Editor’s note: Melissa Orlov, LLC, is a marriage consultant who specializes in working with couples impacted by ADHD. She is the author of the award-winning book, The ADHD Effect on Marriage: Understand and Rebuild Your Marriage in Six Steps, and provides seminars for couples and therapists. Her continuing education presentation for GoodTherapy.org, The ADHD Effect on Couples, is scheduled for 9 a.m. PST on January 25. This event is available free with 1.5 CE credits for all GoodTherapy.org members. For details, please click here.

In your couples practice, you may well encounter couples in which one partner is chronically angry while the other keeps making mistakes that are hard to understand, such as regularly forgetting to do something they’ve committed to, constantly irritating their partner by being late, or never cleaning up after themselves. The angry partner tries many things to motivate his or her partner—nagging, scolding, pleading, crying—but nothing seems to work. The forgetful partner is genuinely contrite, yet continues doing the same “stupid” things.

It is possible that this couple’s relationship is being impacted by undiagnosed attention-deficit hyperactivity (ADHD).

Learning how to work with couples affected by ADHD is a relatively new and very much needed skill in couples therapy. It is only recently that we have been thinking much about ADHD in adults, and according to expert ADHD researcher Dr. Russell Barkley, as many as 90% of adults with ADHD remain undiagnosed (1). Clients often don’t know they have ADHD or that it contributes to their marital issues. Many times, neither do their therapists. Unfortunately, unrecognized ADHD can wreak havoc in a relationship—in some research studies, almost doubling rates of marital dysfunction and divorce (2).

One of the side effects of the repetitive missteps of an ADHD partner is that anger builds in the relationship. Chronic distractibility, disorganization, and difficulty remembering things are hallmark traits of adult ADHD that can severely impact one’s life. They also don’t play particularly well in a relationship or at home. A chronically distracted partner is often not particularly good at attending to his or her partner in a way that communicates love. The feelings of love are there, but the partner is simply off doing other things. It is no surprise that non-ADHD partners often report that they feel intensely lonely in their relationship (3).

As distraction, disorganization, and other ADHD symptoms continue unabated, partners of those with ADHD can lose patience and become so angry that it colors every aspect of the relationship. Minor gaffes become major blow-ups because they are symbolic of bigger issues in the relationship. For example, an ADHD partner who leaves the milk out on the counter may be reprimanded by his or her partner for “never paying attention” or being “lazy,” even though in other situations leaving milk out might be considered a “nonevent.”

With enough rebukes, an ADHD partner (who often suffers from self-esteem issues in any event) begins to avoid engaging with the non-ADHD partner. Anger that he or she is being constantly criticized builds, too. Arguments escalate more and more quickly, and the couple find themselves in a strong, negative behavioral spiral. They don’t understand their partner’s seemingly arbitrary behavior, but do understand they don’t like it.

My observation is that by the time ADHD-impacted couples make it to counseling, they are often in very significant trouble. They’ve tried everything they can think of to “fix” things, but because they don’t know about the ADHD, have not found a workable solution to their conflicts. They are suffering from great emotional pain, and are often feeling hopeless about the relationship. Many are trying to decide whether to get divorced, but are confused. They feel they ought to be able to do better and don’t understand why they can’t.

The good news for therapists is that working with these couples can literally turn their lives around. First, couples are typically greatly relieved to realize that there is a reason for their problems. Also, identifying ADHD provides a significant chance for behavioral improvement in the ADHD partner. With effort, about 70% of those with ADHD can find treatment that provides almost complete, or at least very significant, improvement in their symptoms (1).

Naming the problem not only provides renewed hope, it creates an opening for redirecting interactions between partners. Certain types of communication tactics, organizing habits, and ways to “attend” to each other simply work better than others for couples impacted by ADHD. These are often not the same tactics that couples not impacted by ADHD use (3), so therapists need new training to optimize their effectiveness.

Sometimes that training includes learning a new style of interacting with clients. I find that these couples respond well to an “activist” approach to counseling that puts the therapist in multiple roles at different points in the therapy—that of expert educator, listener, ADHD coach, sex advisor, and investigator, to name some of the most common. These couples tend not to learn through self-reflection. Rather, they need active guidance to learn a new skill set that will enable them to live together successfully and bridge their often very considerable differences.

