A natural solution for ADD/ADHD

ADHD (Attention Deficit Disorder with or without Hyperactivity) is currently the most frequently diagnosed psychiatric 'illness' among young North Americans. Eleven per cent of them are diagnosed at least once between the ages of 4 and 17. The number of cases diagnosed and treated has increased so much in the last decade that it makes you wonder whether something that affects so many people is really an illness at all - and rightly so!Recent neuroscience research shows that ADHD sufferers are brain-programmed to seek out novelty: a characteristic that until recently (a few thousand years ago) represented an evolutionary advantage. Compared with other people, the reward circuits in the ADHD brain are under-fed by a routine and unstimulating daily life.To compensate, ADHDers are attracted by new and exciting experiences. They are known for their impatience and restlessness in response to the constraints and procedures that characterise our modern world. In short, people with ADHD don't have a disease so much as a set of behavioural traits that don't fit in with the expectations of our contemporary culture.From the point of view of teachers, parents and the world at large, the problems of ADHD children take the form of a lack of concentration and attention and impulsive behaviour. But if you have this 'illness', the real problem is that your brain perceives only a fundamentally uninteresting world around it. One of my patients, a young woman of 20, is typical. "I've been on Adderall (Amphetamine) for years to help me concentrate," she told me at our first meeting.Before taking Adderall, she couldn't stand sitting in meetings and would lose concentration within minutes. Like many people with ADHD, she sought out interesting and varied experiences to relieve boredom, and also resorted to alcohol. But when she came across something new and stimulating, she was able to concentrate extraordinarily well. I knew that she loved to paint and I asked her how long she could maintain her attention while handling her palette and brushes. She replied that she could paint for hours on end without any problem.'Rewards' such as sex, money, drugs and novel situations all trigger the release of dopamine in the brain's reward circuits, a region deep beneath the cortex. Apart from the feeling of pleasure, this dopamine signal tells your brain something like, "Pay attention, this is an important experience to remember." The more novel and unpredictable the experience, the greater the activity in your reward centre.But what is stimulating for one person may be boring, unbearable or, on the contrary, exciting for another. There is great variability in the sensitivity of this reward circuit. Clinicians have been aware of this for a long time, and daily experience demonstrates it. Think of the adrenaline junkies who bungee jump without breaking a sweat and compare them with the anxious bystanders for whom the experience elicits only terror and dread!Dr Nora D. Volkow, a scientist who heads the National Institute on Drug Abuse, has studied the dopamine reward pathway in people with ADHD. Using a PET scan, she and her colleagues compared the number of dopamine receptors in this area of the brain in a group of (untreated) adults with ADHD with that in a group of healthy controls. What she found was striking. The ADHD adults had significantly fewer D2 and D3 receptors (two subtypes of dopamine receptors) in their reward circuits than the non-ADHD group. In addition, the lower the level of dopamine receptors, the greater the symptoms of inattention in the subjects. Studies in children have shown similar changes in dopamine function. These results suggest that ADHD sufferers have reward circuits that are less sensitive to inclusion than those of the rest of us. Having an under-reactive reward circuit makes normally interesting activities dull and explains, in part, why ADHDers find repetitive, routine tasks unrewarding and even painfully boring. Psychostimulants such as Adderall and Ritalin help ADHD sufferers by blocking the re-uptake of dopamine around their neurons, thereby increasing its level in the brain. Another of my patients, a 28-year-old man, suffered a lot at his job in an advertising agency. Sitting at a desk for long hours and concentrating on a brief was almost impossible.He was multitasking, listening to music and texting, 'working' to escape the routine. Eventually, he left his job for a start-up, which puts him in a constantly changing environment. He is much happier and - little surprise - has lost his ADHD symptoms. My patient simply 'treated' his ADHD by swapping his very routine work environment for one that was more varied and less predictable. Suddenly, his biggest flaws (impatience, short attention span and restlessness) became strengths, and I think this is fundamental to understanding what's going on in ADHD. Humans evolved over millions of years as nomadic hunter-gatherers.It was when we invented agriculture, around 10,000 years ago, that we settled down and started living a more sedentary and boring life. Previously, as hunters, we had to adapt to a constantly changing environment where dangers were as unpredictable as the time of our next meal.In such a context, a short, shifting and intense attention span and an attraction to discovery were a selective advantage. This profile made it easier to locate and secure 'rewards', such as a mate or a nice piece of mastodon meat. In short, what we now call ADHD would have made you a champion in the Palaeolithic. In fact, we have modern evidence to support this hypothesis. There is a tribe in Kenya called the Ariaal, traditionally nomadic animal herders. More recently, a sub-group has seceded and settled down to farm. Dr Dan Eisenberg, an anthropologist at the University of Washington, compared the frequency of a genetic variant of the type 4 dopamine receptor called DRD4 7R in the nomadic and sedentary Ariaal groups. This genetic variant reduces the sensitivity of the dopamine receptor and is specifically linked to ADHD.Dan Eisenberg found that nomads carrying the DRD4 7R variant were better