ADHD brains present unique challenges, but the condition is highly treatable − a primary care nurse practitioner with ADHD explains the science

 

ADHD is characterized by symptoms such as inattention, hyperactivity and impulsivity. Nuthawut Somsuk/iStock / Getty Images Plus via Getty Images

“My brain has way too many tabs open.”

“Why can’t I complete tasks?”

“Why do I lose track of time?”

“Why can’t I pay attention?”

These are all things people with attention-deficit/hyperactivity disorder, or ADHD, may ask themselves daily, if not hourly.

As a family nurse practitioner in primary care, I have diagnosed and treated numerous patients with ADHD. I was also diagnosed with it at the age of 21.

Understanding how the wiring differs in a brain with ADHD and what improves functioning is critical to help those struggling because of their brain’s uniqueness.

Scientists have recognized differences in the brains of people with and without ADHD.

How brains with ADHD differ

Research has identified multiple differences in how brains with ADHD work.

Put simply, ADHD significantly affects executive function.

Executive functioning is a set of cognitive processes, including planning, prioritizing, impulse control, flexibility, time management and emotional regulation, that help people achieve long-term goals.

These processes occur in the prefrontal cortex – the “personality center” – of the brain.

In addition to the prefrontal cortex, ADHD affects other areas of the brain, including the basal ganglia, an area that regulates communication within the brain, and the cerebellum, which is responsible for movement and balance. All three work together regulating attention, executive function motor activity and impulse control.

ADHD affects the prefrontal cortex, basal ganglia and cerebellum. Entesar Ali Saber, et al., CC BY

Chemical messengers called neurotransmitters allow brain cells to communicate with each other. Dopamine and norepinephrine are two key neurotransmitters that play critical roles in the executive functioning of the brain.

Dopamine controls motivation, rewards and pleasure. We get a flood of dopamine from pleasurable things such as eating, drinking alcohol, having sex, and receiving affirmations or good grades. That flood also motivates us to repeat the “rewarding” behavior. Norepinephrine is responsible for sustaining attention and helps with executive functioning.

People with ADHD have lower levels of dopamine and norepinephrine in brain regions, including the prefrontal cortex. This leads to difficulty in sustaining cognitive functions such as attention, impulse control and motivation.

Studies show that people with ADHD have more dopamine transporters in the brain. Think of transporters as vacuums that suck dopamine back up into the neuron, making it less available.

As a result, there is less activation by dopamine and norepinephrine in the prefrontal cortex and the mesolimbic pathway, the area that processes rewards and motivation. Less dopamine can drive people to seek out stimulating rewards such as technology, food or drugs.

Researchers have identified at least 27 possible genetic markers that modulate dopamine regulation in the brain.

ADHD affects the presence of dopamine and norepinephrine. Nikpapag/Wikimedia Commons, CC BY-SA

Diagnosing ADHD

Nearly everyone with or without ADHD show some symptoms such as forgetfulness. For instance, when you can’t tolerate sitting in a meeting for one moment longer or you can’t remember why you came into a room.

A true ADHD diagnosis takes into account multiple factors.

If you struggle with ADHD, you have at least five to six symptoms in the inattentive, hyperactive or impulsive categories, such as forgetfulness, trouble sitting still, losing items and getting easily distracted.

For a formal diagnosis, ADHD symptoms need to have been present before the age of 12, something that can be determined in childhood or, as in my case, much later.

Also, ADHD symptoms must negatively affect the person in multiple settings, such as at home, in school or at work – and they can’t be explained away by other conditions, such as thyroid dysfunction, diabetes, sleep deprivation or anemia.

Research shows that girls with ADHD more often display inattentive symptoms along with characteristics not traditionally associated with ADHD, such as shyness, perfectionism and eating disorders. Patients, particularly women and girls, can develop depression or anxiety – or both – because of untreated ADHD. Once ADHD is treated, anxiety and depression symptoms are greatly reduced.

Women and girls may have symptoms not typically associated with ADHD.

How ADHD medications alter neurotransmitters

The American Academy of Pediatrics provides evidence-based guidelines for the treatment of ADHD in children and teens.

The first U.S. guidelines for the treatment of adult ADHD are expected to be released in fall 2024.

If patients are 6 or older, stimulant or nonstimulant medications may be used, along with behavioral therapy.