Yes, these couples often have really significant problems. Not all of them stay together. But with the right assistance, many of them are able to turn their relationships back into something they treasure. For therapists, it can be incredibly fulfilling work.

References:

1. Barkley, R.A. (2010). Taking charge of adult ADHD. New York, NY: The Guilford Press.
2. Barkley, R. A., Murphy, K. R., Fischer, M. (2008). ADHD in adults: What the science says.New York, NY: The Guilford Press.
3. Orlov, M.C. (2010). The ADHD effect on marriage: Understand and rebuild your relationship in six steps. Plantation, FL: Specialty Press.

Adults and children with attention-deficit hyperactivity disorder (ADHD) often exhibit patterns of behavior that are different from individuals without ADHD. They tend to be more impulsive, have less focused attention, and take more risks. Tests that measure inhibitory control and attention can require subjects to respond rapidly to risk/reward scenarios. Other assessment tools used to gauge symptoms of inattention in ADHD prompt subjects to answer questions that are posed one after the other. All of these methods explore levels of cognitive functioning, processing speed, and working memory. But in a recent study, Walter Roberts of the Department of Psychology at the University of Kentucky posed a different question.

Roberts theorized that perhaps the impulsivity and inattention associated with ADHD were not merely the result of impaired cognitive ability, but inability to multitask due to decreased response capacity. To test this theory, Roberts conducted a study comparing 33 individuals without ADHD to 38 with ADHD in two separate tasks. The first task was designed to demonstrate response-selection ability, while the second test measured working memory. Together, the two tasks captured how well the participants responded under increased processing burdens. Roberts found that as the cognitive load became greater, the performance of both groups decreased. In the first task, the decline was more evident in the participants with ADHD, which suggests that these individuals have deficits in response-selection resources.

When Roberts assessed each group on the working-memory task, however, he found virtually no difference in their performance with respect to accuracy, but the ADHD group did take longer to respond. This could reveal a task-switching impairment in those with ADHD. Also, as the time between memory tasks decreased, the performance decreased for the ADHD group. These results show that although multitasking is one mechanism that appears to be negatively affected in people with ADHD, overall memory capacity is not. “This limited processing capacity may have implications for understanding cognitive dysfunction in adults with ADHD,” Roberts said. For example, maintaining employment requires constant cognitive task-switching, making it potentially more difficult for people with ADHD than for those without. Comprehending oral and written material in classroom settings could also deplete processing capacity and result in academic challenges for children with ADHD. Roberts hopes the results of his study will open the door for further exploration into the factors that could contribute to cognitive and behavioral impairments in those with ADHD.

Reference:
Roberts, Walter, Richard Milich, and Mark T. Filmore. Constraints on information processing capacity in adults with ADHD. Neuropsychology 26.6 (2012): 695-703. Print.

For children and adolescents with attention deficit hyperactivity (ADHD), Ritalin (methylphenidate) is typically the medication of choice. As a psychostimulant drug, Ritalin increases the concentration of the neurotransmitters dopamine and noradrenalin in the brain. These neurotransmitters are partly responsible for impulse control and attention, among other things.

Studies in both rats and humans have verified that Ritalin effectively controls the three primary symptoms of ADHD: inattention, hyperactivity, and impulsivity. When ADHD goes into remission, the person’s quality of life and performance in work or school measurably improve.

Despite these benefits, critics have wondered about the potential negative effects of this heavily prescribed medication. For one thing, no one fully understands how Ritalin functions in the brain. More importantly, little information exists as to the long-term effects of a psychostimulant drug on the developing brain. A recent study with rats highlighted a possibly adverse effect of Ritalin that had previously been overlooked.

Adolescent play behavior is important in terms of both mental and social development. Through play, children learn the basic “rules” of social interaction and receive the rewards of companionship. Isolated children often have difficulty adjusting to adult life and navigating social situations. Researchers investigating Ritalin’s effect on social play found that the medication significantly reduces the behavior in rats.

