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ADHD, iPads, sleep and concentration problems: 
Shedding new light on ADHD?

 Psychology Practice Brainclinics
At schools, the idea still prevails that easily distracted children and children with ADHD should not be seated too close to the window, since they might be distracted by what is happening outside. Also, ADHD is often associated with difficulties in executive functioning and attention. Are these symptoms truly the core issue in ADHD, or could there be a different underlying cause? In this article, I will discuss this in further detail and show that some easily distracted children might be better off sitting closer to the window.
Most parents are aware that no two children are the same. Accordingly, we know that no two children with ADHD are the same, even though they share the same “diagnosis”. Oddly enough, this principle is only recently beginning to get accepted in psychiatry. Over the last few years, it has become clearer that the treatment of ADHD with psychostimulants such as Ritalin only has sustained effects beyond 2 years in 30-40% of the patients. These recent findings indicate that we should accept the possibility of more than one cause for ADHD and that – from a neurobiological perspective – it is not a homogeneous disorder. This development is often referred to as ‘Personalized Medicine’ or ‘Precision Medicine’, wherein the diversity of causes for “ADHD behavior”, with most likely a corresponding diversity in the required treatment approaches, is the starting point. At Brainclinics for the last 10-15 years we have conducted research on such ADHD subgroups. These studies indicate a subgroup among children with ADHD, in which brain activity (as measured with the Electroencephalogram, or EEG) shows clear signs of drowsiness. This subgroup also appears to be the group that respond well to psychostimulant medication (such as Ritalin) and neurofeedback. Conceptually, it is also very understandable that a psychostimulant should have an effect when there are signs of drowsiness.
Over the last 10 years, we have extensively investigated the use of neurofeedback as a treatment for ADHD. Unfortunately, some parties are ‘over-claiming’ all kinds of uses of neurofeedback. When consulting the Internet, one would almost think that neurofeedback is a panacea for everything. In addition, there is a wide variety in “neurofeedback methods” applied, of which some are well investigated and known to have good clinical effects in ADHD. However, there are also many questionable methods, which have not been investigated at all. In summary, one should have relatively most confidence in therapists who claim less (e.g., who limit themselves to the treatment of ADHD). And, just like regular ADHD treatment should be carried out by a trained psychologist, the same should apply to neurofeedback treatment (and this is often not the case). 
In working with neurofeedback and ADHD, we have noticed for years that the most common “side effect” reported by patients, was that they slept better, even when no sleeping problems were present. Based on this fact and other scientific studies explaining this “sleep enhancing effect” of neurofeedback, we recently published a model that relates sleep problems to symptoms in the ADHD spectrum, such as concentration problems, impulsivity, etc. (Arns & Kenemans, 2012).
What does this relationship between sleep problems and ‘symptoms of ADHD’ entail? 
To understand this better, it is important to distinguish between ‘sleep deprivation’, i.e. a full night without sleep, of which we know that it substantially affects daily functioning, and sleep restriction. Sleep restriction means sleeping half an hour or an hour less. It is known that, in the long term, this results in impaired attention functioning and in the typical ‘drowsiness’ brain activity as described above. If adults are requested to sleep 6 instead of 8 hours per night for two consecutive weeks, their attention and concentration will gradually decline from day to day. When asked about their functioning after two weeks of sleep restriction, they will report no complaints. However, when attention is measured objectively, it will become clear that their functioning is at the same level as it would have been after two nights of full sleep deprivation! The big difference of sleep restriction as compared to sleep deprivation lies in the fact that a person would have to get an equal number of normal ‘8 hour sleep’ nights in order to function at the same level as before the sleep restriction. In other words, sleeping-in on the weekends is not sufficient to recover from the loss of sleep during the week. Furthermore, large-scale studies have shown that sleep duration is positively correlated with executive functioning and school functioning, and negatively correlated with externalizing behavior (disobedient, disturbing, hyperactive and impulsive behavior, etc.). Also, several studies have shown that healthy children exposed to sleep restriction will display more ‘ADHD-like’ behavior.
