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How Exercise Affects the Brain: Age and Genetics Play a Role


May 18, 2012

Exercise clears the mind. It gets the blood pumping and more oxygen is delivered to the brain. This is familiar territory, but Dartmouth's David Bucci thinks there is much more going on.


"In the last several years there have been data suggesting that neurobiological changes are happening -- [there are] very brain-specific mechanisms at work here," says Bucci, an associate professor in the Department of Psychological and Brain Sciences.

From his studies, Bucci and his collaborators have revealed important new findings:

  • The effects of exercise are different on memory as well as on the brain, depending on whether the exerciser is an adolescent or an adult.
  • A gene has been identified which seems to mediate the degree to which exercise has a beneficial effect. This has implications for the potential use of exercise as an intervention for mental illness.

Bucci began his pursuit of the link between exercise and memory with attention deficit hyperactivity disorder (ADHD), one of the most common childhood psychological disorders. Bucci is concerned that the treatment of choice seems to be medication.


"The notion of pumping children full of psycho-stimulants at an early age is troublesome," Bucci cautions. "We frankly don't know the long-term effects of administering drugs at an early age -- drugs that affect the brain -- so looking for alternative therapies is clearly important."


Anecdotal evidence from colleagues at the University of Vermont started Bucci down the track of ADHD. Based on observations of ADHD children in Vermont summer camps, athletes or team sports players were found to respond better to behavioral interventions than more sedentary children. While systematic empirical data is lacking, this association of exercise with a reduction of characteristic ADHD behaviors was persuasive enough for Bucci.


Coupled with his interest in learning and memory and their underlying brain functions, Bucci and teams of graduate and undergraduate students embarked upon a project of scientific inquiry, investigating the potential connection between exercise and brain function. They published papers documenting their results, with the most recent now available in the online version of the journal Neuroscience.


Bucci is quick to point out that "the teams of both graduate and undergraduates are responsible for all this work, certainly not just me." Michael Hopkins, a graduate student at the time, is first author on the papers.


Early on, laboratory rats that exhibit ADHD-like behavior demonstrated that exercise was able to reduce the extent of these behaviors. The researchers also found that exercise was more beneficial for female rats than males, similar to how it differentially affects male and female children with ADHD.


Moving forward, they investigated a mechanism through which exercise seems to improve learning and memory. This is "brain derived neurotrophic factor" (BDNF) and it is involved in growth of the developing brain. The degree of BDNF expression in exercising rats correlated positively with improved memory, and exercising as an adolescent had longer lasting effects compared to the same duration of exercise, but done as an adult.


"The implication is that exercising during development, as your brain is growing, is changing the brain in concert with normal developmental changes, resulting in your having more permanent wiring of the brain in support of things like learning and memory," says Bucci. "It seems important to [exercise] early in life."


Bucci's latest paper was a move to take the studies of exercise and memory in rats and apply them to humans. The subjects in this new study were Dartmouth undergraduates and individuals recruited from the Hanover community.


Bucci says that, "the really interesting finding was that, depending on the person's genotype for that trophic factor [BDNF], they either did or did not reap the benefits of exercise on learning and memory. This could mean that you may be able to predict which ADHD child, if we genotype them and look at their DNA, would respond to exercise as a treatment and which ones wouldn't."


Bucci concludes that the notion that exercise is good for health including mental health is not a huge surprise. "The interesting question in terms of mental health and cognitive function is how exercise affects mental function and the brain." This is the question Bucci, his colleagues, and students continue to pursue.


Dartmouth College. "How exercise affects the brain: Age and genetics play a role." ScienceDaily, 18 May 2012. Web. 16 Aug. 2012.