Adolescent rats treated with low doses of Ritalin were apt to ignore invitation to play, instead remaining focused on their general environment. The effect was surprisingly specific. Rats demonstrated the same overall activity levels as untreated counterparts, but less overt play behavior and social interaction. Some rats were isolated for up to 24 hours before release into a play area. Researchers believed a long period of isolation would enhance play despite the effects of Ritalin, but they were mistaken. Regardless of isolation period, Ritalin proved to be a powerful blocker of normal, social play behavior.

The beneficial effects of Ritalin for people with ADHD are inseparable from the possibly negative effects of inhibited play. By its very nature, play is a complex, dynamic, but not necessarily focused activity. One of the primary aspects of Ritalin’s overall effect is to inhibit “unfocused,” freewheeling behaviors—including play, apparently. This calls for more research and possibly long-term studies of the potential consequences of Ritalin prescription throughout childhood and adolescence. It’s possible that this medication poses more risks than previously believed.

References:

1. Attention deficit hyperactivity disorder (ADHD) – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
2. Vandershuren, L., Trezza, V., Griffioen-Roose, S., Schiepers, O., Van Leeuwen, N., De Vries, T.J., and Schoffelmeer, A. (2008). Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology, 33, (12), 2946-2956.

Play therapy is widely recognized as an effective therapeutic approach for children who are unable or unwilling to communicate their psychological distress. Elementary-aged children represent an especially vulnerable segment of the population when it comes to mental health barriers. First, it is during these formative years that behavior patterns are set. Children who have psychological problems early on tend to have higher rates of substance misuse, aggression, risk-taking behavior, and academic challenges than their peers. Additionally, many young children who have attention-deficit hyperactivity disorder, obsessive compulsive disorder, posttraumatic stress, autism, or other difficulties may have significant academic challenges and can benefit greatly from effective and meaningful in-school therapy.

But believing in the viability of play therapy and delivering it are two different things. Many school counselors report significant barriers to play therapy. Christine Ebrahim of the Department of Counseling at Loyola University in New York wanted to take a closer look at the barriers that counselors faced and how they overcame them. Ebrahim enlisted 359 elementary school counselors from the American School Counselor Association and had them complete online surveys regarding barriers to play therapy. The participants reported barriers such as time, space allocation, financial resources, and administrative and parental support. However, nearly all the counselors who cited these obstacles also described how they overcame them. For instance, they used their own money for supplies when they could not get funding, moved sessions to alternative locations when space was limited, and provided education about the benefits of play therapy when administrative and parental support was lacking.

One barrier was more difficult to surmount: the limited availability of play therapy training. “In looking at the data, most counselors identified specifically a lack of training as their primary problem,” Ebrahim said. Play therapy courses are not part of the curriculum at all colleges. Therefore, counselors are forced to learn through textbooks or online, or they must pay for training out of their own pockets. These results are promising in that they suggest that counselors are willing to do whatever it takes to offer play therapy to students in need. However, Ebrahim believes the findings clearly demonstrate that elementary school counselors are in desperate need of more professional play therapy training.

Reference:
Ebrahim, C., Steen, R. L., Paradise, L. (2012). Overcoming school counselors’ barriers to play therapy. International Journal of Play Therapy. Advance online publication. doi: 10.1037/a0029791

Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

Related articles:
6 CAM Tools for Achieving Better Health, Emotional Balance, and Contentment
Biofeedback for Treatment of Migraines and Stress
10 Complementary Therapies That Can Help Children

Children with social, emotional, and behavioral difficulties (SEBD) often exhibit speech, language, and communication needs (SLCN) as well. Clinicians and educators who work with these children have the challenge of identifying which type of treatments will best serve the needs of these special children. SEBD has been shown to be linked to communication deficits, but this relationship has not been fully explored. Gender, social conditions, intelligence, and relationship styles are factors that contribute to both SLCN and SEBD. Most children with these problems are not identified until they enter school, making the correlation between them more convoluted. For instance, executive function deficits may not be discovered until children enter school and exhibit symptoms of attention deficit hyperactivity disorder (ADHD). Other children may live with negative psychological and physical conditions such as abuse or neglect that can cause the children to stifle their communication, resulting in communication problems later on.

