How Ritalin Works In Brain To Boost Cognition, Focus Attention

ScienceDaily (June 25, 2008) — Stimulant medications such as Ritalin have been prescribed for decades to treat attention deficit hyperactivity disorder (ADHD), and their popularity as "cognition enhancers" has recently surged among the healthy, as well.

What's now starting to catch up is knowledge of what these drugs actually do in the brain. In a paper publishing online this week in Biological Psychiatry, University of Wisconsin-Madison psychology researchers David Devilbiss and Craig Berridge report that Ritalin fine-tunes the functioning of neurons in the prefrontal cortex (PFC) - a brain region involved in attention, decision-making and impulse control - while having few effects outside it.

Because of the potential for addiction and abuse, controversy has swirled for years around the use of stimulants to treat ADHD, especially in children. By helping pinpoint Ritalin's action in the brain, the study should give drug developers a better road map to follow as they search for safer alternatives.

At the same time, the results support the idea that today's ADHD drugs may be safer than people think, says Berridge. Mounting behavioral and neurochemical evidence suggests that clinically relevant doses of Ritalin primarily target the PFC, without affecting brain centers linked to over-arousal and addiction. In other words, Ritalin at low doses doesn't appear to act like a stimulant at all.

"It's the higher doses of these drugs that are normally associated with their effects as stimulants, those that increase locomotor activity, impair cognition and target neurotransmitters all over the brain," says Berridge. "These lower doses are diametrically opposed to that. Instead, they help the PFC better do what it's supposed to do."

A behavioral disorder marked by hyperactivity, impulsivity and the inability to concentrate, ADHD has been treated for more than a half-century with Ritalin, Adderall and other stimulant drugs. New reports also indicate these meds have lately been embraced by healthy Americans of all ages as a means to boost mental performance.

Yet, despite their prevalence, we know remarkably little about how these drugs work, especially at lower doses that have been proven clinically to calm behavior and focus attention in ADHD patients, says Berridge. In 2006, his team reported that therapeutic doses of Ritalin boosted neurotransmitter levels primarily in the PFC, suggesting a selective targeting of this region of the brain. Since then, he and Devilbiss have focused on how Ritalin acts on PFC neurons to enhance cognition.

To answer this, the pair studied PFC neurons in rats under a variety of Ritalin doses, including one that improved the animals' performance in a working memory task of the type that ADHD patients have trouble completing. Using a sophisticated new system for monitoring many neurons at once through a set of microelectrodes, the scientists observed both the random, spontaneous firings of PFC neurons and their response to stimulation of an important pathway into the PFC, the hippocampus.

Much like tiny microphones, the electrodes record a pop every time a neuron fires, Devilbiss explains. Analyzing the complex patterns of "voices" that emerge is challenging but also powerful, because it allows study of neurons on many levels.

"Similar to listening to a choir, you can understand the music by listening to individual voices," says Devilbiss, "or you can listen to the interplay between the voices of the ensemble and how the different voices combine."

When they listened to individual PFC neurons, the scientists found that while cognition-enhancing doses of Ritalin had little effect on spontaneous activity, the neurons' sensitivity to signals coming from the hippocampus increased dramatically. Under higher, stimulatory doses, on the other hand, PFC neurons stopped responding to incoming information.

"This suggests that the therapeutic effects of Ritalin likely stem from this fine-tuning of PFC sensitivity," says Berridge. "You're improving the ability of these neurons to respond to behaviorally relevant signals, and that translates into better cognition, attention and working memory." Higher doses associated with drug abuse and cognitive impairment, in contrast, impair functioning of the PFC.

More intriguing still were the results that came from tuning into the entire chorus of neurons at once. When groups of neurons were already "singing" together strongly, Ritalin reinforced this coordinated activity. At the same time, the drug weakened activity that wasn't well coordinated to begin with. All of this suggests that Ritalin strengthens dominant and important signals within the PFC, while lessening weaker signals that may act as distractors, says Berridge.

"These results show a new level of action for cognition-enhancing doses of Ritalin that couldn't have been predicted from single neuron analyses," he says. "So, if you're searching for drugs that might replace Ritalin, this is one effect you could potentially look for."

He and Devilbiss also hope the research will help unravel an even deeper mystery: exactly how neurons encode complex behavior and cognition.

