Wel­come to a new edi­tion of Grand Rounds blog car­ni­val, the weekly edi­tion of what’s best in the health and med­ical blo­gos­phere. This week, twenty four blog­gers share data, insights, ques­tions, reflec­tions and more. Enjoy! Read the rest of this entry »

In 2005 the Amer­i­can Acad­emy of Pedi­atrics (AAP) began an ini­tia­tive to pro­mote an approach to care among its mem­bers in which “…the pedi­atric team works in part­ner­ship with a child and a child’s fam­ily to assure that all of the med­ical and non-medical needs of the patient are met.” A crit­i­cally impor­tant focus of this approach is the role of the fam­ily and child — as devel­op­men­tally appro­pri­ate — in the devel­op­ment of an over­all plan of care.

This shared decision-making approach is espe­cially impor­tant for con­di­tions like ADHD where there is not a sin­gle treat­ment that is the most appro­pri­ate and pre­ferred option for all patients. How­ever, Read the rest of this entry »

Although ADHD used to be con­sid­ered a dis­or­der of child­hood, follow-up stud­ies indi­cate that between 30% and 60% of chil­dren with ADHD con­tinue to expe­ri­ence symp­toms and impair­ment in adult­hood. And, even when ADHD symp­toms decline over time, many indi­vid­u­als con­tinue to expe­ri­ence sig­nif­i­cant impair­ment in impor­tant areas of functioning.

For exam­ple, chil­dren with ADHD have Read the rest of this entry »

Wel­come to the XL edi­tion of Sci­en­tia Pro Pub­lica (or, since we are try­ing to speak Eng­lish, the 40th edi­tion of “Sci­ence for the Peo­ple”), the rotat­ing blog car­ni­val that show­cases the finest sci­ence, med­ical and envi­ron­ment writ­ing pub­lished in the blogosphere.

Quick now — ask a ques­tion, any ques­tion, that comes to mind. Chances are some­one in this excel­lent ros­ter of sci­ence blog­gers has antic­i­pated it and pro­vided an answer below. Enjoy!

About our­selves

1. Why do I feel bet­ter after I exer­cise (pic: brainblogger)
2. Can thought­ful blog­ging and read­ing build brain reserve and delay dementia
3. What’s the bor­der­line between high and low func­tion­ing — autism research examples
4. Can we learn to multi-task more effectively
5. Should you mind your brain

About our bod­ies Read the rest of this entry »

Many par­ents, health care pro­fes­sion­als, and edu­ca­tors agree that there is a press­ing need to develop effec­tive treat­ments for ADHD to com­ple­ment or sub­sti­tute for tra­di­tional med­ica­tion and behav­ior ther­apy approaches. This is because such treat­ments do not work for every­one, impor­tant dif­fi­cul­ties often remain even when these treat­ments are effec­tive, and evi­dence for the long-term ben­e­fits of these treat­ments remains less com­pelling than one would like. In addi­tion, in the case of med­ica­tion treat­ment, some indi­vid­u­als expe­ri­ence intol­er­a­ble side effects and many have con­cerns about tak­ing ADHD med­ica­tion for an extended period.

One alter­na­tive approach to treat­ing ADHD has relied on the use of Com­pound Herbal Prepa­ra­tions (CHP) derived from tra­di­tional Chi­nese med­i­cine. Prac­ti­tion­ers of this approach believe that such prepa­ra­tions have impor­tant cog­ni­tive enhanc­ing prop­er­ties because they sup­ply essen­tial nutri­ents, fatty acids, phos­pho­lipids, amino acids, B vit­a­mins, min­er­als, and other micronu­tri­ents that are impor­tant for opti­mal brain growth and devel­op­ment. As a treat­ment for ADHD, the idea is that many indi­vid­u­als with ADHD have defi­cien­cies in essen­tial nutri­ents that com­pro­mise healthy brain devel­op­ment and result in ADHD symp­toms. Pro­vid­ing these nutri­ents via an appro­pri­ately pre­pared herbal com­pound thus has the poten­tial to be ther­a­peu­tic and reduce these symptoms.

This idea was tested recently in a randomized-controlled trial of a spe­cific CHP for chil­dren with ADHD [Katz, Kol-Degani, & Kav-Venaki (2010). A com­pound herbal prepa­ra­tion (CHP) in the treat­ment of ADHD: A ran­dom­ized con­trolled trial. Jour­nal of Atten­tion Dis­or­ders. Pub­lished online on March 12, 2010.] Par­tic­i­pants were 120 6–12 year-old chil­dren newly diag­nosed with ADHD based on a com­pre­hen­sive diag­nos­tic eval­u­a­tion. These chil­dren were all eval­u­ated at the Sheba Med­ical Cen­ter, one of the largest university-affiliated ter­tiary care cen­ters in Israel.

