Strengths and Weaknss of ADHD sypmtoms and Normal behaviour scale (SWAN)

This scale can be used in a few different ways, originally this was had 4 frequency codes – Not at all, Just a little, Quite a bit, and Very much.

More recently, it has been used in a 7 point scale from -3 to +3, as far above average to far below average “compared with other children”.

  1.  Give close attention to detail and avoid careless mistakes
  2.  Sustain attention on tasks or play activities
  3.  Listen when spoken to directly
  4.  Follow through on instructions & finish school work/chores
  5.  Organize tasks and activities
  6.  Engage in tasks that require sustained mental effort
  7.  Keep track of things necessary for activities
  8.  Ignore extraneous stimuli
  9.  Remember daily activities
  10.  Sit still (control movement of hands/ feet or control squirming)
  11.  Stay seated (when required by class rules/social conventions)
  12.  Modulate motor activity (inhibit inappropriate running/climbing)
  13.  Play quietly (keep noise level reasonable)
  14.  Settle down and rest (control constant activity)
  15.  Modulate verbal activity (control excess talking)
  16.  Reflect on questions (control blurting out answers)
  17.  Await turn (stand in line and take turns)
  18.  Enter into conversations & games (control interrupting/intruding)

Adults with ADHD are Divergent Thinkers

This study took 90 college students, all with similar (and reasonably high) academic achievements, half who had a ADHD diagnosis, and half who didn’t. They did two common ADHD tests on all participants, the Current Symptoms Scale and Childhood Symptoms Scale and  the BAADS tests. They exluded those with an ADHD test that didn’t fit those two scales, and also excluded those without a diagnosis who did fit the scales. Those in the ADHD group all were not currently taking medication.

It is thought that two facets of creativity are convergent thinking which is the ability to form associations between disparate concepts, and divergent thinking which is the ability to generate multiple ideas or solutions to a problem.

In this test, the students with ADHD did worse on the convergent thinking tasks, but better on the divergent thinking task.

In the divergent thinking test, participants did the UUT (Unusual Uses Test) and had to think of multiple uses for an object, (eg a brick or bucket). The test measured their responses for fluency, flexibility and originality. The quantitative analysis showed better performance in this task, but the researches also commented on the very cool qualitative differences too. Typical responses from all participants for brick were “building a house” and “bulding a wall”, but some responses by the ADHD participants included “crush to make lipstick”, “use as a pencil holder” and “write on surfaces like concrete”.

In the convergent thinkers test, participants did the RAT (Remote Associates Test) had to understand 18 word trios (e.g. mines, lick, and sprinkle) and then to generate a word that relates to all three words in the set (e.g. salt). Participants had 5 minutes to complete the test and were given scores for each correct answer. The study didn’t really go into this – but immediately I would wonder who decided what was a correct answer? Perhaps the ADHD were applying their badass divergent thinking skills to this test, and in fact the test itself rewards less creative answers?

Finally there was a semantic IOR test, which aims to measure executive inhibition, which basically means that they had to look at a computer screen, where words were flashed up (e.g. tiger) to determine a category, and then other words are flashed up (e.g. pen, lion or ilon) and participants needed to press a button if they were associated or not, points were allocated for correct answers and response time. Both groups had mainly correct answers, so these weren’t analysed, but non-ADHD students were faster.

So what?… Divergent thinking is cool, and people with ADHD are good at it – yay!

White, H. A. & Shah, P., 2006. Uninhibited imaginations: Creativity in adults with Attention-Deficit/Hyperactivity Disorder. Personality and Individual Differences, Volume 40, pp. 1121-1131.

Concerta in Adults – Placebo Controlled Registration Trial

This study was one of two studies that were used to register Concerta for the treatment of ADHD in Adults.

401 adults with ADHD were randomly assigned to receive either placebo or Concerta (18mg, 36mg, or 72mg/day) for 5 weeks.

At the beginning of the study, they took the Conners’ Adult ADHD Rating Scale (CAARS) test, and then took the test again at the end of the 5 weeks.

The study showed statistically significant improvements in the concerta group compared to the placebo group, with dose dependent response.

There was greater improvements in the innatentive symptoms compared to the hyperactivity/impusive symptoms.

Concerta Trial.JPGMedori, R., Ramos-Quiroga, J.A., Casas, M., Kooij, J.J.S., Niemelä, A., Trott, G., Lee, E. & Buitelaar, J.K. 2008, “A Randomized, Placebo-Controlled Trial of Three Fixed Dosages of Prolonged-Release OROS Methylphenidate in Adults with Attention-Deficit/Hyperactivity Disorder”, Biological Psychiatry, vol. 63, no. 10, pp. 981-989.

Weight Loss in Obese Adults with Newly Diagnosed ADHD

So this study was done in Canada, and looked at patients who were severely obese, and had trouble losing weight. There is a bit of evidence now (insert some links here about the relationship between obesity and ADHD, that before doing gastric surgery on people, to screen them for undiagnosed ADHD. These patients had had so much trouble sticking to any diet or exercise plans, and generally started out really well, and with high intensity (sound familiar), then found the routine, and extended executive function required to plan and execute the diet difficult.

Basically they put the newly diagnosed patients on medication (mainly Adderall, but also concerta and some other one that I don’t know about) and they found that the patients lost on average 15kg over 15 months!! They offered them a visit with the dietician, but only half took advantage of this, due to it costing $100. Basically they gave them a little talk on reducing calorie intake to around about 700kcal deficit, and if they did see the dietician, they were given 3 choices for each meal and snack.

So what?… ADHD is really common in severely obese people, treatment of ADHD is associated with significant long-term weight loss for people who have previously failed at weight loss.

Levy, L., Fleming, J. & Klar, D., 2009. Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. International Journal of Obesity, Volume 33, pp. 326-334.

Resting-state MRI in Adults with ADHD

This study took about 200 adults, half with ADHD, and put them in an MRI machine for 9 minutes, to try and better understand the specific neural architecture for adults with ADHD.

Most participants were on medication, but all didn’t take their medications for 24 hours prior to the test. Interestingly there were more women than men, and also interesting was that the participants were all about early to mid-thirties, and most had only been on medication for a couple of years.

The researches expected to see significant differences in all parts of the brain, but in fact only saw difference in the executive control centre, where people with ADHD had stronger connectivity networks.

Mostert, J. C. et al., 2016. Characterising resting-state functional connectivity in a large sample of adults with ADHD. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 67, pp. 82-91.