Stimulants are divided into two drug classes: amphetamines, such as Adderall and Vyvanse, and methylphenidates, such as Concerta, Ritalin and Focalin.

Nonstimulants such as Strattera are recommended if patients cannot tolerate or prefer not to take stimulant medications.

Stimulants block the dopamine and norepinephrine transporters, preventing them from depleting those neurotransmitters, so more dopamine is available to activate key areas of the brain.

Amphetamines also increase the release of dopamine and norepinephrine from neurons. These increased levels allow the brain to find challenging tasks, such as doing homework, more rewarding. Because more dopamine is available, the brain’s desire for stimulating rewards decreases.

Methylphenidates are typically the drug of choice for children, while amphetamines are most effective in adults.

Numerous studies have found that stimulants improve ADHD symptoms, patient motivation, parental quality of life and behavioral ratings from teachers. Stimulants decrease anxiety and emotional dysregulation in children. Nonstimulants also improve ADHD symptoms.

Improved outcomes

People with ADHD attempt suicide at twice the rate of people without ADHD. They also have three times the rate of suicidal ideation and six times the rate of completed suicide.

Treating patients with ADHD with stimulant medication, in addition to behavioral therapy, has been shown to decrease suicide attempts, unplanned pregnancies and substance use. One study found that treating children with ADHD with methylphenidate reduced their risk of burn injuries by 57%.

In addition to medication, cognitive behavioral therapy for adults, executive function training, particularly in adolescents, and positive parenting interventions have been shown to be effective for ADHD symptoms. Most researchers agree that behavioral training is most effective when combined with medication.

Positive parenting

Research has found significant improvement in the quality of life for both parents and children when parents participated in positive parenting education. The effect is even more pronounced when combined with medication.

One such model, called the “Nurtured Heart Approach,” has been used by families, schools, foster care organizations and behavioral health groups, including the New Jersey Children’s System of Care. It emphasizes praise and encouragement, the setting of clear boundaries for acceptable behavior, and teaches children to self-regulate emotions and behaviors.

As a medical provider, I have witnessed such models work wonders in families and classrooms.

Dietary supplements

Multiple studies have demonstrated that children with ADHD have lower levels of vitamin D in their bloodstream.

Having adequate iron in one’s body, stored in the protein ferritin, is important to create dopamine and norepinephrine, the neurotransmitters that are lacking in ADHD. Research has demonstrated that low levels of ferritin cause a disruption in dopamine activity. Children with lower levels are more likely to be diagnosed with ADHD.

For this reason, it’s important for providers to check ferritin levels and not serum iron, which is often used incorrectly to diagnose iron deficiency.

Taking steps forward

If you think your child or you may have ADHD, speak with a health care provider who is familiar with ADHD treatment. For school accommodations, the first place to start is with your provider.

Research is still ongoing, but high intake of processed foods may worsen ADHD symptoms.

Pay attention to sleep; sleep apnea and sleep disordered breathing are common in people with ADHD.

And make sure to get in lots of exercise, because it can improve executive functioning and impulse control while boosting dopamine and norepinephrine levels.

Though overwhelming, I’m happy to say that living with ADHD can be rewarding.

ADHD comes with multiple benefits: We are resilient, unconventional and creative. We have intense energy that, once harnessed, can be used for incredible good.

Kate Harrington, Lecturer of Clinical Pathophysiology and Family Nurse Practitioner, Kennesaw State University

This article is republished from The Conversation under a Creative Commons license.

What GoFundMe conceals: The campaigns that fail

 

Faran Kaplan’s neighbor set up a GoFundMe page for him that raised over $100,000 after his wife was killed and other relatives injured in an accident. Pete Marovich/The Washington Post via Getty Images

Long before the advent of reality television, the popular game show “Queen for a Day” thrilled American audiences by giving women who told heartbreaking tales of financial struggles a chance at winning expensive items that could help solve their problems.

Throughout its 1956-1964 run, each episode featured contestants describing a misfortune that had struck them or their families, such as polio, rheumatic fever or hunting accidents. They asked for everything from bunk beds to beauty school tuition to improve their lot.

Eventually, a clap-o-meter would appear, superimposed over each woman’s face. The winner would be chosen based on the volume of the audience’s applause. She was crowned Queen for a Day and lavished with dishwashers, sewing machines and sofas, while the losers – and the millions of Americans who had tuned in on their TV sets – watched.

