ADHD misdiagnoses

I'd never thought of this, but it sure sounds plausible. This study says one reason some kindergarteners are diagnosed as ADHD is that they are fidgetier than the other kids in class. One reason some kids are fidgetier than other kids in kindergarten is that they are a year younger than the oldest kids in class.

Kids born on December 1, who are the youngest kids in their kindergarten class California, are a year smaller and have a year less cognitive and social development than kids born on December 2 of the year before. This is why athletes and school leaders are disproportionately born in the early part of a school year, because that makes them a year bigger, smarter, and more coordinated than the kids born late in the cycle.

And the study linked to above says there may be a million kids misdiagnosed as ADHD. A million kids getting stimulants every day for years. I guess that's no worse than giving them bisphenyl A or organophosphates, which we do as a matter of government policy of acquiescing to corporate convenience. At least Ritalin doesn't screw up their sex hormones.

For the record, I was 4 years 6 months and 8 days on entering kindergarten; 4 years 6 months was the cutoff in California back in the Pleistocene. My mom had to go to work, and kindergarten was child care. She always regretted it. I was always glad. I wasn't the biggest, most coordinated, or most mature, but I was still the smartest. Although I guess it would be convenient to blame my character faults on it.

Another bad thing you can do to a fetus

Children who were exposed to organophosphate pesticides while still in their mother's womb were more likely to develop attention disorders years later. ... Organophosphate pesticides act by disrupting neurotransmitters, particularly acetylcholine, which plays an important role in sustaining attention and short-term memory. ... Many of these same UC Berkeley researchers are also finding that children with certain genetic traits may be at greater risk. ...

In the study on attention problems, researchers tested for six metabolites of organophosphate pesticides in mothers twice during pregnancy and in the children several times after birth. Together, the metabolites represent the breakdown products of about 80 percent of all the organophosphate pesticides used in the Salinas Valley.

The researchers then evaluated the children at age 3.5 and 5 years for symptoms of attention disorders and ADHD using maternal reports of child behavior, performance on standardized computer tests, and behavior ratings from examiners. They controlled for potentially confounding factors such as birthweight, lead exposure and breastfeeding.

Each tenfold increase in prenatal pesticide metabolites was linked to having five times the odds of scoring high on the computerized tests at age 5, suggesting a greater likelihood of a child having clinical ADHD. The effect appeared to be stronger for boys than for girls.

I'm not good at always washing fruit before putting it in the bowl nor veggies when I'm cooking, but this suggests that pregnant women, and people who cook for them, should fetishize washing fruits and veggies, make it as strong a stricture as not drinking.

My first thought is to ask why we are putting poisons like that on our food, and my second thought is the answer: We can't grow as much of the types of food people want to eat, as many people as want to eat it, at a price they are willing to pay, without industrial farming, which requires vast amounts of pesticides to sustain itself.

It's one of  those cases where the interests of the individual do not match the interests of the group. I would never use a pesticide on my home-grown tomatoes. I have some Safer Soap that I  haven't used in years, and I infused some olive oil with red peppers to spray on them, to try to deter the skunks, so I lose some tomatoes to bugs, but on the other hand, I don't eat any organophosphates with my tomatoes. (Terrible crop this year. Sparse crop of mostly mealy tomatoes. The one that has had any decent tomatoes is a Celebrity, but even it has had just a few tomatoes. Usually in August we're harvesting big basketfuls, but we're getting only a few per week, and them not very good. I blame the weather.)


But if the interest of the group is having enough food for everyone, we need pesticides, and a system for washing them off before we eat them. Maybe there's a way to clean them before packing at the grower. Keep the pesticide on the farm. 

Behavior affects brain activity in ADHD kids

Okay, this is certifiably weird. Behavioral interventions influence ADHD in the same way that medication does. That is, "by normalising activity in the same brain systems."

The computer task was capturing the green aliens while avoiding the black aliens. ADHD kids were better at it when they were on their meds, and this also showed up as more normal EEGs. It turned out if you gave the kids either rewards for succeeding or penalties for failing at the alien-capturing game,  their EEGs changed in the same way, though the effect was greater with the drugs.

"When the children were given rewards or penalties, their attention and self-control was much improved," says Dr Maddie Groom, first author of the study. "We suspect that both medication and motivational incentives work by making a task more appealing, capturing the child's attention and engaging his or her brain response control systems."

It's interesting that the rewards had to be immediate and consistent to work.

The drug these kids were on (methylphenidate) is thought to increase dopamine levels. I guess it's plausible that the prospect of a reward or penalty could increase dopamine levels in the brain. Why not? Or it could work through another mechanism.Why not? Everything is always more complicated than you think it is.

So it's not really weird, just an interesting coincidence that leads us again into questions of biological influences on behavior.

It also gives a big boost to the idea of behavioral therapies' affecting the biology of the brain. The practical implications of it are, if you have a choice between changing the brain chemistry by adding a chemical to it or by changing a behavior, why wouldn't you pick changing the behavior? (You do know I'm not a doctor, don't you? You realize this is advice from a humanities major, not a scientist.) The researchers say you could maybe do it for moderate ADHD, because the effect of behavioral change, though in the same place as medication, is not of the same magnitude. Drugs give a bigger effect, and so should be used in the more severe cases.

How Ritalin works; or, a pill to increase learning?

In addition to improving a kid's ability to focus, by increasing the release of dopamine, Ritalin also improves learning, by increasing brain plasticity, by releasing another type of dopamine. This is based on rats learning that sugar water followed a flash of light and a sound. Rats given Ritalin (in doses relatively the same as those give human kids) learned that faster than rats not given Ritalin. If researchers blocked D1 (for dopamine) receptors, Ritalin no longer helped learning; if they blocked D2 receptors, Ritalin didn't improve focus.

