What we thought we knew about ADHD medicine
A recent study from Washington University in St. Louis, published in the journal Science Cell It changes what we thought we knew stimulating drugs affect the brain and change children’s behavior attention– attention deficit/hyperactivity disorder (ADHD).
Stimulants such as Ritalin and Vivance block the reuptake of neurotransmitters dopamine and norepinephrine, thereby increasing their concentration at the synapse level. This part is not a question. The question is which areas of the brain are affected by this activity. Since the prefrontal cortex contains our attention circuits, it makes sense that this is the area of the brain where stimulants exert their effects.
But this is not true.
What the new MRI data tells us
This new study looked at nearly 12,000 functional magnetic resonance imaging studies (fMRIs) in children aged 8 to 11 years at rest. Of these, 337 were images of children who received a stimulant on the morning of the study. In these children, the researchers found no activity in any of the brain regions that control attention.
Ok… So if stimulants don’t increase attention by activating the attention areas of our brains, how do they work (because they do for most kids)? fMRIs showed the greatest changes in functional connectivity (FC) in brain areas associated with excitement (dorsal and ventral attention networks, DAN and VAN and frontoparietal network), as well as those areas associated with the expectation of rewards (frontal or parietal). memory network or SAL/PMN).
ADHD is more about reward and stimulation than attention deficit disorder
And that makes sense. We have used stimulants to treat narcolepsy as well as related sleepiness brain injury. It also explains why so many parents of children with ADHD have said to me, “But Dr. attention deficit when he can play video games for hours?”
It turns out that if our brain convinces us that a task is fun and interesting, or rewards us for our attention with a hit of dopamine, a simple task can become salient and worth our time, making it easier to focus. In other words, stimulants reward our brains before we start, so we can persevere in something that would otherwise not interest us.
Main results about sleep
Another interesting finding of this study has to do with brain changes that occur during sleep deprivation. About half of the children in this study reported getting less than the recommended nine hours of sleep per night. Of interest is the pattern of functional connectivity produced by the stimulator medicine reflected in a well-rested brain. This finding has been proven in the classroom as well. Sleep-deprived children using stimulants had the same scores as well-rested children who did not take the drug.
The importance of the study is not that stimulant drugs work. That was not the question. Research only asks us to think about it What kind of they work Now, doctors who prescribe these drugs need to reframe our conversations with parents about them motivation and rewards, and not only about the brain of the neglected.
Also in the research findings is the importance of diagnosing adequate sleep and optimizing sleep schedules in children as a primary or concurrent intervention. Medicines cannot replace good sleep. Although ADHD medication can compensate for sleep deprivation in the short term, both in terms of brain changes in fMRI and classroom performance, the long-term consequences of chronic sleep deprivation are still serious and include increased risk of sleep deprivation. depression and cell damage from stressas well as neuronal loss.