Today, something like that black-and-white TV show plays out nonstop, but on different devices. It’s the plot of GoFundMe, the world’s largest crowdfunding website for personal causes.

The privately owned company says it helped people raise over US$30 billion in donations between 2010 and early 2024. While that total sounds impressive, GoFundMe’s success leaves behind a trail of failed campaigns and disappointed users – a reality that the platform is designed to hide.

The ‘Queen for a Day’ show obliged contestants to air their needs publicly.

Behind the success stories

If you open GoFundMe’s Discover page, you’ll find a cascade of misfortunes.

People from many walks of life use the platform to tell the public about the cancers and diabetes cases, house fires and other tragedies that have beset them or their loved ones. They ask for help paying for everything from medical treatment to college textbooks.

A fundraising meter appears, usually next to a photo of the person seeking help, and gauges how the appeal has resonated with website visitors. Winners go viral, blow through their goals and raise tens of thousands of dollars.

Others hope the crowd will choose them next.

We are political sociologists interested in how people across North America use digital technologies to cope with the high cost of health care and higher education. As part of our research, we conducted 50 in-depth interviews and surveyed over 600 crowdfunding users between 2018 and 2021. We also analyzed data from nearly 2 million GoFundMe campaigns.

In “GoFailMe: The Unfulfilled Promise of Digital Crowdfunding,” our book based on this research, we explain that behind GoFundMe’s winners, whose stories are paraded on the site’s front page and its podcast – “True Stories of Good People” – stands a long line of also-rans.

They raise almost no money this way but are put through an emotional roller coaster and give up a considerable amount of their privacy and personal data.

Digital hurdles

When these platforms emerged in the 2000s, crowdfunding companies promised to use the internet’s networking capabilities to remove gatekeepers and democratize fundraising, so that anyone with a worthy cause could access the money they needed.

Far from this techno-optimistic vision, we find striking inequalities throughout GoFundMe’s fundraising process.

First, there’s the digital divide. Many low-income people simply don’t ask for help using crowdfunding because they don’t know about it, can’t reliably access the internet, or are too intimidated by technology.

For those who can get in the virtual door, crowdfunding rewards users who already have many economic advantages in the offline world. Wealthier people are more likely to be able to use online services, while poorer and less-educated users have a harder time marketing their misfortunes with compelling narratives, eye-catching photos and engaging videos.

And crowdfunding works best when there’s a crowd willing and able to help, which usually begins with family, friends and acquaintances. But if your family and friends are broke, like you, then there’s little help to be had, no matter how good your campaign is or how deftly you promote it.

GoFundMe’s invisible majority

We estimate that only about 17% of U.S. GoFundMe campaigns for health care and emergency costs meet their goal. We’ve also found that most of the funds raised are concentrated among a very small group of campaigns.

We saw in the data we analyzed that the top 5% of highest-earning campaigns claimed about half of all dollars raised on GoFundMe. Because relatively well-off users tend to be more successful at crowdfunding, such a disparity is likely to only worsen already high levels of economic inequality in the U.S.

Despite the company’s assurances that every worthy cause has a place on GoFundMe, most of its users simply don’t get the funds they need when they use the platform.

But you wouldn’t know this from browsing GoFundMe.

Failure doesn’t sell.

The droves of campaigns that never get off the ground are largely hidden by an algorithmic recommendation system that promotes the most successful cases to prominence while sweeping the rest into the platform’s search results. This appears to be highly profitable for GoFundMe, which earns revenue from fees and tips added to donations but leaves many users feeling disappointed and some even duped.

One user we interviewed, whose campaign for help with medical costs ended up not receiving a single donation, likened the experience to “shouting into that well of sadness, hoping people will see and hear you.”

Asked for comment, the company said our book was “rife with misconceptions,” but GoFundMe didn’t provide any details about what the people who don’t meet their stated fundraising goals get from the platform. “We are constantly innovating our product to ensure more organizers achieve greater success,” GoFundMe added.

‘Queen for a Day’ 2.0?

People have always asked for help, and every era has its way of deciding who gets it.

In the 1950s, media companies experimented with new combinations of charity and entertainment and invented the TV game show. We agree with critics who consider “Queen for a Day” to be among the genre’s worst exploiters of hardship for profit.

