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ADHD and Executive Function

January 27, 2013 Leave a comment
Human Eye with different lines. The line of si...

Human Eye with different lines of sights.

We know that ADHD exists, so I’m not going to go into proofs that the child is not “raised irresponsibily”.  On the other hand, having a child with any disability does require you to be a more sophisticated parent and more sympathetic.

Executive Function (EF)

Executive Functions or EF are the skills used to filter, organize, and prioritize stimulus and cognition to perform a function.  Kids with ADHD  “exhibited significant impairment on neuropsychological
measures of response inhibition, vigilance, working memory, and planning”.   

Tests

From the neuropsych perspective, the Wisconsin Card Sort,  the Rey–Osterreith, and the Tower of Hanoi have been used to test EF.  You may have seen these tests on the Neuropsych Report when you had your child tested at the psychologists office.

EF part of ADHD or IS ADHD?

The International Journal of Disability, Development and Education, published a paper about how ADHD can be looked at with respect to EF with two perspectives: 1) Executive Function is part of the ADHD diagnosis or 2) Executive Function is the reason you have ADHD in the first place. 

Many meta studies have shown that while there is weakness of executive functioning in a part of the ADHD population it is not a singular representation of ADHD behaviors and outcomes.  Some studies show that only 30% of those diagnosed with ADHD have executive functioning problems.  And  people with autism, oppositional defiant, traumatic brain injury and other disorders also show EF problems.

Others like Denckla, Barkley, T.E. Brown and others show that there is significant cognitive impact, especially the ability to inhibit.  Brown has modeled the areas where this cognitive deficit can be seen:

  1. Activation: Organising, prioritising and activating to work.
  2. Focus: Focusing, sustaining, and shifting attention to tasks.
  3. Effort: Regulating alertness, sustaining effort, and processing speed.
  4. Emotion: Managing frustration and regulating emotions.
  5. Memory: Utilising working memory and accessing recall.
  6. Action: Monitoring and self-regulating action.

Brown argues that tests traditionally used in a neuropsych report are insufficient indicators of EF strengths.  The reason for this is that dissecting a problem into constituent parts is reductionist and does not reflect the whole.  While you can put body parts together and add electricity, you will not get a whole functioning human from it.  Rather a test of normal daily functions is a better indicator of EF ability.

Stealth Dyslexia

Sometimes EF problems can result from Stealth Dyslexia.  Have you or child made “stupid mistakes”?  You know that 3+12=15, but on a test you may multiply the left hand side and come up with an answer of 36, and not know you made the mistake.  Even if you go back and check.  Dyslexia originally thought to be a reading disorder may manifest in several ways not currently recognized as dyslexia.  What if the dyslexia manifested cognitively outside of just reading?  Eides and Eides have determined that Stealth Dyslexia have these in common:

  • Characteristic dyslexic difficulties with word processing and written output.  This is sometimes found as high IQ and verbal comprehension but trouble with output: terseness, spelling mistakes etc.
  • Findings on neurological and neuropsychological testing consistent with the visual language, auditory, and motor processing deficits characteristic of dyslexia.  Visual Percepetion issues and not attention could be the cause of coding/tracking problems.  Visual Problems can often be addressed by seeing a Developmental Optometrist.  Central Auditory Processing Disorder (CAPD) is found in many kids (and adults) where one cannot manage and filter background sounds from primary communication.
  • Reading skills that appear to fall within the normal or even superior range for children their age, at least on silent reading comprehension.  But writing and listening may be problematic.  Sometimes one can tape the lecture knowing that ideas will be recorded for later recall, several times if needed.   That way one can listen to the lecture and absorb the concepts.

