A friend asked me recently why I was interested enough in neuroplasticity to undertake the creation and maintenance of a blog on the subject. I replied, and I had to think for a moment, that I found it exciting because it was a new frontier in medicine. The friend happens to be a physician and her response was a knowing smile and a nod. I have read that almost all of our knowledge in the field of neuroscience has been gained in the last ten years. But there is more to my interest than that. Neuroplasticity means hope, hope that things will change. I read a post on a site called MD Junction by a patient who is particularly depression prone. She takes great comfort, not that new findings in neuroscience can treat her depression but that it can help reverse negative behaviors and habits. Current thinking in the treatment of neurological disorders is that if you don’t have symptoms you don’t have the disorder. For example, a firefighter might have been diagnosed with ADHD in high school but in his high stimulation job, he functions quite well–so no symptoms, no ADHD. To me this means that the disorder gets separated from the person. Not long after my diagnosis, a friend said to me at a low point, “You are not an ADHD person–you are a person with ADHD.” I still have symptoms, even on medication but I have never forgotten the hope inherent in my friend’s statement. And he would know because he too has been diagnosed with ADHD. Hope means many things but perhaps the most important is the idea of change. St. Augustine said that hope has two lovely daughters: anger at the way things are and courage to see that they do not remain the way they are.
A friend recently posted a link on Facebook to a report by a research team from Duke University Medical Central along with some Australian scientists who found that, “Addictive drugs may hijack the same nerve cells and connections in the brain that serve a powerful, ancient instinct: the appetite for salt.” One of the co-authors of the report, Wolfgang Lietke, M.D., Ph.D. said, “We were surprised and gratified to see that blocking addiction-related pathways could powerfully interfere with sodium appetite. Our findings have profound and far-reaching medical implications, and could lead to a new understanding of addiction and the detrimental consequences when obesity-generating foods are overloaded with sodium.” You can read more about the study and its implications for addiction research here.
This finding reminded me of something Tim Bilkey M.D. told me in a consultation following his diagnosis of my ADHD. He noted that in his clinical practice he was finding that patients with ADHD had cravings for salt in snacks not sugar. He wondered whether there might be some connection to the fact that the most commonly prescribed drugs for this condition–Dexedrine and amphetamine–are technically salts.
By now most of you have seen the Youtube video of the gorilla walking through a group of people passing a basketball and marveled that you missed him as he passed through the players. Don’t worry, apparently about half of the people that watch the video miss the gorilla. If you haven’t seen it you can follow this link: basketball gorilla . The mechanism at work here is called in-attentional blindness and happens to people when their cognitive capacity is stressed or with individuals with lower working memory capacity. That would be me. You can read an article about the implications here. One implication the article describes is driving and talking on the phone. Driving is an attention rich task and so is talking on the phone and you really can’t do both at the same time. Hence the reason we now have a low prohibiting it. Yeah I know you can do it. So can I. Or so I thought. Apparently one of the giveaways that you are not paying attention happens when your eyes are focused, almost unblinkingly and straight ahead, on the road in front. You don’t normally drive like that. When you drive normally, your eyes move around, scanning the area, not just in front of you, but to the sides as well and then, every so often, also check the rear and side view mirrors. The gorilla video is another nail in the coffin that people with low working memory capacity (pretty well anyone with ADHD) may think they can multi-task but actually can’t. Suffice it to say, I no longer try to do both although I do use a Bluetooth hands-free speaker even though another finding says that in terms of attentional capacity, it really doesn’t make a lot of difference whether you are holding a phone or talking hands-free.
Study co-author Jason Watson, assistant professor of psychology, said: “The potential implications are that if we are all paying attention as we are driving, some individuals may have enough extra flexibility in their attention to notice distractions that could cause accidents.”
However he went on to say, “That doesn’t mean people ought to be self-distracting by talking on a cell phone while driving — even if they have better control over their attention. Our prior research has shown that very few individuals [only 2.5 percent] are capable of handling driving and talking on a cell phone without impairment.”
