ADHD: Do sunny climates reduce the symptoms of ADHD?

Attention-deficit/hyperactivity disorder, or ADHD, is the most common childhood psychiatric disorder.

ADHD is more and more believed to have a genetic element but other risk factors have also been identified, including premature birth, low birth weight, a mother's use of alcohol or tobacco during pregnancy, and environmental exposures to toxins like lead.

ADHD is characterized by an inability to focus, poor attention, hyperactivity, and impulsive behavior, and the normal process of brain maturation is delayed in children with ADHD.

Many individuals with ADHD also report sleep-related difficulties and disorders. In fact, sleep disorder treatments and chronobiological interventions intended to restore normal circadian rhythms, including light exposure therapy, claim to improve ADHD symptoms.

Estimates suggest that the average worldwide prevalence of ADHD ranges from about 5 to 7%, but it also varies greatly by country and region.

A simple visual comparison of data maps released by the U.S. Centers for Disease Control and Prevention and the U.S. Department of Energy that display ADHD prevalence rates by state and solar intensities (sunlight) across the country, respectively, reveals an interesting pattern indicative of an association.

So does this mean that there could be an identifiable relationship between ADHD prevalence rates and the sunlight intensity levels of particular regions?

The accumulation of these points led Dr. Martijn Arns and his colleagues to systematically and scientifically investigate this question.

They collected and analyzed multiple data-sets from the United States and 9 other countries.

Reporting their findings in the current issue of Biological Psychiatry, they did find a relationship between solar intensity and ADHD prevalence.

Even after controlling for factors that are known to be associated with ADHD, both U.S. and non-U.S. regions with high sunlight intensity have a lower prevalence of ADHD, suggesting that high sunlight intensity may exert a 'protective' effect for ADHD.

To further validate their work, they also looked at this same relationship with autism and major depressive disorder diagnoses.

They found that the findings were specific to ADHD, with no associations observed between the other two disorders.

Dr. John Krystal

"The reported association is intriguing, but it raises many questions that have no answers," commented Dr. John Krystal, Editor of Biological Psychiatry.

"Do sunny climates reduce the severity or prevalence of ADHD and if so, how? Do people, who are prone to develop ADHD, tend to move away from sunny climates and if so, why?"

As with all scientific research, further work is necessary, including a prospective replication of these findings.

It is also important to realize that this data reflects only an association - not a causation - between ADHD and solar intensity levels so worried parents should not start planning cross-country moves.

However, these findings do have significant implications, explains Dr. Arns.

"From the public health perspective, manufacturers of tablets, smartphones and PCs could investigate the possibility of time-modulated color-adjustment of screens, to prevent unwanted exposure to blue light in the evening."

"These results could also point the way to prevention of a sub-group of ADHD, by increasing the exposure to natural light during the day in countries and states with low solar intensity.

For example, skylight systems in classrooms and scheduling playtime in line with the biological clock could be explored further."

More information: The article is "Geographic Variation in the Prevalence of Attention-Deficit/Hyperactivity Disorder: The Sunny Perspective" by Martijn Arns, Kristiaan B. van der Heijden, L. Eugene Arnold, and J. Leon Kenemans (DOI: 10.1016/j.biopsych.2013.02.010). The article appears in Biological Psychiatry, Volume 74, Issue 8 (October 15, 2013)

ADHD: Single dose of Ritalin (MPH) can reduce fall risk in older adults

Ben-Gurion University of the Negev (BGU) researchers have discovered that a single dose of Ritalin (methylphenidate or MPH), used to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, helps to improve balance control during walking, hence reducing the risk of falls among elderly adults.

Falls in older adults are the leading cause of hip fractures and other injury-related visits to emergency rooms and of accidental death. Age-related deterioration in gait and balance is a major contributor to falls in older adults.

According to a study published in The Journals of Gerontology, the BGU researchers found that a single dose of MPH improves walking by reducing the number of step errors and the step error rate in both single and dual tasks.