(Editor´s note: Dr. David Rabiner, author of this arti­cle, pre­vi­ously reviewed a 2005 meta-analysis whose find­ings need to be kept in mind to con­tex­tu­al­ize this new study. In the arti­cle Dietary Inter­ven­tion for ADHD: A Meta-Analysis, Dr. Rabiner con­cluded that “Results from this meta-analysis pro­vide strong evi­dence that the behav­ior of chil­dren with ADHD can be made worse by dietary fac­tors, and that elim­i­nat­ing AFCs from their diets will, on aver­age, result in behav­ioral improve­ments. This result is con­sis­tent with with accu­mu­lat­ing evi­dence that neu­robe­hav­ioral tox­i­c­ity may result from a wide vari­ety of dis­trib­uted chemicals.”)

Chil­dren were ran­domly assigned to receive either the CHP (n=80) or a placebo (n=40) that was spe­cially pre­pared to Read the rest of this entry »

Work­ing mem­ory (WM) is the cog­ni­tive sys­tem respon­si­ble for the tem­po­rary stor­age and manip­u­la­tion of infor­ma­tion and plays an impor­tant role in both learn­ing and focus­ing atten­tion. Con­sid­er­able research has doc­u­mented that many chil­dren and adults with ADHD have WM deficits and that this con­tributes to dif­fi­cul­ties asso­ci­ated with the dis­or­der. For an excel­lent intro­duc­tion to the role of WM deficits in ADHD, click here.

A sim­ple exam­ple illus­trates the impor­tance of WM for par­tic­u­lar aca­d­e­mic tasks. Try adding 3 and 9 in your head. That was prob­a­bly easy for you. Now try­ing adding 33 and 99. That was prob­a­bly more dif­fi­cult. Finally, try adding 333 and 999. This is quite chal­leng­ing for most adults even though each cal­cu­la­tion required is triv­ially easy. The chal­lenge occurred because you need to store infor­ma­tion — the sum of 3+9 in the one’s col­umn and then ten’s col­umn — as you process the remain­ing part of the prob­lem, i.e., 3+9 in the hundred’s col­umn, and this taxed your WM. If your WM capac­ity was exceeded, you could not com­plete the prob­lem successfully.

This sim­ple prob­lem also illus­trates the dif­fer­ence between short-term mem­ory (STM) and WM. Short-term mem­ory sim­ply involves retain­ing infor­ma­tion in mind for short peri­ods of time, e.g., remem­ber­ing that the prob­lem you need to solve is 333+999. Work­ing mem­ory, in con­trast, involves men­tally manip­u­lat­ing — or ‘work­ing’ with — retained infor­ma­tion and comes into play in a wide range of learn­ing activ­i­ties. For exam­ple, to answer ques­tions about a sci­ence chap­ter, a child not only has to cor­rectly retain fac­tual infor­ma­tion but must men­tally work with that infor­ma­tion to answer ques­tions about it. Thus, when a child’s WM capac­ity is low rel­a­tive to peers, aca­d­e­mic per­for­mance is likely to be com­pro­mised in mul­ti­ple areas.

Because WM deficits play an impor­tant role in the strug­gles expe­ri­enced by many indi­vid­u­als with ADHD, it is impor­tant to con­sider how dif­fer­ent inter­ven­tions address this aspect of the dis­or­der. In this study, the authors were inter­ested in com­par­ing the impact of Work­ing Mem­ory Train­ing and stim­u­lant med­ica­tion treat­ment on the WM per­for­mance of chil­dren diag­nosed with ADHD.

Par­tic­i­pants were 25 8–11 year-old chil­dren with ADHD (21 boy and 4 girls) who were being treated with stim­u­lant med­ica­tion. Children’s mem­ory per­for­mance was assessed on 4 occa­sions using the Auto­mated Work­ing Mem­ory Assess­ment (AWMA), a com­put­er­ized test that mea­sures ver­bal short-term mem­ory, ver­bal work­ing mem­ory, visuo-spatial short-term mem­ory, and visuo-spatial work­ing memory.

