how to design a high-qual­i­ty sci­en­tif­ic study.)

(Update as of March 2009: Dr. David Rabin­er has writ­ten an update to the arti­cle below based on a new­er study. You can read it click­ing on link: New Study Sup­ports Neu­ro­feed­back Treat­ment for ADHD)
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How Strong is the Research Sup­port for Neu­ro­feed­back Treat­ment of Chil­dren with ADHD?

Nei­ther of the two promi­nent approach­es to treat­ing ADHD — med­ica­tion treat­ment and behav­ior ther­a­py — are expect­ed to effect long term changes in the child. Med­ica­tion treat­ment induces short-term changes in brain activ­i­ty that is asso­ci­at­ed with a reduc­tion in symp­toms for many indi­vid­u­als. Behav­ior ther­a­py attempts to cre­ate a set of envi­ron­men­tal con­tin­gen­cies that pro­mote desired behav­ior in the child, but which is unlike­ly to endure when those con­tin­gen­cies are removed.

In recent years, researchers have begun devot­ing greater atten­tion to the pos­si­bil­i­ty that chil­dren — and adults — may be pro­vid­ed with par­tic­u­lar kinds of expe­ri­ences that may induce alter­ations in brain func­tion­ing that are asso­ci­at­ed with more endur­ing changes, i.e., they do not dis­si­pate as soon as treat­ment ends.

Neu­ro­feed­back — also known as EEG Biofeed­back — is reflec­tive of this approach and has a his­to­ry that goes back [Read more…] about How Strong is the Research Sup­port for Neu­ro­feed­back in Atten­tion Deficits?

Physical and Mental Exercise: Why Pitch One Against the other?

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Read­er There­sa Cerul­li just for­ward­ed this Let­ter to the Edi­tor that she had sent to the New York Times and went unpub­lished. The let­ter address­es the OpEd men­tioned here (pitch­ing phys­i­cal vs. men­tal exer­cise), and refers to the Cogmed work­ing mem­o­ry train­ing pro­gram, whose results have been stud­ied in mul­ti­ple papers pub­lished in top med­ical and sci­en­tif­ic jour­nals.

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Dear Edi­tor:

I applaud San­dra Aamodt and Sam Wang for throw­ing some cold water on the cur­rent brain fit­ness craze in their recent New York Times Mag­a­zine Opin­ion Edi­to­r­i­al “Exer­cise on the Brain.”  They are cor­rect in label­ing the host of “men­tal fit­ness” prod­ucts that tar­get aging baby boomers as “inspired by sci­ence ”  not to be con­fused with actu­al­ly proven by sci­ence. For the last 30 years, terms like “brain plas­tic­i­ty” have been wide­ly and casu­al­ly used, cre­at­ing hype that risks drown­ing out the real break­throughs that brain researchers are mak­ing in this area.

How­ev­er, I would like to dis­tin­guish the “men­tal fit­ness” trend that Aamodt and Wang right­ly crit­i­cize from actu­al researched-based cog­ni­tive train­ing such as the Cogmed pro­gram devel­oped in Swe­den. Unlike “men­tal fit­ness” pro­grams, cog­ni­tive train­ing pro­grams focus very nar­row­ly on spe­cif­ic cog­ni­tive func­tions that research has shown to be plas­tic. This is in stark con­trast to com­pil­ing a smat­ter­ing of exer­cis­es or activ­i­ties that are gen­er­al­ly thought to be [Read more…] about Phys­i­cal and Men­tal Exer­cise: Why Pitch One Against the other?