20 Gluten-Free Lunch Ideas:

Taking your lunch to school or work saves you money, but it can be a hassle when you're living with a gluten allergy.  Something as simple as a peanut butter and jelly sandwich becomes a nightmare of buying expensive bread or making your own.  Although you can make your own gluten-free bread ahead of time for days you want a sandwich, here's a list of 20 non-sandwich lunches for a frugal gluten-free lifestyle:


  1. Gluten-free pizza
  2. Cream cheese wraps with homemade gluten-free tortillas
  3. Deviled eggs
  4. Chef's salad
  5. Gluten-free pasta salad (quinoa pasta is best)
  6. Thai food (rice noodles)
  7. Chili
  8. Nachos
  9. Burritos with gluten-free tortillas
  10. Greek quinoa salad
  11. Veggies with hummus and cottage cheese
  12. Moroccan lentil salad
  13. Hard tacos
  14. Soft tacos with corn tortillas
  15. Lettuce wraps (use gluten-free soy sauce)
  16. Peanut butter and jelly roll-ups with gluten-free tortillas
  17. Pepperoni pizza wraps with gluten-free tortillas
  18. Taco salad with crunchy tortilla chips on top
  19. Fried rice
  20. Quiche muffins (recipe below)


Quiche Muffin Recipe

Makes 12


  • 8-10 eggs
  • ¼ cup frozen, chopped spinach (thawed)
  • ¼ cup green onions diced
  • 2 wedges Happy Cow swiss cheese (or 2 tablespoons cream cheese)
  • 3 slices turkey or ham, diced
  • ¼ cup mushrooms, diced
  • 3 cloves crushed garlic
  • seasoning to taste

Preheat your oven to 325°F. Blend all of the ingredients in a food processor, or just beat very well with a whisk. Pour them into a greased cupcake pan, about 2/3 full. Place them in the oven for about 10 minutes, or until set. Allow to cool before putting them into plastic storage bags. Freeze or refrigerate. After thawing, place them in microwave on high for about 30 seconds before serving.

Packing Gluten-Free Lunches

Some of these lunches would do well if you have access to a microwave at work. Also, it pays to invest in a small cooler to keep the meats chilled before lunch.

If you're packing lunch for your kids, here are ideas to prepare your gluten-free kids to go to school, with age-appropriate lunch ideas.

Gluten-Free Snacks

Snacks on the side are relatively easy.  There are a lot of very gluten-free friendly snacks out there if you read the labels.  Some of our family favorites are:

  • Baby carrots
  • Celery and peanut butter
  • Kettle chips
  • Tortilla chips
  • Popcorn
  • Pop Chips
  • Apples
  • Oranges
  • Almonds
  • Peanuts
  • Honey Nut Chex

Upcoming Session Dates

for the Sensory Learning Program


Tuesday, September 4 through

Saturday, September 15


Monday, October 1 through

Friday, October 12


Monday, October 15 through

Friday, October 26


Monday, October 29 through

Friday, November 9



Did You Know?


SIRRI offers these services for both children & adults:

  • Neurofeedback & Biofeedback
  • qEEG / Brain Mapping
  • Cognitive Retraining: memory, processing & problem solving skills
  • Attention, Concentration & Focus Training
  • Auditory & Visual Processing
  • Reading Development: fluency & comprehension
  • Balance, Coordination & Motor Planning Development
  • Stress & Anxiety Management
  • IEP Advocacy




Cellist Achieves Optimal Performance Through Neurofeedback


May 9, 2012

"Practice makes perfect," the saying goes. Optimal performance, however, can require more than talent, effort, and repetition. Training the brain to reduce stress through neurofeedback can remove barriers and enhance one's innate abilities.


An article in the journal Biofeedback presents the narrative of a young cellist who was able to realize the potential of his talent and eliminate debilitating migraine headaches. This case study is part of a special section in the Spring 2012 issue focusing on optimal functioning.


Enhancing people's performance in business, performing and visual arts, academia, and sports can be realized through biofeedback and neurofeedback training. Tools of stress reduction, mental imagery training, psychology, and psycho-physiological technology are combined to help people reach their goals.


The author and practitioner in this case study has combined her work and study in the fields of theater, social work, and neurofeedback. In her practice, she coaches clients to achieve outstanding performances. For example, a singer can better understand and interpret a musical selection, allowing that singer to better convey the emotion of the music, resulting in a noticeably improved performance.