At time 1, the assess­ment was con­ducted when chil­dren had been off med­ica­tion for at least 24 hours. The sec­ond assess­ment occurred an aver­age of 5 months later and when chil­dren were on med­ica­tion. The third assess­ment occurred after chil­dren had com­pleted 5 weeks of Cogmed Work­ing Mem­ory Train­ing using the stan­dard train­ing pro­to­col (see below). The final assess­ment occurred approx­i­mately 6 months after train­ing had ended. This design enabled the researchers to make the fol­low­ing comparisons:

- WM per­for­mance on med­ica­tion vs. off med­ica­tion (T1 vs T2)
– WM per­for­mance on med­ica­tion vs. after train­ing (T2 vs. T3)
– WM per­for­mance imme­di­ately after train­ing ended vs. 6 months fol­low­ing train­ing (T3 vs. T4)

This final com­par­i­son pro­vided infor­ma­tion on whether any ben­e­fits pro­vided by the train­ing had endured.

In addi­tion to mea­sur­ing STM and WM at each time point, mea­sures of IQ were col­lected at times 1, 2, and 3.

- Work­ing Mem­ory Train­ing -

WM train­ing was con­ducted using the stan­dard Cogmed train­ing pro­to­col with each child com­plet­ing 20–25 train­ing ses­sions within a 25 day period. The train­ing requires the stor­age and manip­u­la­tion of sequences of ver­bal, e.g., repeat­ing back a sequence of dig­its in reverse order, and/or visuo-spatial infor­ma­tion, e.g., recall­ing the loca­tion of objects on dif­fer­ent por­tions of the com­puter screen.

Dif­fi­culty level is cal­i­brated on a trial by trial basis so the child is always work­ing at a level that closely matches their per­for­mance. For exam­ple, if a child suc­cess­fully recalled three dig­its in reverse order, on the next trial he had to recall four. When a trial was failed, the next trial was made eas­ier by reduc­ing the num­ber of items to be recalled. This method of ‘adap­tive train­ing’ is thought to be a key ele­ment because it requires the child to ‘stretch’ their WM capac­ity to move through the program.

- Results -

- Impact of Short-Term Mem­ory and Work­ing Mem­ory -

Med­ica­tion vs. no med­ica­tion — When tested on med­ica­tion, Read the rest of this entry »

Here you have the March edi­tion of our monthly newslet­ter cov­er­ing cog­ni­tive health and brain fit­ness top­ics. Please remem­ber that you can sub­scribe to receive this Newslet­ter by email, using the box at the top of this page. I know I am biased — but do believe this Newslet­ter issue might well be our best so far. I hope you find the time to enjoy it!

Bird’s Eye View

Brain Fit­ness Sur­vey: Over 2,000 thought­ful responses to our Jan­u­ary sur­vey (Thank You!) rein­force the need for pub­lic aware­ness ini­tia­tives and qual­ity infor­ma­tion to help eval­u­ate and nav­i­gate lifestyle and prod­uct claims, as well as the need for more research, an expanded health­care cul­ture, as more. Given this con­text, we are pub­lish­ing The Sharp­Brains Guide to Brain Fit­ness in May 2009, a book with 18 Inter­views with Sci­en­tists, Prac­ti­cal Advice, and Prod­uct Reviews, in addi­tion to our annual mar­ket report for pro­fes­sion­als and exec­u­tives (to be pub­lished in April). If you have ideas to help us pro­mote the book, please reply to this email and let us know!

Life­long Learning

What started as an aca­d­e­mic dis­pute regard­ing dis­clo­sure of con­flict of inter­est is now snow­balling into the main­stream media, due to the over-reaction by JAMA edi­tors as reported in this Wall Street Jour­nal blog post, JAMA edi­tor calls Critic a “Nobody and a Noth­ing”

In sum­mary, Dr. Jonathan Leo, the “Critic”, dared to draw atten­tion to 2 impor­tant points regard­ing a study com­par­ing the effi­cacy of ther­apy vs. med­ica­tion pub­lished in the Jour­nal of the Amer­i­can Acad­emy of Med­i­cine (JAMA) — one of the most pres­ti­gious sci­en­tific publications:

1) The study results were pre­sented and reported in a biased way, since they favored one spe­cific inter­ven­tion, a drug, while ignor­ing another one, therapy-based, that had equally sta­tis­ti­cally sig­nif­i­cant effects.

2) Both the lead author of the study and one of the main experts asked to com­ment on the study in sev­eral media out­lets had undis­closed and unre­ported con­flicts of inter­est. JAMA could have done a 5-minute Google search to iden­tify and report the con­flict of inter­est of the lead author (received a vari­ety of rev­enues from the drugmaker).