The possibilities for companies like GoFundMe to use technology in new ways to improve people’s lives have never been greater. At the same time, the opportunities to profit from a crisis are also growing.

To fulfill crowdfunding’s democratic promise, we believe that GoFundMe should be far more open about the success of all its campaigns, including those that flounder. It could also do much more to make the platform more accessible to the people who are experiencing the most economic distress.

Until it takes those steps, its users would be wise to proceed with caution – recognizing that behind every viral success lie countless untold stories of unmet needs.

Martin Lukk, Ph.D. Candidate in Sociology, University of Toronto and Erik Schneiderhan, Professor of Sociology, University of Toronto

This article is republished from The Conversation under a Creative Commons license.

SHADOWS OF DEATH

 

 My latest Ebook for sale on Amazon - 

 

 

 SHADOWS OF DEATH

https://www.amazon.com/SHADOWS-DEATH-LAURA-ONEALE-ebook/dp/B0CJ7XNV22

 

 I did not use AI to help -   it's my own work.....

Herewith a little preview........

"Alone and terrified, Betty clung to Dan's body, seeking comfort in his presence. As the darkness of night descended, the sound of approaching sirens grew louder, signaling the arrival of law enforcement and medical responders. The scene they were rushing toward was one of tragedy and devastation.

As the first police car screeched to a halt, officers quickly emerged, their uniforms a beacon of authority in the dimming light. They fanned out, their movements purposeful and efficient, scanning the area with flashlights for any signs of danger or evidence.

Following closely behind, the ambulance arrived, its urgent arrival marked by the blare of sirens. Paramedics leaped into action, their training evident in the swift and coordinated manner in which they approached the scene. Carrying their medical equipment with practiced ease, they assessed the situation, ready to administer aid to those in need.

The scene buzzed with activity, the flashing lights of emergency vehicles casting an eerie glow. Radios crackled with updates as police and medics worked seamlessly together, their shared goal of preserving life and restoring order guiding their every move. Despite the chaos, there was a sense of calm determination among the responders as they worked tirelessly to unravel the tragedy that had unfolded.

Amid the flashing lights and hushed murmurs of onlookers, a tense atmosphere enveloped the scene. Police officers worked diligently to secure the area, interviewing witnesses and gathering evidence to reconstruct the sequence of events. Meanwhile, the medics, realizing the tragic outcome, provided support and comfort to the grieving family and friends.

As time passed, the chaotic scene began to transform. The deceased were respectfully moved to waiting ambulances, while police officers continued their investigation with methodical precision. Despite the somber mood, the professionalism of the responders remained unwavering as they worked to bring closure to the tragic incident."

 

 

Hope you support me, and there are other books available as well.

 

Thanks

Laura

https://www.amazon.com/SHADOWS-DEATH-LAURA-ONEALE-ebook/dp/B0CJ7XNV22

Oklahoma’s superintendent orders public schools to teach the Bible – relying on controversial views about religious freedom

 

Instruction about the Bible can be legal – the question is how it’s done, and what the intent is. Pascal Deloche/Godong/Universal Images Group via Getty Images

In the days since Oklahoma’s state superintendent, Ryan Walters, ordered school districts to teach the Bible, he’s been defending his mandate.

For example, he claimed in an interview on NewsNation that the Bible had “been removed from classrooms, and we’re saying, listen, we’re proud to be the first state to bring it back.”

In reality, U.S. federal law has never prevented public schools from including the Bible as an appropriate aid in the teaching of secular subjects. Rather, what current Supreme Court precedent forbids is use of the Bible as part of religious training in public schools.

Walters’ mandate – sent to districts on June 27, 2024 – seems to blur this line between secular and religious instruction. It also contributes to a larger trend of state officials striving to weaken the boundaries between religion and state.

Another prominent example is the new law in Louisiana requiring every public school classroom to display the Ten Commandments. This law has already generated a lawsuit from civil rights groups.

As someone who studies religious liberty law, I see these state initiatives as part of a larger push to increase the presence of Christianity in the public sphere and to challenge constitutional protections for religious freedom.

Secular vs. religious use

The major Supreme Court case dealing with Bible reading in public schools is Abbington v. Schempp, which was decided in 1963.

