Category: ADHD

The dramatic increase in the diagnosis of ADHD has not been accompanied by a rise in clinically significant symptoms

GettyImages-687790406.jpgBy guest blogger Helge Hasselmann

Across the globe, ADHD prevalence is estimated around 5 per cent. It’s a figure that’s been rising for decades. For example, Sweden saw ADHD diagnoses among 10-year olds increase more than sevenfold from 1990 to 2007. Similar spikes have been reported from other countries, too, including Taiwan and the US, suggesting this may be a universal phenomenon. In fact, looking at dispensed ADHD medication as a proxy measure of ADHD prevalence, studies from the UK show an even steeper increase.

Does this mean that more people today really have ADHD than in the past? Not necessarily. For example, greater awareness by clinicians, teachers or parents could have simply captured more patients who had previously had been “under the radar”. Such a shift in awareness or diagnostic behaviour would inflate the rate of ADHD diagnoses without necessarily more people having clinical ADHD. However, if this is not the true or full explanation, then perhaps ADHD symptoms really have become more frequent or severe over the years. A new study in The Journal of Child Psychology and Psychiatry from Sweden with almost 20,000 participants has now provided a preliminary answer.

Continue reading “The dramatic increase in the diagnosis of ADHD has not been accompanied by a rise in clinically significant symptoms”

ADHD Summer Camp

For harassed doctors and stressed-out parents, it can be tempting to treat a challenging child with ADHD (attention deficit hyperactivity disorder) with pills and leave it at that. After all, early results from the one of the largest trials of its kind in the United States – the Multimodal Treatment Study of Children with ADHD (MTA) – showed that behavioural outcomes were better for children given the psychostimulant Ritalin, than for those given psychological treatment. However, follow-up data over several years has shown that the advantages of drug treatment aren’t sustained over the longer term. The position of the UK’s independent health advisory body, NICE, is that drug treatments for ADHD should only ever be part of a broader treatment package, including psycho-educational sessions for parents (pdf). The hunt continues for the most effective treatment or mix of treatments.

It’s in this context that a team of German psychologists, led by Wolf-Dieter Gerber at the University of Kiel, has published a new report looking at the benefits of combining drug treatment for ADHD with an intensive Summer Camp.

Eighteen children with an ADHD diagnosis (aged 9 to 17 years), all on medication, spent 12 days at one such camp, which included social skills training conducted in a playful manner, attention training and sports. Crucially, the camp also incorporated “response cost token-based behaviour training” – that is, the children earned or lost tokens according to whether they followed or broke the camp rules. They were encouraged to compare their token totals each evening and a winner was declared for each day following an “Olympics style” format. At the end of the camp, the tokens could be exchanged for prizes.

A control group of 19 age-matched children with ADHD, also on medication, didn’t go to camp, but their parents received a one-and-a-half hour-long psycho-educational session in which they were taught, amongst other things, about using a token strategy in the home.

Six months later, the children from both groups were tested on a range of neuropsychological measures and their outcomes compared with their pre-intervention test performance.

The key finding is that only the Summer Camp kids showed a reduction in the variability of their reaction times. This is significant because highly sporadic reaction times are a hallmark of ADHD, indicative of reduced self control. Moreover, only the Summer Camp group showed significant improvements in selective and sustained attention and the capacity to integrate information. It’s likely these cognitive changes were clinically significant. Only those children who received higher ratings from their teachers (in terms of improved impulsivity, hyperactivity and inattention) showed positive changes in the variability of their reaction time scores on the neuropsych tests.

“We believe this study has merit” the researchers said, “as the ADHD Summer Camp can be regarded as a novelty in ADHD treatment. We could find no comparable intervention programmes that included stringent … [token reward and punishment] techniques.”


Gerber, W., Gerber-von Müller, G., Andrasik, F., Niederberger, U., Siniatchkin, M., Kowalski, J., Petermann, U., and Petermann, F. (2012). The impact of a multimodal Summer Camp Training on neuropsychological functioning in children and adolescents with ADHD: An exploratory study. Child Neuropsychology, 18 (3), 242-255 DOI: 10.1080/09297049.2011.599115

Post written by Christian Jarrett for the BPS Research Digest.

Adult ADHD leads to more accidents and poorer performance at work

What happens when children with a diagnosis of attention deficit hyperactivity disorder (ADHD) grow up and go to work? According to Ronald Kessler and colleagues, at least some of them continue to experience cognitive difficulties, thus impairing their work performance and increasing the number of accidents they are involved in.

Kessler’s team surveyed 8563 staff, including office and manual workers,  at a major American manufacturing firm. They found 1.9 per cent of them met the criteria for Adult ADHD (based on self-report) and that those with the condition rated their own work performance lower than their colleagues rated theirs, took more time off work sick, and were twice as likely to have had an accident at work during the preceding year.