In this perspective it is also interesting to know that today, children sleep an average of 1 hour and 15 minutes less than a 100 years ago. More objectively, studies using EEG, have substantiated this trend further and reveal that, during the last ten years, healthy children’s brain activity is showing more signs of drowsiness. Considering this, it becomes clear that sleep indeed plays a fundamental role in our daily functioning, and that it can indeed play a role in the development of complaints that are also seen in ADHD. In addition, these trends may partly explain the increase of concentration problems and increased prevalence of ADHD. 
It is known that various sleep disorders are more common among children with ADHD, such as Restless Legs Syndrome (RLS) and sleep-breathing problems or sleep apnea (manifested through snoring, and a temporary cessation of breathing during sleep). Interestingly, it was observed in several studies that treating sleep disorders such as RLS and sleep apnea also resulted in a substantial improvement in ADHD complaints. Another – more subtle – sleeping problem that occurs in 70-80% of children and adults with ADHD, is sleep onset insomnia (SOI), i.e. having trouble falling asleep at an age-appropriate bedtime. This is not just a subjective complaint; it can be determined objectively by measuring the release of melatonin (sleep hormone) in the evening, according to Dutch researchers. For a better understanding of this matter, it is important to know that, besides rods and cones (responsible for processing visual information), we also have a third receptor in our eyes, the melanopsin receptor. This receptor is sensitive to blue light only and is responsible for the regulation of our biological clock. Blue light in the morning – in line with the time of day that sunlight is most intense – is what our biological clock has evolved against through the last millions of years. Likewise, excessive exposure to blue light in the evening leads to a suppression of the sleep hormone melatonin, thereby postponing the feeling of being tired resulting in people falling asleep later. The old-fashioned light bulb or incandescent light mainly emits light in the red spectrum and hardly any light in the blue spectrum (that is why incandescent light bulbs are energy inefficient; since most of the energy is transformed into infrared, e.g. heat). In contrast, modern LED lamps and energy saving lamps (CFL), as well as tablets, computer screens and mobile phones have a peak in the blue spectrum and thus emit a lot of blue light (just look at the ‘blue’ reflection on someone’s face when behind a smartphone or tablet in the dark). Exposure to these light sources at the ‘wrong’ time of day, i.e. in the evening, can disrupt our biological clock and make us fall asleep at a later time, hence causing the sleep restriction mentioned above. Interestingly, this effect can be reversed by increasing blue light exposure in the morning.
Based on these data, it might be presumed that there is a relationship between exposure to sunlight and the prevalence of ADHD. Last year we published a study in Biological Psychiatry where we exactly demonstrated this, also see the figure below. In this figure, the prevalence of ADHD is shown on the left, and the annual intensity of sunlight (in KWh/m2/yr.) is shown on the right. These findings demonstrate that a high intensity of sunlight is associated with a lower prevalence of ADHD. Meanwhile, we have confirmed this relationship in five different datasets, including a dataset with European countries. This relationship explains 34-57% of the prevalence of ADHD in the US and other countries, which is a considerable proportion. 

What is the role of iPads, PCs and LED lamps? And prevention of ADHD?

Now, of course the question arises whether it is recommendable to keep children from using the iPad or computer in the evening. Our research shows that sufficient exposure to sunlight during the day may have a preventative effect in ADHD. However, it is our interpretation that this is caused by an excessive amount of blue light exposure in the evening. Banning modern media use in the evening will probably not be realistic. However, free software is available (like F.lux) that will adjust the color settings on the screen of your PC, Mac or iPad, depending on the time of day. Manufacturers of modern media should perhaps consider implementing this functionality by default. Also, LED manufacturers may consider developing LED lights with less affinity in the blue spectrum. Yet, a simple advice may be to just get more daylight exposure in the morning. A project of which we're still dreaming, is to literally ‘take the roof off’ in schools in the Netherlands, in order to use skylight to provide natural light in the classrooms. The only ‘side effect’ of such an intervention would be a substantial savings on energy costs, thus an ecologically sustainable solution, and possibly a decrease of concentration problems and ADHD. Until that time, simple advices like walking the dog in the morning, walking or cycling to school instead of using a car and, as argued above, providing a seat by the window for that easily distracted child, are a good start.