Some of the neat part of this is just learning more about the brain. The best part is the speculation it brings on. Suppose they find a drug that only enhances D1 release and (or some other drug that enhances the ability to learn), and even suppose we know it not to have any harmful side effects. Would we want to give it to all kids to generally improve their ability to learn? I don't mean requiring it, like vaccinations, just making it legally available to everyone without a social stigma, like steroids for the brain.

I'd be all for it. But imagine a high-school brain bowl where some kids are juiced and some are not. Is it fair to the non-drugged kids that the drugged kids all know more because they've been on super-Ritalin since kindergarten? Is this like steroids in baseball and track and field? Logically they are the same: taking a drug to increase your ability to learn or to increase your ability to train hard. Maybe the reason they feel different to me is that it's now my ox being gored. I would take a pill to learn better but not to train harder.

And I would see it less as a way for people who already learn well to learn even better, but even more as a public health measure, like adding folic acid to bread to prevent spinal bifida, only this would increase the percentage of people who can read car repair manuals or rental agreements.

I wonder if there are any foods (not food supplements) with nutrients that increase the release of D1. Google will know.

Another clue about ADHD

ADHD has been related to attention processes in the past, and now:

Researchers at Universitat Autònoma de Barcelona and the Vall d'Hebron University Hospital have now discovered anomalies in the brain's reward system related to the neural circuits of motivation and gratification. In children with ADHD, the degree of motivation when carrying out an activity is related to the immediacy with which the objectives of the activity are met. This would explain why their attention and hyperactivity levels differ depending on the tasks being carried out.

The importance of this to us non-scientists is it's another link between biological processes and behavior. When a kid consistently "misbehaves," the first guess at a cause should be something happening in the brain rather than just a bad kid. That doesn't mean a child care provider could diagnose anything physical from behavior, but providers, parents, and counselors should keep the possibility in mind when figuring out how to deal with what are euphemistically called "challenging behaviors." It won't be many years before the relevant genetic information is available for every kid. We just have to figure out how to use it responsibly. Just.

Lead and ADHD

This Science Daily article says ADHD may be up to 70% heritable and seeks to find the source of the other 30%. They point to lead in the environment, saying it turns off some genes in the brain.

If this is true, ADHD should have become less frequent when lead interior house paint was replaced with acrylic. I wonder if it did. Unless the lead-ADHD relationship is not dose related. Some masters student should find this out. Free thesis subject.

Of course, the heritability of ADHD should vary according to neighborhood, because heritability is the relative importance of genes to a condition that also has an environmental component, not the absolute importance to the condition, because the environment may change from place to place, so unless it's 100% genetic, heritability can vary. So if lead is one of the environmental culprits, the relative genetic influence on the incidence of ADHD would be high in neighborhoods with little lead in the environment and lower in neighborhoods with more lead.

But the article says it's not by neighborhood at all. I'll bet it used to be, when poor homes still had lead paint in them, but now, they say, there is a universal low level of lead, and every kid has it.

In that case, I'm afraid I'm pessimistic about removing it.

Playing brain games to ameliorate ADHD

I've seen reports of teaching monkeys to play computer games with a joystick and a wired helmet, and then disconnecting the joystick, and they keep playing the game with their brain only. This has recently been done with people, too.

Now it has a clinical application in Britain. They put a special helmet on a kid with ADHD, so the kid can play a computer game with just the mind 3 times a week for 12 weeks. The kid really has to concentrate to make the game work, and they said it reduced impulsive behavior. I have no way to evaluate it, but if it works, cool.

The system is called Play Attention. They're planning to roll it out across the UK this month.

Another bad thing about phthalates: ADHD

Phthalates are chemicals put into plastics to make them stay pliable, as well as "enteric coatings of pharmaceutical pills and nutritional supplements to viscosity control agents, gelling agents, film formers, stabilizers, dispersants, lubricants, binders, emulsifying agents, and suspending agents" in all sorts of products. They were recently shown to be related to female play behavior by preschool boys.

This study in Korea, reported in Science Daily, "found a significant positive association between phthalate exposure and ADHD, meaning that the higher the concentration of phthalate metabolites in the urine, the worse the ADHD symptoms and/or test scores."

Common chemical in plastic linked to girly-boy play

Phthalates are a common additive to plastics to help them stay pliable. You find them in PVC, plastic tubing, some soaps and lotions. One way they get into the body is by being released when the plastic is heated, for example in a microwave with food in a plastic bowl. Another way is by rubbing them on a baby's skin in lotion or powder. 

We already knew that exposure to phthalates are a risk factor for low-birth-weight babies, obese diabetic men, and does bad stuff to little boys' genitals. This is why they are now banned in teethers, play bath items, soft books, dolls and plastic figures.

Now we know it makes little boys play like girls. Researchers contacted mothers of children ages 3 1/2 to 6 1/2 years from a previous survey and had them fill out the Preschool Activities Inventory (PSAI), which is:

(D)esigned to discriminate play behavior within and between the sexes, and in the past has been shown to reflect the endocrine-disrupting properties of other toxins, such as PCBs and dioxins. The PSAI addressed three aspects of play: types of toys children choose (trucks versus dolls), activities (rough-and-tumble play, for example), and child characteristics…. Higher scores meant more male-typical play and lower scores meant more female-typical play.

Then they compared play-behavior scores and the levels of phthalate metabolites in their mothers' prenatal urine samples, finding that higher concentrations of the chemicals were associated with less masculine play behavior scores. They think it may involve changing testosterone levels in the womb.

Moral: Don't microwave your food in plastic containers or dishes.