"Most studies look at how something that impairs cognition affects PFC neurons. But to really understand how neurons encode cognitive function, you want to see what neurons do when cognition is improved," says Berridge. "So this work sets the stage for examining the interplay among PFC neurons, higher cognition, and the action of therapeutic drugs."

The work was funded by the National Institute on Drug Abuse, the National Institute of Mental Health and the UW-Madison Discovery Seed Grant Program.

Thriving with ADHD

For all you who asked, here is the outline for the February 3, 2009 Teleconference Thriving with ADHD

What is ADHD
• A medical condition characterized by inattention, impulsivity and or hyperactivity
• Approximately 5-7 percent of school-aged children have ADHD
• 2 million children in US
• 5 million adults US
ADHD is not
• Lack of motivation
• Poor parenting
• A result of parenting
• Laziness
• Low intelligence
• Uncommon
Executive Function
• "Executive Function" refers to a set of mental processes that serve as the boss of our brain, the organizer, strategic planner and Chief Executive Officer of our brain.
• We use executive function when we perform activities such as planning, organizing, strategizing, paying attention to details and remembering information.
When The Boss is Out
• Difficulty with
– Problem solving
– Organization
– Managing behavior
– Mood modulation
– Starting and stopping behaviors
– Staying on task
EF Observable Behavior
• TIME MANAGEMENT
– Finish work on time
– Keep track of time
– Make and keep plans
• ATTENTION
– Stay on task
– Make and act on corrections while speaking, thinking, reading and writing
• ORGANIZING THOUGHTS TO COMMUNICATE THEM
– Ask for what one needs
– Communicate ides in a relevant sequential manner
– Express emotional state thoughtfully
– Act on self-corrections while speaking, thinking, reading and writing
EF Observable Behavior
• PLANNING
– Initiating relevant tasks
– Acting on independently generated ideas or plans
– Planning a project
– Projecting how much time is needed for a project
• MEMORY
– Holding information in working memory
– Retaining and using information in the moment
– Retrieving information from memory
– Keeping track of more than one thing at once
Additional Domains
• IMPULSIVITY
• MOOD MODULATION
• SENSORY STIMULATION
Co-morbid Issues
• ODD
• CD
• Tics
• Anxiety
• Depression
• Social issues
• Self-esteem
Managing ADHD
• Structure
• Organization
• Planning
• Mastery
• Family mission
• Family values
• Clear rules
• Clear expectations
• Clear consequences

Hear You Then.

Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.

Thrive with ADHD

There are an estimated 1.46 to 2.46 million children with ADHD in the United States, constituting 3 to 5 percent of the school student population.

It has been documented that approximately 25 to 30 percent of all children with ADHD also have learning disabilities. Likewise, children with ADHD have coexisting psychiatric disorders at a much higher rate.

These children and their parents need the skills to enhance attention, contain impulsivity, increase delay and manage their motors. Join a fruitful conversation as you learn to help your child thrive with ADHD and associated challenges.

Teleconference TUESDAY FEB 3, 2009 Thriving with ADHD - Whether your children are diagnosed with ADHD or not, this teleconference is for you if your children are overactive, impulsive or have executive function challenges.

Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.

Hear you there!

Three Components of Successful School Programs for Children with ADHD

The ADHD child’s school success is often dependent on his or her ability to attend to tasks and teacher and classroom expectations with minimal distraction. When a child exhibits behaviors associated with ADHD, consequences may include difficulties with school and with forming relationships with his or her peers if appropriate instructional methodologies and interventions are not implemented.

There are an estimated 1.46 to 2.46 million children with ADHD in the United States, constituting 3 to 5 percent of the school student population. It has been documented that approximately 25 to 30 percent of all children with ADHD also have learning disabilities. Likewise, children with ADHD have coexisting psychiatric disorders at a much higher rate.

When selecting and implementing successful school strategies and practices for the ADHD student, it is imperative to understand the characteristics of the child, including those pertaining to disabilities. This knowledge will be useful in the evaluation and implementation of successful practices, which are often the same practices that benefit students without ADHD.