Gluten-Free Recipe:
Raspberry Lemon Cheesecake Cookies
Author: Kristina Sloggett
Serves: 12-15 cookies
  • 1 tablespoon flax seed, freshly ground
  • 2 tablespoons warm water
  • ⅓ cup coconut oil
  • ⅓ cup cream cheese, softened
  • ½ cup sugar (agave, coconut nectar, raw sugar)
  • 1 cup gluten free all purpose flour
  • 1 teaspoon baking powder
  • ½ teaspoon xanthan gum
  • pinch salt
  • ¾ pint fresh raspberries
  • zest of ½ small lemon
  1. Preheat oven to 350 degrees.
  2. Grind flax seed in blender, coffee grinder. Place 1 tablespoon ground flax in a bowl, add water and stir. Place in refrigerator to set into gel (this equals / replaces one egg).
  3. Cream together coconut oil, cream cheese, and sugar; stir in flax mixture.
  4. Add flour to the top of this mixture, do not stir. Add baking powder, xanthan gum and salt, stirring into the flour before combining flour with coconut cream cheese.
  5. Fold in raspberries and lemon zest. Drop cookies by spoonful onto prepared (silpat, parchment) baking sheet, bake at 350 for approximately 15 minutes.
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Former Broncos
Seek Concussion
Relief Through
By Brian Maass
CBS Denver
February 8, 2016
About a dozen former Denver Broncos, some from the Orange Crush era, are taking part in a research study they say is helping them recover from post-concussion symptoms and traumatic brain injuries. They believe those injuries were suffered during their playing days.
After going through the protocol, “It was kind of like night and day,” said former Denver Broncos offensive lineman Dave Studdard, “The light came back on, clarity just everywhere.”
Studdard spent 10 seasons with the Broncos from 1979-1988.
CBS4 was on hand as Studdard went through one of his final sessions at New Hope For the Brain, a Lakewood based performance and rehabilitation center. Studdard said he believes he suffered from as many as 200 concussions during his days protecting Bronco quarterbacks like John Elway and Craig Morton.
He said concussion protocol in his playing days consisted of “Take a play off then come back in.” A few years ago, Studdard said he noticed he “couldn’t get anything clear in my mind… a constant fog. I felt like I was in a big fog and didn’t know how to get out.”
In 2015, Studdard heard about the New Hope For The Brain program from another former NFL player and decided to give it a try.
After about the third or fourth session Studdard says,”It just opened up on me. I feel like I’m 35 years old again. They’ve given me back my life that the NFL took away from me.”
Studdard is not alone. Jon Keyworth, a former Broncos running back from 1974- 1980. Keyworth lives in Montrose and went through the program last summer after years of what he and his wife describe as severe depression, confusion and anger.
“I could not find or remember what I was doing,” Keyworth told CBS4. “I had thousands of five yard collisions.”
His wife, Claudia, said her husband’s depression and mood swings were “Terrifying for me. I can see why these men put a gun to their chest.”
“He didn’t know what was wrong with him,” said Claudia Keyworth, but suspected a career of untreated concussions had left her husband with brain injuries.
Keyworth commuted weekly from Montrose to Lakewood for the two dozen weekly sessions last summer.
“I got up out of the seat- I had not felt that clarity for four years,” said Keyworth.
His wife says he is “Eighty or 90 percent better than he was.”
Dr. Penny Montgomery, co-owner of the Lakewood center, said the former NFL players are being offered neurofeedback technology which can reduce concussion related symptoms and potentially improve brain function.
“We know there are things that can be done for them,” Montgomery told CBS4. “The brain heals itself; we have to provide the environment for it.”
Montgomery said the techniques being employed at her clinic essentially help the brain reorganize and rebalance itself. She said her clinic has worked with about a dozen former Bronco players since last July and many show brain improvement and improvement in brain function.
She said players wives are among the first to notice the differences, “Some of them say it’s like getting their husband back. They’re saying their husbands are functioning better and are more energetic.”
Montgomery said follow up testing has shown the brain improvements for former Broncos and other NFL players are holding up.
Montgomery told CBS4 she is conducting the treatments for the former players for free and the NFL is generally not offering financial assistance. She said many of the former players couldn’t afford the treatments and have debilitating brain issues.
“We made a promise to the players we would help them and we are sticking with our promise,” said Montgomery. “I think it’s a moral obligation.”
Montgomery said follow up testing six months after the conclusion of the treatment sessions, has shown improvements holding.