Processing Speed

Yes slow processing speed is a recognized condition and can contribute to the impulsivity of ADHD.  People with SPS (I just made that up), cannot participate in dynamic conversations because just as they’ve figured out the pace, direction and tone, it has moved on.  They also have trouble “getting” things that are taught.  You might find very intelligent people teaching themselves, and rather than get behind they teach themselves ahead of everyone else. If you cannot keep up, you might just  forget it and decide to go for things.  And this may become a habit, that manifest as EF.  Some studies show that processing speed normalizes around 27 years of age, but if you can’t wait that long…or have regressed because of TBI, you can consider neurofeedback or SimplySmarter which works on sequential processing  and therefore could help processing speed in general. 

Medications have not been known to help with any of these things that interfere with clear EF, but knowledge of these aspects may allow you to have the sympathy to support your child (spouse?) better.

Categories: Affect/Emotion, Anxiety, Autism

EMDR for PTSD

January 21, 2013 1 comment
EMDR

EMDR

EMDR stands for Eye Movement Desensitization and Reprocessing, originally coined by Dr. Francine Shapiro Ph.D.  She had been recalling  her own traumatic event while taking a walk, and realized that when her eye movements went from side-to-side that the  feelings and “pull” of that event lessened noticeably.   She then decided to investigate the dynamics further and  developed an 8 stage approach to EMDR.   To summarize the patient is creates a safe place in their imagination for retreat if any trauma is found to be overwhelming during the session.  Once this has been established the patient is brought back to the negative memories while they watch a light move from side to side.  After each movement session, the client reevaluates to see if the positive cognition (a preferred alternate to the same situation) is true.  When the client is satisfied that the positive cognition is true and the negative is not, the session is “installed” in the body through the client scanning their body and attend to any physical discomfort.

Does EMDR Work?

This processes then was studied several times by Dr. Shapiro and several  other researchers.  Even critics of the method still agree that there is a positive response, it is more a matter of whether eye movements are central to the therapeutic effects.  The evidence for the work is handily summarized  in a Q&A with Dr. Shapiro and the New York Times readers.   Some believe that desensitization was the key dynamic, while others claim that the eye movements are analogous to R.E.M. sleep eye movements  and this is how trauma is processed.  These studies have been supported by the American Psychiatric Association  (for example for rape) as well as the Department of Defense for soldiers returning from war.

Personal Response

Having done a lot of work on myself,  medically, psychologically and with nutrition, I felt that whatever was slowing down my progress must be subsconscious.  I asked my therapist if she knew anyone trained in other types of techniques such as hypnosis and found she was trained by Dr. Shapiro.  So we did our own sessions,  I ended up needing only 5 sessions for me to process what I was consciously aware of.   It was highly successful, and as a result I was able to move onto another level of self discovery entirely positive.

Variations

More than Eyes

Since the original discovery of EMDR, it has been found that the same effect can be had by using sound or touch on both sides of the body.  So while advancement is not dependent on eyes, it seems that the bilaterality is the key.  It appears that the bilaterality is a method of creating new flows that bypass the “stuck feeling” in the psyche and allow resolutions

Brainspotting

Brainspotting

Brainspotting

Brainspotting, a book by David Grand is a technique that extends that found in  EMDR .  The author used EMDR to address most of his trauma, but could not find a way to resolve it completely.  He realized that there was a location in an individual’s visual field that could be identified by patterns in eye movement when the patient looked in that direction and rested there.  These signify unresolved processes that are held in the brain, very much like one can hold trauma in the body.  The patient is guided to attend to this location and be with the trauma, then observe and watch the dynamics change as one follows the changes.  The brain is now able to process the trauma so it loses its hold and now becomes a memory.

Worth Trying

Bothe EMDR and Brainspotting are thought to be efficient ways to address trauma that is held in the brain.  They each require a lot less time that talk therapy and seem to have evidence to back up their efficacy.   If you decide to try it, please let us know how you did!

Categories: Affect/Emotion, Trauma

The Myths of Happiness

January 6, 2013 Leave a comment

I heard a review of this book on the radio, and thought you may be interested in the discussion. Sonya Lyubomirsky is a psychologist who has studied happiness. She has found that happiness is not “attainable” but rather a state that is maintained regardless of the highs and lows in ones life.