William, the young musician, sought relief from migraine headaches that were affecting him almost daily. His therapy, however, did not take the approach of treating the headaches, but of focusing on William as a person and as a performer. By improving his functionality, working through moments of obsessiveness, self-criticism, fear, and anxiety, the headaches could also be resolved.


William's therapist conducted neurofeedback -- using sensors to read his brainwaves, analyzing these with NeuroOptimal™ software, and then giving feedback to the brain through a visual display and sound. With this information, the brain can learn to self-correct. This technology assists in getting people past that moment when they obsess over whether they have given the correct answer or hit the right note.


NeuroOptimal feedback, guided imagery, and coaching about decisions regarding his music helped William move beyond the difficulties he encountered. During his senior recital at his college, he was able to give a relaxed, confident performance that was met with a standing ovation.


Allen Press Publishing Services. "Cellist achieves optimal performance through neurofeedback." ScienceDaily, 9 May 2012. Web. 16 Aug. 2012.

Why Being Young for Grade Increases Odds of ADHD Diagnosis and Stimulant Medication

By: Dr. David Rabiner

June 21, 2012

ADHD is the most com­monly diag­nosed neu­robe­hav­ioral dis­or­der in chil­dren and sub­stan­tial evi­dence indi­cates that bio­log­i­cal fac­tors play an impor­tant role in its devel­op­ment. For exam­ple, although the exact mech­a­nism by which genetic fac­tors con­vey increased risk for ADHD remains unclear, the impor­tance of genetic trans­mis­sion has been doc­u­mented in a num­ber of pub­lished studies.


Even though bio­log­i­cal fac­tors are widely regarded as impor­tant in the devel­op­ment of ADHD, no med­ical or bio­log­i­cal test is rec­om­mended for rou­tine use when diag­nos­ing ADHD. Instead,like vir­tu­ally all psy­chi­atric dis­or­ders, ADHD is defined by a con­stel­la­tion of behav­ioral symp­toms that are gen­er­ally reported on by a child’s par­ents and teacher. Also, in nearly all cases, it is par­ents’ and/or teach­ers’ con­cerns about a child’s abil­ity to focus and reg­u­lar their behav­ior that leads to a child being eval­u­ated for ADHD in the first place.


While some chil­dren dis­play suf­fi­cient inat­ten­tive and/or hyperactive-impulsive behav­ior to be diag­nosed with ADHD as preschool­ers, it is gen­er­ally not before chil­dren enter school that con­cerns related to atten­tion and hyper­ac­tiv­ity arise. This may be espe­cially true for inat­ten­tive symp­toms, as demands for sus­tained atten­tion become much greater when chil­dren start in school.


Teach­ers can observe how a child’s abil­ity to reg­u­late atten­tion and behav­ior com­pares to an entire class­room — some­thing par­ents typ­i­cally can’t do — and their judge­ments may thus be par­tic­u­larly influ­en­tial in whether a child is eval­u­ated for ADHD and diag­nosed with the disorder.


A num­ber of fac­tors may con­tribute to dif­fer­ences in children’s abil­ity to focus and reg­u­late their behav­ior when they enter school. One fac­tor cer­tainly is ADHD, as chil­dren with the con­di­tion will be observed by teach­ers to be more inat­ten­tive and/or hyper­ac­tive. Another fac­tor — and one that may be fre­quently over­looked — is their age rel­a­tive to most of their class­mates. This is the issue inves­ti­gated in the stud­ies that are sum­ma­rized below.


Pub­lic school sys­tems have spe­cific dates that a child must be born by to begin kinder­garten. Con­sider two chil­dren in a school sys­tem where the cut-off is Decem­ber 31st. Jack is born on Decem­ber 31st, 2007 and would thus be eli­gi­ble to enter kinder­garten dur­ing fall 2012. Com­pared to most of his class­mates who were born as early as 1/1/2007, he will be rel­a­tively young. On aver­age, in fact, Jack would be about 6 months younger than his peers.