At issue was a Pennsylvania law, enacted in 1913, requiring that “At least ten verses from the Holy Bible shall be read, without comment, at the opening of each public school on each school day.” The law allowed children to be excused at their parents’ request.

The Schempp family, whose children attended Pennsylvania public schools, sued on the grounds that the law violated the First Amendment of the U.S. Constitution.

In an 8-1 decision, the Supreme Court agreed that the law violated the First Amendment’s establishment clause, which forbids government from making any law “respecting an establishment of religion.”

Originally, the establishment clause applied only to the federal government. That changed after the ratification of the 14th Amendment in 1868. The Supreme Court has interpreted the 14th Amendment as requiring state governments, including public schools, to abide by most of the Bill of Rights.

The issue of Bibles in classrooms has made its way to the Supreme Court before – will it again? AP Photo/Mariam Zuhaib

In the Pennsylvania case, the Supreme Court clarified that public school lessons involving the Bible or religion can be constitutional “when presented objectively as part of a secular program of education.” For example, religious texts can be used in classrooms as part of a comparative religion lesson, or when studied as literature.

Crucially, however, the court found that the Pennsylvania law violated the establishment clause because its purpose was religious, not secular. The daily Bible reading constituted “a religious ceremony” that “was intended by the State to be so,” whether or not children were allowed to be excused.

Christian nationalism

Messaging about the new mandate blurs the distinction between secular and religious Bible instruction.

For example, in Walters’ memo instructing schools to teach the Bible, he states that “The Bible is one of the most historically significant books and a cornerstone of Western civilization, along with the Ten Commandments. They will be referenced as an appropriate study of history, civilization, ethics, comparative religion, or the like, as well as for their substantial influence on our nation’s founders and the foundational principles of our Constitution.”

Similarly, in an announcement about the mandate, he claimed that the Bible was “a necessary historical document to teach our kids about the history of this country, to have a complete understanding of Western civilization, to have an understanding of the basis of our legal system.”

These explanations highlight the challenge of differentiating secular and religious uses of the Bible in education. Reading religious texts may provide useful context for some history lessons – for example, in explaining some colonists’ beliefs. Yet arguments that the Bible is central to understanding U.S. history and law are also a pillar of Christian nationalism, which is the belief that Christianity should have a privileged place in politics, law and society in the U.S. because “America is a Christian nation.”

Many scholars reject this controversial view of history, arguing, for example, that it misrepresents the founders’ religious and political views.

Yet this belief has been gaining momentum within the U.S. political right. As Yale sociologist Philip Gorski has noted, Christian nationalism “is no longer operating beneath the surface or in the background. It’s now front and center at commanding heights of power.”

According to a 2022 Pew survey, more than 4 in 10 Americans think that “the U.S. should be a Christian nation,” though they disagree about what that means.

The Americans United for Separation of Church and State describes Walters’ mandate as “textbook Christian Nationalism” and has stated that they are “ready to step in” to try to block it.

Part of a trend

Superintendent of Public Instruction Ryan Walters presides over a state Board of Education meeting in April 2023 in Oklahoma City. AP Photo/Sue Ogrocki

Walters’ mandate aligns with a broader movement to challenge limits around religion in public schools. This movement has made significant strides at the Supreme Court in recent years.

For example, in 2022 the court ruled that, in at least some circumstances, public money could be used for tuition at private religious schools in Maine, and that a public high school football coach had the right to pray with his players at the 50-yard line after games.

Another challenge occurred in Oklahoma in 2023, when the Oklahoma Statewide Virtual Charter School Board approved a charter for a Catholic institution. This move, which was supported by Walters and Gov. Kevin Stitt, would have established the nation’s first religious charter school. The Oklahoma Supreme Court struck down that plan on June 25, 2024, finding it unconstitutional.

Two days later, Walters sent his memo about Bible instruction. Oklahoma law already permits using the Bible to teach about religion, history and other matters in public schools. Walters’ mandate, however, goes much further. It mandates, rather than merely permits, statewide Bible instruction. “Every teacher, every classroom in the state will have a Bible,” he pronounced.

Under current precedent, the mandate appears unconstitutional. In order for that to change, Walters’ mandate or another one like it may need to end up before the U.S. Supreme Court.

Mark Satta, Assistant Professor of Philosophy, Wayne State University

This article is republished from The Conversation under a Creative Commons license.