"Our results add to a growing body of evidence showing that MPH may have a role as a therapeutic option for improving gait and reducing fall risk in older adults," said Itshak Melzer of BGU's Schwartz Movement Analysis and Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences.

"This is especially true in real-life situations, where the requirement to walk commonly occurs under more complicated, 'dual task' circumstances with cognitive attention focused elsewhere (e.g., watching traffic, talking) and not on performing a specific motor task."

The study participants were 30 healthy older adults who were at least 70 years-old and had the ability to walk 70 feet (20 meters) without personal assistance or an assistive device.

The participants were given a single dose (10 mg.) of MPH and were assessed under four task conditions of single and combined motor and cognitive tasks.

"The enhanced attention that comes about as a result of MPH may lead to improved balance control during walking, especially in dual task conditions," Meltzer explains.

"Our findings that MPH improves gait can be explained not just by its effect of attentional improvements, but also by indications that it has a direct influence on areas of the brain that deal with motor and balance control."

More Information: "Effect of Single Dose Methylphenidate on Walking and Postural Stability Under Single- and Dual-Task Conditions in Older Adults—A Double-Blind Randomized Control Trial"

Mindfulness: Increasing Wellbeing and Reducing Stress in UK school children

Mindfulness – a mental training that develops sustained attention that can change the ways people think, act and feel – could reduce symptoms of stress and depression and promote wellbeing among school children, according to a new study published online by the British Journal of Psychiatry.

With the summer exam season in full swing, school children are currently experiencing higher levels of stress than at any other time of year.

The research showed that interventions to reduce stress in children have the biggest impact at this time of year.

There is growing evidence that mindfulness-based approaches for adults are effective at enhancing mental health and wellbeing.

However, very few controlled trials have evaluated their effectiveness among young people.

A team of researchers led by Professor Willem Kuyken from the University of Exeter, in association with the University of Oxford, the University of Cambridge and the Mindfulness in Schools Project, recruited 522 pupils, aged between 12 and 16 years, from 12 secondary schools to take part in the study.

256 pupils at six of the schools were taught the Mindfulness in Schools Project's curriculum, a nine week introduction to mindfulness designed for the classroom.

Richard Burnett who co-created the curriculum said: "Our mindfulness curriculum aims to engage even the most cynical of adolescent audience with the basics of mindfulness. We use striking visuals, film clips and activities to bring it to life without losing the expertise and integrity of classic mindfulness teaching".

The other 266 pupils at the other six schools did not receive the mindfulness lessons, and acted as a control group.

All the pupils were followed up after a three month period. The follow-up was timed to coincide with the summer exam period – which is a potential time of high stress for young people.

The researchers found that those children who participated in the mindfulness programme reported fewer depressive symptoms, lower stress and greater wellbeing than the young people in the control group.

Encouragingly, around 80% of the young people said they continued using practices taught in MiSP's mindfulness curriculum after completing the nine week programme.

Teachers and schools also rated the curriculum as worthwhile and very enjoyable to learn and teach.

Prompt Intervention needed to reduce lifelong effects of childhood abuse

Preschool children who have been neglected or emotionally abused exhibit a range of emotional and behavioral difficulties and adverse mother-child interactions that indicate these children require prompt evaluation and interventions, according to a systematic review by Aideen Mary Naughton of NHS Public Health Wales, Pontypool in Wales, and her colleagues.

A total of 42 studies of children age 0 to 6 years with confirmed neglect or emotional abuse who had emotional, behavioural, and developmental features recorded or for whom the carer-child interaction was documented were analyzed.

Key features in the child included aggression, withdrawal or passivity, developmental delay, poor peer interaction, and transition from ambivalent to avoidant insecure attachment pattern and from passive to increasingly aggressive behaviour and negative self-representation.

Emotional knowledge, cognitive function, and language deteriorate without intervention. Poor sensitivity, hospitality, criticism, or disinterest characterize maternal-child interactions.