John is born on Jan­u­ary 1st 2008 and would thus be inel­i­gi­ble to enroll in the fall. Instead, he would need to wait until fall 2013 before start­ing kinder­garten. Thus, com­pared to most of his class­mates who could be born as late as 12/31/2008, he will be rel­a­tively old; on aver­age, he would be about 6 months older.


Although an age dif­fer­ence of 6 roughly may make lit­tle if any dif­fer­ence in the abil­ity of older chil­dren and ado­les­cents to focus, attend, and reg­u­late their behav­ior, it may make a sub­stan­tial dif­fer­ence in 5 and 6 year-olds. And, dif­fer­ences in nearly a year — which may be present between the old­est and youngest child in a grade — could be asso­ci­ated with large dif­fer­ences on these dimen­sions. This sug­gests that chil­dren rel­a­tively young for grade at the start of school will, on aver­age, be less able to reg­u­late their atten­tion and behav­ior than their class­mates. As a result, young-for-grade chil­dren may be more likely to be seen as strug­gling by teach­ers who would con­vey their con­cerns to par­ents. In many cases, this may lead par­ents to have their child eval­u­ated for ADHD and poten­tially increase the rate of ADHD diag­no­sis and treat­ment in young-for-grade chil­dren. Is there evi­dence that this is the case?


Three recently pub­lished stud­ies pro­vide com­pelling evi­dence that a child’s age rel­a­tive to his or her class­mates is an impor­tant fac­tor in whether they are diag­nosed for ADHD. Results from these stud­ies are sum­ma­rized below.


Study 1

The first study of this issue [Evans, et al., (2010). Mea­sur­ing inap­pro­pri­ate med­ical diag­no­sis and treat­ment in sur­vey data: The case of ADHD among school-age chil­dren. ‚i>Journal of Health Eco­nom­ics, 29, 657–693] used data from the National Health Inter­view Sur­vey (NHIS), an annual sur­vey of house­holds in the US that col­lects data on the extent of ill­ness, dis­ease, and dis­abil­ity in the civil­ian pop­u­la­tion. The infor­ma­tion col­lected includes whether sam­ple mem­bers had been diag­nosed with ADHD and pre­scribed stim­u­lant medication.


The authors used sur­vey data from 1997 to 2006 and only included chil­dren from states with a state-wide birth date cut-off for school entry in place when the child was five. Based on this cut-off, which var­ied by state, they exam­ined ADHD diag­no­sis and treat­ment rates for over 35,000 7 to 17 year olds who were born up to 120 days before (i.e., rel­a­tively young for grade) or up to 120 days after (i.e., rel­a­tively old for grade) the state cut-off.

Results indi­cated that 9.7% of young-for-grade chil­dren had been diag­nosed with ADHD com­pared to 7.6% of those rel­a­tively old-for-grade, a dif­fer­ence of approx­i­mately 27%. Rates of stim­u­lant usage were also sig­nif­i­cantly dif­fer­ent, 4.5% vs. 4%.


Study 2

A sec­ond study [Elder (2010). The impor­tance of rel­a­tive stan­dards in ADHD diag­no­sis: Evi­dence based on exact birth dates. Jour­nal of Health Eco­nom­ics, 29, 641–656] used data from another large national data set — the Early Child­hood Lon­gi­tu­di­nal Study — to exam­ine this issue. The data set ini­tially included over 18,600 kinder­garten stu­dents from over 1000 kinder­garten pro­grams in the US in the fall of 1998; chil­dren were fol­lowed peri­od­i­cally through 2007 when most were in 8th grade. Avail­able infor­ma­tion includes par­ent and teacher rat­ings of children’s ADHD symp­toms, diag­noses, and stim­u­lant med­ica­tion treat­ments; final results were based on over 11,750 children.