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Antidepressant Use During Pregnancy Linked to Autism
Live Science
December 15, 2015
Women in a new study who took antidepressants during their second and third trimesters of pregnancy showed an 87 percent increased risk of having a child with an autism spectrum disorder, compared with women who did not take medications for depression while expecting.
The researchers also found that mothers who used a certain class of antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), had more than double the risk of having a child with autism spectrum disorder (ASD), according to the study published today (Dec. 14) in the journal JAMA Pediatrics. ASD is a group of conditions that includes autism, Asperger syndrome or other pervasive developmental disorders.
The findings suggest that using antidepressants, especially SSRIs, during the second and third trimester of pregnancy increases the risk of having a child with autism, said study author Anick Berard, a professor of pharmacy at the University of Montreal, who specializes in drug use during pregnancy. Some SSRIs that may be used during pregnancy include Zoloft, Prozac and Celexa.
Previous studies have shown that having depression itself may increase the risk of  autism. But the new study showed that the increase in the risk of having a child with autism that is linked to antidepressants is above and beyond the increase in risk of autism that is associated with maternal depression, Berard said. In the new study, depression in moms was associated with a 20 percent increased risk of autism, she said. [Beyond Vaccines: 5 Things that Might Really Cause Autism]
The analysis also found that women who were prescribed more than one class of antidepressants during the last six months of pregnancy were more than four times more likely to have a child with autism, compared with women who did not take antidepressants while pregnant.
Antidepressants are one of the most frequently used medications during pregnancy, with an estimated 7 to 13 percent of American women taking them while pregnant, according to one study.
Of the previous studies that have looked for a link between the development of autism in children and antidepressant use during pregnancy, some — but not all — have found that there is an association. This new study is one of the largest to show this association, according to the researchers.
“This study is the first to quantify autism risk based on the class of antidepressants used by a woman during pregnancy, and the first to find an increased risk with SSRIs mostly,” Berard told Live Science.
Depression during pregnancy
In an editorial accompanying the study that was published in the same issue of JAMA Pediatrics, Dr. Bryan King, a child psychiatrist at Seattle Children’s Hospital, wrote that the increasing prevalence of autistic spectrum disorders have led researchers to a “search for explanations, particularly among environmental factors." 
And in the ongoing search for environmental contributions to the risk of ASD, gestational exposures are increasing as an area of focus, said King, who was not involved in the research.
Although the exact cause of autism is not yet known, there is probably a strong genetic factor involved, but exposure to certain factors in the environment may also play a role, she said.
Exposure to an antidepressant during in utero development is one such factor. In the new study, the researchers analyzed data collected from all 145,500 pregnancies that occurred in the Canadian province of Quebec over the 20-year period between January 1998 and December 2009, in which mothers had a full-term pregnancy and gave birth to only one baby.
The researchers followed up with the children until age 10; there were 1,054 children who were diagnosed with ASD.
Using information gathered from hospital records in Quebec, as well as a prescription drug database and a database that showed physician visits, the researchers looked at whether the women in the study had filled a prescription for antidepressants at any time during their pregnancy, or one month before conception.
The analysis found that about 4,700 infants, or 3.2 percent of babies, were exposed to antidepressants at some point during their mothers’ pregnancies. Among these babies, 46 developed autism.
But the researchers found that only a mother’s use of antidepressants during the second or third trimester was associated with a greater risk of autism in children. There was no increase in ASD risk that was linked to using these medications during early pregnancy.
The second and third trimesters are a critical time for brain development in the fetus, Berard said. Taking SSRIs during this period inhibits levels of serotonin, a chemical that can affect a person’s mood, but is also essential for brain cell development in the fetus, she said. [11 Facts Every Parent Should Know About Their Baby’s Brain]
Depression is a serious and debilitating condition, and the new findings do not suggest that pregnant women with depression should go untreated, Berard said. But with evidence mounting of an increased risk of adverse pregnancy outcomes with antidepressant use, antidepressants are not always the best solution, she said.
The majority of depressed pregnant women are mildly to moderately depressed, and exercise and psychotherapy have been shown to be effective treatments when depression is not severe, Berard said.
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for both children & adults:
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  • 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
  • Peak Performance
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