"Lifelong consequences include physical and mental health problems; impairments in language, social, and communication skills; and severe effects on brain development and hormonal functioning."

The study concludes, "early intervention has the potential to change children's lives."

Explore further: Traumatized mothers avoid tough talks with kids, study shows

More information: JAMA Pediatr. Published online June 10, 2013. doi:10.1001/jamapediatrics.2013.192

Are Reading and other Learning Disabilities Preventable? | Reading & Other Learning Disabilities

Are Reading and Other Learning Disabilities Preventable?

Perhaps you had this experience: You approached your child’s school about your kindergarten age child, expressing concern that he or she may have a learning disability. While sympathetic, your school’s psychologist, reading specialist, or other diagnostic expert responded that learning disabilities cannot be diagnosed until a child has been unable to succeed academically despite conscientious instruction.

Several years later, you attended a meeting with your school’s multi-disciplinary team who explained that your child indeed does have a learning disability. Your emotions felt chaotic – a mixture of relief, worry, sorrow – and perhaps frustration or even anger that years had passed since you recognised that your child’s development was not typical, but rather different from his peers in subtle yet important ways.

It is a fact that learning disabilities cannot be 'positively' diagnosed in early childhood. Unlike severe developmental disabilities, learning disabilities are mild neurocognitive deficits that cannot be easily distinguished from the broad range of typical early childhood development.

However, it is also a fact that it is possible to identify children with 'increased risk' of developing learning disabilities in the future, e.g. as elementary school students.

Children with 'increased risk' of learning disabilities frequently share one or more of these characteristics:

• A mother, father, sister or brother with an Autistic Spectrum Disorders, ADHD, or Learning Disability
• Low birth weight, defined as a weight less than 2500 grams or 5.5 pounds
• Delayed speech—failure to combine two or more words into short phrases by 24 months of age
• A diagnosis of ADHD

These risk factors are associated with increased risk of learning disabilities because many learning disabilities are the result of a developmental trajectory that starts before birth, and continues through adulthood.

As preschoolers, children at 'increased risk' have trouble:

• Rhyming
• “Reading”—really recognising—signs like Coke, McDonalds and other frequently occurring printed words
• Recognising parts of books such as the cover, title
• Recognising letters of his or her own name
• Quickly retrieving words, measured by asking a child to rapidly name a category such as “animals”

If we know this then 'What about prevention?'

Many of the home-based interventions that can reduce the risk of learning disabilities, especially reading disabilities, are parenting habits that apply to all children.

The common element of all home—based interventions is the systematic exposure of children to rich, engaging, and expressive language. The best example of this is shared reading.

'Shared Reading', is when parents read to their children, and through this activity, books take on an added dimension of parental love and affection. Children hear models of reading that are more accurate and more advanced than their own.

They begin to associate letters with sounds and words with meaning. Using books with predictable rhyme patterns and simple rhythms, such as the Dr. Seuss books, teaches the acceptable and common sound system of our language.

Old fashioned entertainment, based on interaction between adults and children rather than video, fulfills a similar purpose. Telling stories about family history, sharing folk tales you learned as a child, playing word games such as 20-questions or I-Spy are ways parents teach their preschool “language apprentices.”

Apprentices need teachers who listen well and listen patiently, and who can demonstrate good conversational skills such as taking turns speaking without interrupting.

Helping children to play creatively, with other children, and with their imaginations is the oldest form of language and social skill training.

Summary

In summary, while diagnosis of learning disabilities is not possible at young ages, parents, schools, healthcare professionals and others can be very attuned to delays in language development that confer increased risk for learning disabilities.

In addition, adults can focus particular attention to Low-Birth-Weight children, and children who were not talking by their second birthday, viewing them as especially vulnerable and needing developmental assessment.

Parents, schools and speech and language therapists can team-up to help reduce the potential risk of learning disabilities.