ADHD diag­no­sis and treat­ment rates were cal­cu­lated for chil­dren born the month before (young-for-grade) and the month after (old-for-grade) the state man­dated cut-off, which was Sep­tem­ber 1 for some states and Decem­ber 1 for oth­ers. For states with the Sep­tem­ber 1 cut-off, 10% of chil­dren born in August were diag­nosed with ADHD com­pared with 4.5% born in Sep­tem­ber. Rates of stim­u­lant med­ica­tion treat­ment were 8.3% vs. 2.5% respec­tively. For states with a Decem­ber 1st cut-off, the diag­no­sis rate for chil­dren born in Novem­ber was 6.8%, more than triple the 1.9% rate for those born in Decem­ber; rates of stim­u­lant treat­ment were 5.0% and 1.5% respectively.


The author exam­ined the impact of rel­a­tive age on whether chil­dren were diag­nosed with learn­ing prob­lems other than ADHD, includ­ing devel­op­men­tal delays, autism, dyslexia, socio-emotional behav­ior dis­or­der, or other learn­ing dis­abil­i­ties. For these other learn­ing prob­lems, no relative-age effects were found.


The author also demon­strated that school start­ing age had a much stronger effect on teach­ers’ per­cep­tions of children’s ADHD symp­toms than on par­ents’ per­cep­tions. He sug­gests this may be because teach­ers rate children’s behav­ior rel­a­tive to other chil­dren in the class, and rel­a­tively young chil­dren are less able to reg­u­late their atten­tion and behav­ior. Par­ents, in con­trast, may use more absolute stan­dards since they are less above to observe their child in rela­tion to a class­room full of peers.


Study 3

The final study [Mor­row et al., (2012). Influ­ence of rel­a­tive age on diag­no­sis and treat­ment of attention-deficit/hyper­ac­tiv­ity dis­or­der in chil­dren.Cana­dian Med­ical Asso­ci­a­tion Jour­nal, DOI:10.1503/cmaj.11619] exam­ined the asso­ci­a­tion between age-for-grade and ADHD diag­no­sis in a study of over 935,000 youth from British Colum­bia who were 6–12 years of age at any time between Decem­ber 1997 and Novem­ber 2008. Thus, the value of this study is that the sam­ple comes from a dif­fer­ent coun­try and entirely dif­fer­ent health care sys­tem than the US.


The cut-off for school entry in British Colum­bia dur­ing this time was Decem­ber 31. Sim­i­lar to the results reviewed above, boys born in Decem­ber were 30% more likely to be diag­nosed with ADHD than boys born in Jan­u­ary; girls born in Decem­ber were 70% more likely to be diag­nosed with ADHD than girls born in Jan­u­ary. Boys were 41% more likely and girls were 77% more likely to be treated with med­ica­tion if they were born in Decem­ber rather than January.


Sum­mary and Implications

Results from 3 inde­pen­dent stud­ies that employed large and rep­re­sen­ta­tive sam­ples indi­cate that chil­dren who are young for their grade are sig­nif­i­cantly more likely than peers to be diag­nosed with ADHD and to be treated with stim­u­lant med­ica­tion. Based on addi­tional analy­ses con­ducted in one of these stud­ies, the rel­a­tive age effect is pri­mar­ily related to teach­ers’ per­cep­tions and does not extend to other learn­ing dis­or­ders. These lat­ter two issues were exam­ined in only one of the three stud­ies, how­ever, and thus require replication.


Why might being young for grade increase the odds of a child’s being diag­nosed with ADHD? One plau­si­ble expla­na­tion is that focus­ing atten­tion and reg­u­lat­ing behav­ior are abil­i­ties that develop over time. At school entry, being up to 12 months younger than class­mates rep­re­sents a sub­stan­tial por­tion of a child’s total age, and these capac­i­ties have had less time to develop. As a result, rel­a­tively young chil­dren will gen­er­ally be less capa­ble than class­mates of reg­u­lat­ing their atten­tion and behav­ior and more likely to be iden­ti­fied by teach­ers as strug­gling on these dimen­sions. They will thus be referred for eval­u­a­tion and diag­nosed with ADHD at higher rates.


It is impor­tant to note that none of the researchers sug­gest that their data raise ques­tions about the valid­ity of ADHD as a ‘real’ dis­or­der with neu­ro­bi­o­log­i­cal under­pin­nings. In my view, using these find­ings to ques­tion the valid­ity of the con­di­tion would be highly problematic.