A comment made in a lecture a few years ago by Umesh Jain, who heads the ADHD clinic at Center For Addiction and Mental Health here in Toronto came back to haunt me over the last couple of days. He said that the major difference between treatment for Adults with ADHD and children is that with the adults you must first deal with the self esteem issues or you won’t get anywhere with treatment. With children, he went on to say, there usually aren’t any self esteem issue. There hasn’t been time. It is a different story with adults where has been failure after failure, defeat after defeat and years of not measuring up, all leading to self condemnation and despair. This is probably the reason that I have trouble controlling my anger when I encounter people who refuse to recognize that the disorder even exists. I hesitate to say that only a person who has been through the kind of failure that a lifetime with ADHD can breed can really understand that. Someone who has been down that path can have a special empathy for another fellow traveler. Perhaps some of us have developed a mechanism that prevents us from feeling sorry for ourselves. You could say this is a part of the resiliency that comes with making it into adulthood coping with a disorder that can be so debilitating. This mechanism doesn’t prevent us from feeling sorry for another individual who is struggling, perhaps still undiagnosed.
I have been puzzled lately, by how quickly I can be moved to tears, not in public, but in the privacy of my own apartment. Any suggestion on television or on the Internet that has to do with human suffering can trigger tears. After the potential for embarrassment I do hold them back in public. It doesn’t seem appropriate for a person with a second degree black belt in karate. But I am still affected.
On the other hand there is an upside to being an adult who has ADHD. Years of failure and defeat but never giving up means you have to have developed resiliency. It means you have staying power and you can survive. If you are an adult who has just been diagnosed–this simple fact may offer hope, perhaps enough hope to help you raise your self esteem.
Dr. Atila Turgay, one of the leading experts in Canada on ADD/ADHD passed away in April. He had been Chief Of Staff at Toronto’s Scarborough Hospital, although recently he had returned to private practice. He was also on the faculty of medicine at the University of Toronto. You can read more about Dr. Turgay at Dr. Kenny Handelman’s blog here. I saw him just before he left his post at the hospital and set up his office at Davisville and Yonge in the heart of Toronto. My reason for being there was a review of medication I had been prescribed for ADD since the physician who was currently writing the prescriptions had not originally either prescribed them nor done the diagnosis. Dr. Turgay performed the shortest test I had ever encountered for the three aspects of working memory. The first two were not uncommon. He asked me to remember a string of seven numbers and then repeat them backwards. He did a similar one for verbal working memory. Then he sat right opposite me and asked me to observe him, without moving, until he asked me to replicate what he did with his fingers and hands. What he did seamed simple enough. His hands were reversed with one finger on one hand touching a finger on the other. But when my turn came to replicate it I could not–even after a couple of tries. I had seen Dr. Turgay describe this test in several lectures sponsored by the Attention Deficit Resource Network but this was my first opportunity to actually do it. His conclusion, after these three short tests, was that I had an impairment in visual/non verbal working memory. Some years ago I did a completed psycho-educational assessment valued at close to $2,000 and a similar component, lasting at least half an hour, had reached the same conclusion.
My visit only lasted a few minutes and the medical part of it was over before I knew it. He concurred with the medication I was taking and with dosages and schedules. Then he quizzed me on my background and interests, as it turned out, to see if I might be of service to the ADD/ADHD community. It wasn’t his suggestion but this meeting was one of the reasons I started this blog. I heard him speak on a couple of times and my appointment with him two years ago only lasted perhaps 20 minutes but I will miss him. Not only was he a great resource to the ADD/ADHD community he was, in my experience, a kind and caring individual.
It was on reading his obituary and remembering his visual/non-verbal working memory test that led to a mini-ah ha moment. I had always marveled that one of the profound and noticeable effects of even a small dose of ritalin would lead to a great improvement in my hand-writing. I’m no expert but I would bet that there is a large component of visual/non-verbal working memory skill in handwriting.