The most common type of treatment for SEBD is cognitive behavioral therapy (CBT). In a recent analysis of existing research, James Law of the Institute of Health and Society at Newcastle University in the UK looked to see whether CBT was ever combined with communication therapy for children. He also studied the research on CBT outcomes in children with Asperger’s, autism, and anxiety to determine whether the therapy had any positive impact on communication skills. For his research, Law examined 19 separate studies that included data from 148 children with SEBD and SLCN.

Although Law did not isolate one particular CBT approach that would be most beneficial for these children, he did discover that variation in communication enhancement techniques had a positive impact. Specifically, more formal techniques appeared to help the children with autism spectrum issues the most, and naturalistic and educational approaches were identified as effective methods for children with mild communication and behavior problems. In conclusion, Law added, “The potential overlap between SLCN and SEBD needs to be widely recognized by practitioners, and the implications for practice of this overlap explored more fully.”

Reference:
Law, J., Plunkett, C. C., Stringer, H. (2012). Communication interventions and their impact on behaviour in the young child: A systematic review. Child Language Teaching and Therapy, 28.1, 7-23.

For children, teens, and college students, summertime is associated with freedom from school and positive emotions. However, summer can also be a time where certain mental health issues need to be tended to even more than usual. Experts share information on what mental health problems can be present more often during summer and how to prevent certain issues.

Peter Zafirides, a psychiatrist in Ohio, said he has noticed a common mental health issue for children, teens, and students during the summer. Many evaluate whether they should still take their medication for attention deficit hyperactivity disorder (ADHD).

“Stimulants are often prescribed during the school year, but depending on the severity of the underlying ADHD, the summers may provide for some time off the medications,” Zafirides said. “But it may not always be smooth-going. The combination of unmedicated ADHD symptoms, along with the less structured days of summer can be very problematic for kids and their parents. Beyond the attention symptoms that worsen, kids can experience mood changes, including anxiety and irritability.”

School can provide a consistent schedule, which can be better for children with certain mental illnesses. “The potential unstructured nature of the summer can feed in to any underlying anxiety disorders and depression present in these kids,” he added.

For children who have ADHD, Zafirides has tips to make summer more bearable. “Children and parents may benefit from sitting down at the beginning of the summer and talking about shared goals and expectations,” Zafirides said. “Have a plan ahead of time to regularly check in with each other and, in an open, nondefensive forum, talk about any changes in behavior or concerns about mood.”

He also has other suggestions that can apply to children and teens with any type of mental illness or mental health issues. “Get outside and enjoy the summer. Try to limit the amount of time online, watching TV, or playing video games,” Zafirides said. “Be active, get plenty of sleep and exercise. If medications will continue over the summer, make sure kids are taking them regularly. Again, summer is less structured, so compliance may not be as consistent, resulting in a worsening of a mental health condition. Always speak to your medical professional before either discontinuing or reducing the dosages of medication.”

Communication is key for healthy relationships and lives. “I think the most important aspect between parents and children in the summer months is to establish clear and respectful lines of communication without either side getting defensive or feeling they are not being heard,” Zafirides said. “An occasional small discussion may be all that is needed to avoid big problems over the summer.”

John Duffy, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens said in an email that depression can be more noticeable during the summer. “I have found that depression driven by loneliness often becomes more pronounced in the summer,” Duffy said. “This may be due in part to the fact that people are more obviously out, about, and social in the summertime. For many young people, summer is a far less-structured time of year than any other season.”

Anxiety issues can also come to the surface. “We often find that anxiety-based issues become apparent due in part to the lack of structure,” Duffy said. “Though most young people claim this is the time of year they most look forward to, many become listless and irritable because of a lack of structured activity.”

The solution to these issues is to provide somewhat consistent structure during the summer. “This might include participation in a sport, a play, a camp or other club, volunteer activity, or a job,” Duffy said. “Kids do better when they are part of something. They are happier, less restless, and more driven. Summer also presents a unique opportunity for young people to investigate strengths and interests, and opportunity that is less open to them during the very-structured school year.”