Dr. Leo has sum­ma­rized the con­tin­u­ing mat­ter in sev­eral impres­sive let­ters. The 2 main ones, in chrono­log­i­cal order:

Clin­i­cal Tri­als of Ther­apy vs. Med­ica­tion: Even in a Tie, Med­ica­tion Wins(BMJ)

- “Cen­tral to the idea of evidence-based med­i­cine is that the choices made by patients and doc­tors to use a cer­tain treat­ment should at least in part be based on sci­en­tific stud­ies pub­lished in peer reviewed aca­d­e­mic jour­nals. For a patient diag­nosed with Read the rest of this entry »

Neu­ro­feed­back — also known as EEG Biofeed­back — is an approach for treat­ing ADHD in which indi­vid­u­als are pro­vided real-time feed­back on their brain­wave pat­terns and taught to alter their typ­i­cal EEG pat­tern to one that is con­sis­tent with a focused, atten­tive state. This is typ­i­cally done by col­lect­ing EEG data from indi­vid­u­als as they focus on stim­uli pre­sented on a com­puter screen. Their abil­ity to con­trol the stim­uli, for exam­ple, keep­ing the smile on a smi­ley face, is con­tin­gent on main­tain­ing the par­tic­u­lar EEG state being trained. Accord­ing to neu­ro­feed­back pro­po­nents, learn­ing how to do this dur­ing train­ing gen­er­al­izes to real world sit­u­a­tions and this results in improved atten­tion and reduced hyperactive/impulsive behavior.

Neu­ro­feed­back treat­ment for ADHD has been con­tro­ver­sial in the field for many years and remains so today. Although a num­ber of pub­lished stud­ies have reported pos­i­tive results many promi­nent ADHD researchers believe that prob­lems with the design of these stud­ies pre­clude con­clud­ing that neu­ro­feed­back is an effec­tive treat­ment. These lim­i­ta­tions have included the absence of ran­dom assign­ment, the lack of appro­pri­ate con­trol groups, raters who are not ‘blind’ to children’s treat­ment sta­tus, and small sam­ples. For addi­tional back­ground, you can find a recent review I wrote on exist­ing research sup­port for neu­ro­feed­back treat­ment of ADHD — along with links to exten­sive reviews of sev­eral recently pub­lished stud­ies -: How Strong is the Research Sup­port for Neu­ro­feed­back in Atten­tion Deficits?

- Results from a New Study of Neurofeedback -

Recently, a study of neu­ro­feed­back treat­ment for ADHD was pub­lished that addresses sev­eral lim­i­ta­tions that have under­mined prior research [Gevensleben, et al., (2009). Is neu­ro­feed­back an effi­ca­cious treat­ment for ADHD? A ran­dom­ized con­trolled clin­i­cal trial. Jour­nal of Child Psy­chol­ogy and Psychiatry.]

The study was con­ducted in Ger­many and began with 102 chil­dren aged 8 to 12. All had been care­fully diag­nosed with ADHD and approx­i­mately over 90% had never received med­ica­tion treat­ment. About 80% were boys. Chil­dren were ran­domly assigned to Read the rest of this entry »

I wanted to alert you to a very inter­est­ing find­ing pub­lished in a recent issue of Sci­ence, one of the world’s lead­ing sci­en­tific journals.

The study was led by Dr. Torkel Kling­berg and his col­leagues from the Karolin­ska Insti­tute in Swe­den. The goal was to learn whether Work­ing Mem­ory Train­ing is asso­ci­ated with changes in brain bio­chem­istry, thus sug­gest­ing a mech­a­nism by which train­ing may lead to enhanced work­ing mem­ory capac­ity and a reduc­tion in atten­tion prob­lems. Thus, although Work­ing Mem­ory Train­ing has pre­vi­ously shown promis­ing results as a treat­ment for work­ing mem­ory and atten­tion dif­fi­cul­ties, this was a basic sci­ence study rather than a treat­ment study.

The major find­ing was that increased work­ing mem­ory capac­ity fol­low­ing train­ing was asso­ci­ated with changes in brain bio­chem­istry. Specif­i­cally, the researchers found changes in the den­sity and bind­ing poten­tial of cor­ti­cal D1 dopamine recep­tors in brain regions that are acti­vated dur­ing work­ing mem­ory tasks.

Results from this study sug­gest a bio­log­i­cal basis for the improve­ment in work­ing mem­ory capac­ity and reduc­tions i Read the rest of this entry »