nourished than nomads without it. But what was striking was to find the opposite for Ariaal farmers: those carrying this genetic variant were significantly leaner than others. So, if you're nomadic, having a gene that favours ADHD behaviour is clearly advantageous (you're better nourished), but the same trait is a disadvantage if you live in a sedentary context. It's not hard to understand why nomadic Ariaals, with their special attention span and attraction to adventure, are likely to cope better in a moving, unpredictable environment, particularly when it comes to finding food. But this same short, intense attention span would not be very useful to farmers, who need to concentrate on activities that require sustained attention, such as going to school, managing crops and negotiating their harvest.You may be wondering what explains the recent explosion in the number of ADHD diagnoses?According to the (American) Centers for Disease Control and Prevention, its prevalence among children rose to 11% in 2011, compared with 7.8% in 2003, a huge increase of 41%. Furthermore, 6.1% of young people were taking medication for ADHD in 2011, an increase of 28% since 2007. Even more alarming: at least 10,000 children aged 2 and 3 are taking these drugs, well in excess of the official paediatric recommendations.The pharmaceutical industry is undoubtedly responsible for part of the increase in the prevalence of ADHD, as it benefits from its treatment. Some blame the increase in school work, but the data do not support this. All the studies show that the number of hours of homework for secondary school pupils has been stable for 30 years. I think another social factor that may be contributing, at least in part, to the ADHD'epidemic', has gone unnoticed.This is the growing contrast between the disciplined and demanding school environment and the highly stimulating digital world where young people spend their time outside school. This digital life, with its online games and attractive social media, represents a world of instant gratification where virtually any original desire or urge can be fulfilled in the blink of an eye. By comparison, school seems even more insipid to a modern child hungry for stimulation than it did in previous decades. This comparatively duller school environment could accentuate inattentive behaviour in pupils, leading to an increase in the number of diagnoses under pressure from teachers and their entourage. Fortunately, there is some positive news. Curiously, the prevalence of ADHD in adults is only 3 to 5%, a fraction of what it is in young people. This suggests that a significant number of ADHD sufferers simply 'recover' from their disability. Why is this? Perhaps because adults are much freer to choose the environment in which they live and pursue a career that better matches their aspirations and the cognitive rewards they seek. If you're a restless child who can't keep still at school, you may become a contractor or a carpenter, but you're less likely to end up a chartered accountant.What could be going on in the ADHD brain that could explain this spontaneous 'recovery'? In an attempt to answer this question, Aaron T. Mattfeld, a neuroscientist from the Massachusetts Institute of Technology (MIT) who currently works at Florida International University in Miami, used MRI to compare brain function in the resting state of three groups of adults: * ADHD sufferers whose problems persisted into adulthood; * ADHD sufferers who had 'recovered'; * non-ADHD control subjects. Normally, when someone is relaxed and not concentrating on a task, there is a synchronisation of brain regions known as the Default Network, which are generally more active during rest than when performing a task. In ADHD, however, these regions appear to be functionally disconnected from each other during rest. Dr Mattfeld found that 'cured' former ADHD adults showed a restoration of normal synchronisation: their brains behaved like those of non-ADHD controls. We don't yet know whether these brain changes preceded or followed the improvement in their behaviour, so the exact mechanism of the adults' recovery is unclear. In fact, in another synchronicity study, an MIT study found that the brains of adults who had recovered resembled those of ADHD adults more than those of controls.In non-ADHD people, when the Default Network is activated, another network, called the Positive Task Network, is inhibited. When the brain concentrates, the Positive Task Network takes over and puts the Default Network to rest. This reciprocal relationship is necessary for concentration. However, the two groups of adult ADHD sufferers, including those who had recovered, showed simultaneous activation of the two networks, as if they were functioning in opposition to each other. So the brains of the adults who had lost most of their symptoms had not recovered completely normal activity.What implications does this new research have for the way in which we apprehend and treat ADHD children? Of course, I'm not saying that we should take our children out of school and send them to the savannah. Nor am I saying that we should stop using stimulant drugs like Ritalin or Adderall, which are safe, effective and very useful for many children suffering from ADHD. But we might be able to help these children by learning from the experience of adults who have recovered from their symptoms. Firstly, we should do all we can to help young ADHDers select school environments or career paths that best suit their discovery-hungry nature, just as adults seem to choose jobs in which they are more likely to succeed.At school, these curious, experience-seeking children would probably be more comfortable in small classes that emphasise manual achievements, assignments and tasks that reinforce their specific ADHD skills, and computer-assisted self-study that adapts to their pace. This will not eliminate the need for many ADHD children to take psychostimulants. But let's not rush to medicalise their curiosity, energy and quest for novelty; in the right environment, these traits are not a handicap; on the contrary, they can be a real asset.