Adults can experience the same mental health issues as children during the summer, especially depression and anxiety. “Depressed adults are more aware, for example, of the degree to which others are socially connected during the summer, and this can serve to amplify the depression,” Duffy said. “Many adults also tell me that, though they want to be more active, limitations imposed by work and other obligations prevent them from doing so. This can contribute to feelings of depression and anxiety as well.”

The National Alliance on Mental Illness website suggests that some people can actually experience seasonal affective disorder (SAD) during the summer. SAD is characterized by depressive episodes that occur during certain times of the year (typically during the winter). In the case of seasonal affective disorder that is experienced during the summer, symptoms tend to be weight loss, minimal appetite, anxiety, irritability, and insomnia. Heat and humidity could worsen this “reverse SAD,” according to the website. Some adults with bipolar disorder are more likely to experience the mania part during spring and summer as well, he said.

William Oswald, the CEO and director of Summit Malibu, a behavioral and addiction treatment center in California, said in an email that all types of mental health issues can occur more often during the summer, such as agoraphobia, addictions and compulsions, as well as the more common depression and seasonal affective disorder.

“When people have a purpose, or curriculum in this case, their minds stay occupied, and boredom is not as prevalent of an issue,” Oswald said. “When they go from being extremely busy to having nothing to do, oftentimes this boredom results in mild, or in some cases severe, forms of depression. Once untreated, depression sets in, people (teens and college students especially) end up self-medicating with drugs or alcohol as a means to simply feel better. This is true of seasonal affective disorder as well—some may not want to be outside, and in turn isolate, resulting in isolative behaviors and a depressive state.”

Oswald has specific preventative tips for each age group during the summer:

Children: “Setting play dates with other kids or sending them to a day-care program where they do outside activities can keep their minds occupied and also help with socialization. This is key to preventing isolating behaviors later on in life.”

Teens: “Having a part-time summer job is the most important thing they can do to protect their mental health. They will learn the importance of a work ethic, earn money (which they can then spend on fun activities), and [prevent] boredom—the number one offender during summer breaks.”

College students: “Having an internship or continuing to work on their educational goals will keep them focused and driven, preventing depression and other detrimental behaviors associated with the disorder.”

Unfortunately, these suggestions will not always work, and in that case it’s best to seek a mental health professional to keep any mental health issues from worsening.

For adults, it can be unfortunate to be stuck inside working when the weather is gorgeous (at least in some places). This can be just another trigger for depression and other mental illnesses like substance-related disorders. “Adults need to utilize their vacation days properly so they have something to look forward to and get to experience summertime weather on days other than the weekend,” Oswald said. “Making time for outdoor activities on the weekend and starting an exercise program will keep one’s mood elevated.”

Adderall (dextroamphetamine and amphetamine) is one of the preferred treatment options for adults with attention-deficit hyperactivity disorder (ADHD). The medication works by increasing an individual’s ability to pay attention and control impulsive behaviors. In people without ADHD, abuse of Adderall generates a euphoric sensation, included elevated feelings of confidence and power. When taken as prescribed, Adderall carries a risk of several unpleasant side effects. These include difficulty sleeping, nervousness, restlessness, and headache. Chest pain, rapid heartbeat, and shortness of breath are all signs of a potentially serious condition, warranting immediate medical attention.

Although the risk is small, there have been several documented cases of young people experiencing sudden heart attacks after taking Adderall without a prescription. The dosages were not especially high in many of these cases. In one such example, a young male suffered an acute heart attack after ingesting 30 mg of Adderall and drinking an unspecified amount of alcohol. He had no history of heart abnormalities. Still more troubling, cardiac events are possible even in the absence of abuse. A 15-year-old boy in otherwise good health experienced a heart attack in response to his usual dose of Adderall. He fully recovered, and terminating the prescription removed any signs of heart irregularities. Doctors are not certain what causes these effects in people. Currently, there’s no test to determine who will or will not develop cardiac side effects when taking Adderall. The best practice right now is to monitor an individual’s symptoms closely and intervene at the first sign of trouble. In addition, a history of heart issues may argue for a treatment plan that does not include a powerful stimulant like Adderall.