I’ll be Happy When

I get that job, get that girl, get that money, have that house, have that baby.  But those big events only give you a bump in terms of happiness, the little things over a sustained basis are the ones that really affect your happiness. Whether negative or positive.  So little bursts of daily positive things will help you more than winning the lottery.

Is Happiness Important?

Hedonic Adaptation means that human beings adjust to whatever pleasure/happiness they have in their lives.  Got a bigger car, fantastic!  The afterglow won’t last that long, because even with that car, you will go back to your normal level of happines.  This could mean that you are always searching for another fix…or you could accept your level of happiness and not try to live at that level of stimulation (and potentially become antisocial in the process).  So it turns out there is a set point for happiness.

What about Striving?

If we were all happy with our situation…I’m looking at you meditators, would we ever try or enjoy anything?  Why go to the moon?  Why find cures for diseases?     It turns out that the heritability index for happiness is 50%.  Which means the half of things that make you happy are NOT your genes. 

Making You Happy

Smile

What helps you get happy (or stay happy) is,  Relationships!  Primary, Seconary and Tertiary: Family, Friends and Associates.  Studies have shown that the poorest societies are still happy because of close family connections.  Richer societies often loosen the family connection when wealth arrives.  Nonetheless there is a certain level of wealth that removes draining problems and this contributes to more happiness.  It’s just that dynamic of happiness creation has a limit.  Which is why more and more wealth does not lead to ultimate satisfaction.  Spending the money on worthy causes can contribute to happiness!  According to the book, the happiest countries are in Latin America (7/10), probably up and coming in terms of wealth but maintaining strong social bonds.

But what is happiness anyway?  It has two components: Frequent Positive Emotions and that you are progressing towards your life goals.

This means that people’s happiness is subjective.  An introvert can be happy with limited social interaction while an extrovert would suffer at the same level, and vice versa.   However generally speaking extroverts are on average happier than extroverts.

 There is also a level of happiness that comes through contrast, such as only being able to pet a favorite animal once a day (hedonic adaptation in reverse).  Could this be why many spiritual leaders give away their stuff rather than hoarding it?   Why start the hedonic snowball?

I’m not happy

If you are already not happy, how can you get it back? 

  • Do things you like
  • Serve others, volunteer, or bake!
  • Stay away from social comparison (Facebook)
  • Remember it’s the journey and not the destination
  • Replay good memories
  • don’t dwell on bad ones
  • Join a supportive group (like church, masjid, book club!)
Categories: Affect/Emotion, Anxiety Tags:

Inflammation and Depression

December 31, 2012 1 comment
Dahlia 'Inflammation'

Dahlia ‘Inflammation’ (Photo credit: F. D. Richards)

According to this Danish post, inflammation causes depression, which causes inflammation.  Depression causes one to have errant sleep, poor stress management, eating poorly, withdrawl from socials support.  This causes epigenetic changes that increase inflammation.

Danish scientists took a cohort of 73,000 people and measured their levels of C-Reactive Protein (CRP)…a marker for inflammation, and mapped those levels to antidepressant dispensation from a pharmacy, and records of people hospitalized for depression.  (You will never be able to do something like this in the USA). 

They found that people with CRP above 3mg/liter had more antidepressant use and hospitalization than those with values under 1mg/liter.  CRP is made in the liver. While the article says that inflammation may affect serotonin in the brain.  We know that serotonin is also found in the GI tract….right next to that liver.  So it must be affected there as well?

 So many more reasons to monitor inflammation, and reduce it.   I suspect that inflammation is our body overextended.  Designed to solve problems here and there such as in injuries, prolonged stress may lead to continuous inflammation.  So stress reduction may be a great way to reduce CRP and maybe therefore depression..