The results are complicated by the fact that staff with ADHD were also more likely to have depression, chronic pain, insomnia and/or chronic fatigue syndrome than their colleagues. However, adult ADHD was still associated with poorer work performance and more sick leave when the influence of these other conditions was taken into account.

Based on the extra sick leave the staff with ADHD took and their lower work performance, the researchers estimated that each staff member with ADHD was costing their employer $4336 a year in lost revenue.

Only four of the staff with ADHD were currently receiving treatment for their condition. Pointing to research showing the efficacy of drug treatments for Adult ADHD, Kessler and his co-workers argued there was a strong case for the screening and treatment of Adult ADHD at work. “Even if treatment led to no more than a 25 per cent reduction in conservatively estimated human capital loss, the financial value of this reduction would exceed the cost of treatment,” they wrote.

It’s worth noting that the acknowledgement section of the paper states that the research was funded by the pharmaceutical company Eli Lilly, and that the lead author has acted as a consultant to them. Eli Lilly develop drug treatments for ADHD.

ResearchBlogging.orgR. C. Kessler, M. Lane, P. E. Stang, D. L. Van Brunt (2008). The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm Psychological Medicine, 39 (01) DOI: 10.1017/S0033291708003309

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Biofeedback training can boost concentration power

Psychologists have developed a form of training, involving biofeedback, that can boost people’s ability to concentrate. The system shows potential as a way to help people with ADHD (i.e an attention deficit). The work was inspired by research showing that brain areas involved in arousal overlap with those involved in sustained attention.

Participants were first tested on a boring concentration task, during which single numbers between 1 and 9 appeared on a computer screen hundreds of times. The task was to press the left mouse key in response to any number that appeared, except for 3.

Half the participants then undertook the biofeedback training, during which they were shown how their arousal levels – as indicated by a computer reading of the sweatiness of their skin – increased when the researcher clapped his hands and called “wake up”. With practice, the participants used the computer feedback to learn to create that burst of arousal entirely by themselves, in time with their own utterance of the word “now”.

The remaining participants, instead of completing this training, played a computer game, and acted as a control group.

All the participants then repeated the boring concentration task. For the participants who’d completed the training, the prompt to boost their own arousal was indicated by a number appearing in grey rather than the usual black (controls also saw this, but for them it did not act as an arousal prompt).

The participants who’d undertaken the biofeedback training, including several with ADHD, showed substantial improvements in their ability to concentrate relative to the controls. This was indicated by a reduction in the number of errors they made (i.e. how many times they pressed the mouse button in response to the number 3), and the fact that their reaction times didn’t become more variable with time, whereas the reactions of the control group did.

Redmond O’Connell and colleagues, who conducted the research, said: “This experiment has demonstrated that a relatively simple cognitive intervention can lead to substantial neuropsychological improvements.”

OCONNELL, R., BELLGROVE, M., DOCKREE, P., LAU, A., FITZGERALD, M., ROBERTSON, I. (2008). Self-Alert Training: Volitional modulation of autonomic arousal improves sustained attention. Neuropsychologia, 46(5), 1379-1390. DOI: 10.1016/j.neuropsychologia.2007.12.018

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Are mental disorders real?

How do the public view mental disorders? Do they see them as real entities with some kind of essence, or do they see them as the invention of human culture? And how does their take differ from that of mental health professionals?

To find out, Woo-kyoung Ahn and colleagues asked 30 university undergrads and 30 experts to answer questions about the nature of a selection of familiar and unfamiliar psychiatric diagnoses, such as ADHD and undifferentiated somatoform disorder, as well as about familiar and unfamiliar medical/physical disorders, such as high blood pressure and nephritic syndrome.

In general, the students and experts believed mental disorders were less ‘real’ than medical disorders. For example, most of the participants agreed that you either have a medical disorder or you don’t, but that this isn’t true for mental disorders (although a third of the experts felt it was). The experts and students also believed more strongly that medical disorders exist ‘naturally’ in the world, than do mental disorders. The familiarity of conditions didn’t make any difference to the participants’ views.

There were also differences between the groups. The students believed both medical and mental disorders have causal features that have to be removed for successful treatment, but the experts only felt this way about medical disorders. Perhaps, the researchers said, “experts’ knowledge about symptom-oriented treatment plans or the lack of agreed upon aetiology [i.e. causes] might have made them more sceptical about mental disorders”.

Ahn and colleagues concluded that these issues could have practical implications: “patients, unlike therapists, may believe a single thing can be changed to cure their mental disorders and therefore might not follow multifaceted treatment plans developed by clinicians believing in complexly caused mental disorders”.

The findings come after a group of mental health professionals in the UK recently called for the abolition of the term ‘schizophrenia’, arguing that it is scientifically meaningless.

Ahn, W-K., Flanagan, E.H., Marsh, J.K. & Sanislow, C.A. (2006). Beliefs about essences and the reality of mental disorders. Psychological Science, 17, 759-766.

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.