The extended-release formulation of Adderall was removed from the Canadian market for several years out of concerns about heart attacks and rampant abuse of the medication. It was eventually reintroduced with stricter guidelines for attending physicians. As always, those who abuse prescription medications like Adderall face far greater risks of dangerous, even lethal, side effects. Heart rhythm problems and heart attacks are the most troubling potential consequences of Adderall abuse. Even those who take the medication according to a doctor’s prescription face the small but real threat of cardiac problems. As research into ADHD and stimulant medications continues, safer drugs and drugs less prone to abuse will most likely be introduced.

References:

1. Centers for Disease Control and Prevention. (n.d.) Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Jiao, X., Velez, S., Ringstad, J., Eyma, V., Miller, D., Bleiberg, M. (2009). Myocardial infarction associated with Adderall XR and alcohol use in a young man. Journal of the American Board of Family Medicine, 22(2), 197-201.
4. Sylvester, A.L., Agarwala, B. (2012). Acute myocardial infarction in a teenager due to Adderall XR. Pediatric Cardiology, 33(1), 155-157.

According to a new study led by A.C. Burnett of the Department of Psychology at the University of Melbourne in Australia, children born prematurely and with low birth weights (LBW) are three-and-a-half times more likely to develop mental health problems such as depression and anxiety than normal birth weight (NBW) children. Children born prematurely are already at increased risk for physical health problems, learning disabilities, and other cognitive challenges. Some research has provided evidence that children who are born prematurely are at a higher risk for behavioral problems and even attention-deficit hyperactivity disorder (ADHD). But until now, there has been little evidence suggesting that these children are also more vulnerable to mood disorders and mental health problems later in life.

In order to examine the relationship between LBW and mental health problems, Burnett analyzed previous studies and looked specifically at prematurity/LBW and how it influenced the development of anxiety and depression in adolescence and young adulthood. Burnett assessed data that was published between 1995 and 2010 and included individuals born prematurely with LBW, ranging in age from 10 to 25 years old. After review, Burnett discovered that children who were born prematurely and had LBW had a significantly higher risk than NBW peers, for the development of psychiatric problems later in life. In particular, the study revealed that the LBW participants were three times more likely to develop an anxiety or depressive disorder in adolescence or young adulthood than those who were born full-term.

The results of this study, the first of its kind, have significant clinical implications. Burnett believes that professionals treating the physical and cognitive impairments in LBW children should be aware of the negative psychological predisposition that these children possess, paying particular attention to mental health needs during adolescence and young adulthood. Burnett added, “The studies reviewed here indicate that, in addition to monitoring and management of medical and cognitive sequelae, the psychological well-being of formerly preterm individuals should be a key part of ongoing care in collaboration between clinicians, individuals and their families.”

Reference:
Burnett, A. C., Anderson, P. J., Cheong J., Doyle, L. W., Davey, C. G., Wood, S. J. Prevalence of Psychiatric Diagnoses in Preterm and Full-term Children, Adolescents and Young Adults: A Meta-analysis. Psychological Medicine 41.12 (2011): 2463-474. Print.

Amphetamine abuse and addiction is a serious and growing public health issue throughout the United States. Addiction inevitably leads to rising health costs, lost productivity, broken families, and progressively declining quality of life for drug users. Medical science has yet to formulate a satisfactory answer to this problem. Rehabilitating users is clearly one of the primary objectives, but there are numerous stumbling blocks along the way. Typical users deny the seriousness of their addiction unless and until dire consequences arise. Withdrawal effects from amphetamine are profound, and recovering addicts experience relapse at alarmingly high rates. The current best practices for addiction treatment include supportive individual therapy, group therapy, and profound lifestyle changes. In severe cases of withdrawal, anti-anxiety medications are often prescribed to ease feelings of fear and discomfort.