Disability community has long wrestled with ‘helpful’ technologies – lessons for everyone in dealing with AI

 

A robotic arm helps a disabled person paint a picture. Jenna Schad /Tufts University

You might have heard that artificial intelligence is going to revolutionize everything, save the world and give everyone superhuman powers. Alternatively, you might have heard that it will take your job, make you lazy and stupid, and make the world a cyberpunk dystopia.

Consider another way to look at AI: as an assistive technology – something that helps you function.

With that view, also consider a community of experts in giving and receiving assistance: the disability community. Many disabled people use technology extensively, both dedicated assistive technologies such as wheelchairs and general-use technologies such as smart home devices.

Equally, many disabled people receive professional and casual assistance from other people. And, despite stereotypes to the contrary, many disabled people regularly give assistance to the disabled and nondisabled people around them.

Disabled people are well experienced in receiving and giving social and technical assistance, which makes them a valuable source of insight into how everyone might relate to AI systems in the future. This potential is a key driver for my work as a disabled person and researcher in AI and robotics.

Actively learning to live with help

While virtually everyone values independence, no one is fully independent. Each of us depends on others to grow our food, care for us when we are ill, give us advice and emotional support, and help us in thousands of interconnected ways. Being disabled means having support needs that are outside what is typical and therefore those needs are much more visible. Because of this, the disability community has reckoned more explicitly with what it means to need help to live than most nondisabled people.

This disability community perspective can be invaluable in approaching new technologies that can assist both disabled and nondisabled people. You can’t substitute pretending to be disabled for the experience of actually being disabled, but accessibility can benefit everyone.

The curb-cut effect – how technologies built for disabled people help everyone – has become a principle of good design.

This is sometimes called the curb-cut effect after the ways that putting a ramp in a curb to help a wheelchair user access the sidewalk also benefits people with strollers, rolling suitcases and bicycles.

Partnering in assistance

You have probably had the experience of someone trying to help you without listening to what you actually need. For example, a parent or friend might “help” you clean and instead end up hiding everything you need.

Disability advocates have long battled this type of well-meaning but intrusive assistance – for example, by putting spikes on wheelchair handles to keep people from pushing a person in a wheelchair without being asked to or advocating for services that keep the disabled person in control.

The disabled community instead offers a model of assistance as a collaborative effort. Applying this to AI can help to ensure that new AI tools support human autonomy rather than taking over.

A key goal of my lab’s work is to develop AI-powered assistive robotics that treat the user as an equal partner. We have shown that this model is not just valuable, but inevitable. For example, most people find it difficult to use a joystick to move a robot arm: The joystick can only move from front to back and side to side, but the arm can move in almost as many ways as a human arm.

The author discusses her work on robots that are designed to help people.

To help, AI can predict what someone is planning to do with the robot and then move the robot accordingly. Previous research assumed that people would ignore this help, but we found that people quickly figured out that the system is doing something, actively worked to understand what it was doing and tried to work with the system to get it to do what they wanted.

Most AI systems don’t make this easy, but my lab’s new approaches to AI empower people to influence robot behavior. We have shown that this results in better interactions in tasks that are creative, like painting. We also have begun to investigate how people can use this control to solve problems outside the ones the robots were designed for. For example, people can use a robot that is trained to carry a cup of water to instead pour the water out to water their plants.

Training AI on human variability

The disability-centered perspective also raises concerns about the huge datasets that power AI. The very nature of data-driven AI is to look for common patterns. In general, the better-represented something is in the data, the better the model works.

If disability means having a body or mind outside what is typical, then disability means not being well-represented in the data. Whether it’s AI systems designed to detect cheating on exams instead detecting students’ disabilities or robots that fail to account for wheelchair users, disabled people’s interactions with AI reveal how those systems are brittle.

One of my goals as an AI researcher is to make AI more responsive and adaptable to real human variation, especially in AI systems that learn directly from interacting with people. We have developed frameworks for testing how robust those AI systems are to real human teaching and explored how robots can learn better from human teachers even when those teachers change over time.

Thinking of AI as an assistive technology, and learning from the disability community, can help to ensure that the AI systems of the future serve people’s needs – with people in the driver’s seat.

Elaine Short, Assistant Professor of Computer Science, Tufts University

This article is republished from The Conversation under a Creative Commons license.