Touch and Move

December 30, 2012 Leave a comment
Massage Faciale © Hélianthal - Office de Touri...

Massage Faciale © Hélianthal – Office de Tourisme de Saint-Jean-de-Luz (Photo credit: Terre et Côte Basques)

YOHAF had a recent show up stress and hormones, I’ve summarized it here for reference.  Please forgive the bulleted summary style!

Massage

Massage releases oxytocin, which reduces fear. Stretching and physical activity with massage add to the effect.

Intervention studies abstract out many other variables such as mood, time, place, practition etc when it comes to massage studies, but why not add these variables back in to suit you.

Moving helps  heal affects of stress.  In this study fruits and vegetables did not address consequences of stress, but movement did.  Rest is also important; need time to recover.

Continous Stress

Stress hormones are also hormones of learning and adaptation, but Downtime is also important to integrate what they’ve learned.

Adrenaline -> Cortisol -> higher blood sugar -> lower immunity healing, digestion, sex hormones go down during acute stressors.  Can present as autoimmune things like Lupus, Thyroidits.  Amygdala grows and hippocampus shrinks.  Now you have chronic inflammation.

Recover by:

  • Be Kind to yourself
  • Eat
  • Rest
  • Walk
  • Avoid Helplessness

 If Cortisol is high/low, sex and thyroid hormones are affected.   If sex hormones are lowered, choleserol will go up. Alcohol raises estrogen in men. 

Stress causes people do want comfort foods raise insulin and cortisol.  Now there is depression and weight gain.  Now progesterone gets low and can cause acne and PCOS.  Sustained stress causes depression and lowered TSH. Pharmaceuticals used to push you when you need rest then messes up other nutrients, like vitamins, carnitine etc.

Movement

Exercise increases metabolism for up to 4 hours, it can also make you smarter.  Around 20-30 minutes of exercise upregulates your metabolism and switches to burning fat!  If stress makes fat, then exercising burns it while it’s being made.  But again be gentle with yourself. If you are in stress mode, exercising more than you can handle can create even more stress.

  • Wireless is also a stressor
  • Socialize
  • Take an iron-free vitamin supplement, especially Vitamin C
  • and minerals
  • Omega 3s from Vegan sources
  • Meditation
  • Art

Fish Oil Bad for you?

December 24, 2012 Leave a comment

We all know how wonderful fish oil is as an anti-inflammatory, improves blood pressure,  improves mood, and a host of other things.  So am I really saying that Fish Oil could be bad for you?

FIsh Oil Bad For You?

But there may be concerns with taking too much or any!

  1. For many years we have known to be wary of Fish Oils that were not specifically tested for mercury contamination.  You can now find many products that say they are mercury free.
  2. Another problem is oxidative stress.    Omega 3 oils are delicate they can break down easily.  Remember they are from COLD water fish.  Having your bottle sit next to a toaster oven or a blowing vent can easily begin to breakdown
  3. Maybe not in a physical way, but if you are vegetarian you can’t really have it at all can you?

But to address these in reverse order, you can easily start taking vegan Omega 3s directly from the algae that produce them.

Ok but then what about Oxidative Stress? We see that too much Omega 3s can decrease lifespan.  However the authors of the study promote the addition of antioxidants, not the removal of the oils.  You can limit the dangers of oxidative stress by taking astaxanthin, found in Krill Oil. In addition another study shows that oxidative stress was actually reduced when specifically using OmaCor capsules. These are prescription fish oils that have been altered and purified. 

This is important when it comes  to well known problems with mercury in fish oil.  But in industrial fish there is also a concern about arsenic.  This is where the vegan oils show the promise of bypassing the mercury and aresenic contamination.

All in all, the dynamics may be dependent on the type of DHA/EPA you are getting, but it could also be dose dependent, a safe bet would be taking no more than 1g per day.  A safer bet would be to get your oils directly from the algae that produces the EFAs.

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