Ironically, amphetamines serve a therapeutic purpose in the treatment of both attention deficit hyperactivity disorder (ADHD) and narcolepsy. Dexedrine (dextroamphetamine), Adderall (dextroamphetamine and amphetamine), and Ritalin (methylphenidate) are the three primary stimulant drugs prescribed for these purposes. Recently, a nonstimulant medication, Strattera (atomoxetine) has received attention both as an alternative treatment for ADHD and as a possible therapy for recovering amphetamine addicts. Researchers in Connecticut discovered that Strattera, when taken over the course of several days, actually suppresses the effects of Dexedrine. Participants in a study group pretreated with Strattera reported fewer positive drug feelings when given a single dose of Dexedrine. Similarly, blood plasma levels showed fewer chemical markers of the heightened mood state typically associated with Dexedrine and other amphetamines.

The mechanics of amphetamine addiction are still something of a mystery. Researchers know that several chemicals in the brain are important to building and maintaining a state of dependence. Dopamine is one of these chemicals, and it plays a major role in the so-called “reward system.” Norepinephrine is thought to be responsible for the feelings of energy and euphoria experienced by users. Effective pharmaceutical interventions will need to disrupt some of the patterns that amphetamines establish within the brain. The most recent experiments have shown that norepinephrine is at least as important as dopamine in generating the stimulating physical and psychological effects of amphetamines. By altering the levels of norepinephrine with Strattera, the positive drug feelings of Dexedrine are greatly reduced.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Atomoxetine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000222/
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Sofuoglu, M., Hill, K., Kosten, T., Poling, J. (2009). Atomoxetine attenuates dextroamphetamine effects in humans. American Journal of Drug and Alcohol Abuse, 35(6), 412-416.

Being the target of bullying can cause a child to internalize and experience a decrease in self-worth. Many children who are victims of bullying become isolated and withdrawn, and often have a limited social circle of friends. “Because many of the correlates and predictors of peer victimization are common in children with ADHD, it is not surprising that children with ADHD are at elevated risk for peer victimization,” said Stephanie L. Cardoos of the Department of Psychology at the University of California, Berkeley. “Although more is known about risk factors for victimization than about protective factors, one well-established protective factor for those at risk of victimization is friendship.” Cardoos and her colleague Stephen P. Hinshaw recently conducted a study to determine what affect friendship would have on bullying. “The overall purpose is to understand factors that may both predict and protect  against peer victimization in girls with ADHD, with a particular focus on friendship as a protective factor,” said Cardoos.

The researchers examined data from 228 girls between the ages of 6 and 12, half of whom had ADHD. The girls were evaluated by counselors at several points during a five week summer camp program and the girls listed who they considered to be their friends and which girls they did and did not like. The team found that all of the girls who were bullied exhibited similar symptoms, regardless of whether they had ADHD or not. “Our core finding was that the presence of a mutual friendship moderated the association between each behavioral risk factor and victimization, such that the presence of at least one friend reduced risk of victimization,” said Cardoos. “The current findings suggest that even for those who may be at elevated risk for deleterious peer effects, such as girls with ADHD, peers can play an important protective role.” She added, “If friends protect by intervening directly in challenging peer situations, it will be important for at-risk children to develop a friend in their natural peer group. In contrast, if friends are most important in increasing self-esteem, interventions outside of the natural peer group may be equally protective.”

Reference:
Cardoos, Stephanie L., and Stephen P. Hinshaw. “Friendship as Protection from Peer Victimization for Girls with and without ADHD.” Journal of Abnormal Child Psychology 39.3 (2011): 1035-045. Print.

Attention Deficit Hyperactivity Disorder (AHDH) is viewed as a neuro-developmental disorder throughout the world. Most cultures recognize that it presents chronic symptoms that cause dysfunction and is a condition that should receive treatment. Although there is some international consensus regarding ADHD, the methods and prevalence of treatment vary greatly from one country to the next. A recent study examined the tolerance and treatment protocols for ADHD in ten different countries, including the United States, Norway, the United Kingdom, the Netherlands, Australia, Canada, Israel, Germany, China and Brazil. The researchers assessed historical data, educational attitudes, costs, treatments, diagnoses, and stigmas relating to ADHD within these ten countries and discovered that there were significant variances. Most notably, the differences were not in the prevalence of ADHD or cultural factors, but rather in the definition of the disorder and the treatments provided. (more…)