Instead, these find­ings sug­gest that many chil­dren who are young for their grade are diag­nosed not because they have the dis­or­der but because they are devel­op­men­tally less advanced than many of their class­mates. By the same token, chil­dren who are rel­a­tively old for their grade may be under­diag­nosed because their inat­ten­tive­ness and hyper­ac­tiv­ity do not seem exces­sive in rela­tion to their younger class­mates. Both out­comes are poten­tially harm­ful and speak to the com­plex­i­ties involved in diag­nos­ing ADHD but not to the valid­ity of ADHD as a legit­i­mate disorder.


Results from these stud­ies high­light the impor­tance of care­ful and accu­rate diag­nos­tic eval­u­a­tions. These stud­ies make an impor­tant con­tri­bu­tion to the field by rais­ing aware­ness of the role that rel­a­tive age can play in increas­ing or decreas­ing the risk of receiv­ing an ADHD diag­no­sis. Although there is no easy way to address this com­pli­cat­ing fac­tor, there are sev­eral steps that may be use­ful to take.


First, clin­i­cians eval­u­at­ing young chil­dren should be espe­cially care­ful when that child is also young rel­a­tive to his class­mates. For chil­dren born close to the cut-off for school entry, spe­cial con­sid­er­a­tion should be given to whether rel­a­tive age may be an impor­tant fac­tor in the child’s behav­ior at school.


Sec­ond, there may be value in nar­row­ing the age ranges used in many of the widely used behav­ior rat­ing scales. Results from these stud­ies sug­gest that there are sig­nif­i­cant nor­ma­tive dif­fer­ences in inat­ten­tive and hyper­ac­tive symp­toms between chil­dren born dur­ing dif­fer­ent months in the same year, let alone in dif­fer­ent years. What is ‘nor­mal’ for a child 6 years and 1 month old dif­fers from what is typ­i­cal for a child 6 years 11 months old.


How­ever, behav­ior rat­ing scales gen­er­ally have age cat­e­gories that encom­pass mul­ti­ple years. Thus, rather than com­par­ing whether the inat­ten­tive behav­iors a teacher reports for a young 6 year old are exces­sive rel­a­tive to other young 6 year old’s, the child’s score will be deter­mined in rela­tion to a ‘nor­ma­tive group’ that includes chil­dren who are sev­eral years older. As a result, chil­dren at the low end of the age range may be more likely to receive ele­vated ADHD symp­tom rat­ing scores than chil­dren at the upper end of the age range. This is very dif­fer­ent from how stan­dard­ized IQ and achieve­ment tests are con­structed, where scores are cal­cu­lated in rela­tion to age groups that span only sev­eral months.


Third, these find­ings high­light the value of ongo­ing efforts to develop a reli­able objec­tive assess­ment mea­sure for ADHD that is not effected by rel­a­tive age effects. As dis­cussed in a prior issue of Atten­tion Research Update, Quan­ti­ta­tive EEG (qEEG) may be a help­ful tool in this regard.


Finally, the asso­ci­a­tion between rel­a­tive age and risk of diag­no­sis high­lights the impor­tance of sys­tem­at­i­cally reeval­u­at­ing chil­dren each year. As chil­dren develop, the impor­tance of rel­a­tive age on the abil­ity to reg­u­late atten­tion and behav­ior is likely to dimin­ish. For exam­ple, one would expect less dif­fer­ence in the abil­ity to sus­tain atten­tion between younger vs. older 15 year-olds com­pared to younger vs. older 6 year– olds. Thus, if a child was incor­rectly diag­nosed with ADHD because he/she was rel­a­tively young at school entry, and thus less capa­ble than peers of reg­u­lat­ing atten­tion and behav­ior, annual reeval­u­a­tions should iden­tify this as the child moves into later grades.



SIRRI Arizona • 4515 S. McClintock Drive, Suite 208 • Tempe, AZ 85282
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