Three Components of Successful Programs for Children with ADHD: The three main components of a successful ADHD school strategy are academic instruction, behavioral interventions, and classroom accommodations. This guide outlines a series of strategies proven successful in not only educating children with ADHD but all children. By incorporating techniques from these three areas into their everyday instructional and classroom management practices, teachers will improve the academic performance and the behavior of their students with ADHD.

Academic Instruction: The first major component of the most effective instruction for children with ADHD is effective school instruction. Teachers can help prepare their students with ADHD to achieve by applying the principles of effective teaching when they introduce, conduct, and conclude each lesson during the school day. The discussion and techniques that follow pertain to the instructional process in general (across subject areas); strategies for specific subject areas appear in the subsequent subsection “Individualizing Instructional Practices.”

Behavioral Interventions: The second major component of effective school instruction for children with ADHD involves the use of behavioral interventions. The purpose of behavioral interventions in the school setting is to assist ADHD students in displaying the behaviors that are most conducive to their own learning and that of classmates. Well-managed classrooms prevent many disciplinary problems and provide an environment that is most favorable for learning. When a teacher’s time must be spent interacting with students whose behaviors are not focused on the lesson being presented, less time is available for assisting other students. Behavioral interventions should be viewed as an opportunity for teaching in the most effective and efficient manner, rather than as an opportunity for punishment.

Classroom Accommodations: The third component of a strategy for effectively educating children with ADHD involves physical school classroom accommodations. Children with ADHD often have difficulty adjusting to the structured environment of a classroom, determining what is important, and focusing on their assigned work. They are easily distracted by other children or by nearby activities in the school classroom. As a result, many children with ADHD benefit from accommodations that reduce distractions in the classroom environment and help them to stay on task and learn. Certain accommodations within the physical and learning environments of the classroom can benefit children with ADHD. Source: U.S. Department of Education. To order a hard copy of this ADD teaching report, e-mail edpubs@inet.ed.gov or call (877) 433-7827.

ADHD Executive Function Deficits and Meditation

"A UCLA study shows that only about half of children diagnosed with attention-deficit hyperactivity disorder, or ADHD, exhibit the cognitive defects commonly associated with the condition.

The study also found that in populations where medication is rarely prescribed to treat ADHD, the prevalence and symptoms of the disorder are roughly equivalent to populations in which medication is widely used.

The results of the first large, longitudinal study of adolescents and ADHD, conducted among the population of northern Finland, appeared in several papers in a special section of the Journal of the American Academy of Child and Adolescent Psychiatry published in December and are currently online.

ADHD is a common, chronic behavioral disorder characterized by inattention, hyperactivity and impulsivity that is thought to affect some 5 to 10 percent of school-age children worldwide.

In adolescence, ADHD is generally associated with cognitive deficits, particularly with working memory and inhibition, which have been linked to overall intelligence and academic achievement, according to UCLA psychiatry professor Susan Smalley, who headed the research. Interestingly, the study showed that these deficits are only present in about half of adolescents diagnosed with ADHD.

Part of the explanation may lie in the common method for diagnosing the disorder. The researchers found that ADHD is an extreme on a normal continuum of behavior that varies in the population, much like height, weight or IQ. Its diagnosis, and thus its prevalence, is defined by where health professionals "draw the line" on this continuum, based on the severity of the symptoms and overall impairment.

However, children with cognitive deficits do not show increased levels of inattention or hyperactivity when compared with other children diagnosed with ADHD, the study found, suggesting that behavior-rating scales alone are not sensitive enough to differentiate between the two groups. Additional psychological testing is recommended to confirm the presence of cognitive impairments."

This is why we often refer the children in our practice for a brief Neuropsychological assessment with a board certified child neuropsychologist. These evaluations are important in recommending a course of intervention. Some children may benefit from executive brain function training others may be subject to misdiagnosis, others may be twice gifted. Children really do come in all shapes and sizes and it is central to their well-being that we learn as much about them as possible to provide them with what they need.

Curiously, we also regard interventions such as mindfulness training, meditation and yoga to be important aspects of intervention for ADHD.

Read what researcher Dr. Susan Smalley has to say about meditation on her thoughtful blog. www.huffingtonpost.com/susan-smalley/medication-or-meditation-_b_14839.html

Then visit www.drthomasebrown.com and read about current research on brain development and ADHD as well. Happy learning.