Saturday, July 12, 2008

Gene research could hold clues to ADHD

Fascinating piece Friday on NPR’s Talk of the Nation Science Friday about new research on Attention Deficit Hyperactivity Disorder (ADHD). To listen to the interview, go to http://www.npr.org/templates/story/story.php?storyId=92455272. Here’s a synopsis:

This week in the Journal of Neuroscience, scientists report that in two brothers with attention deficit hyperactivity disorder, or ADHD, a genetic change appears to make one of the brain's neurochemical pathways — the dopamine transporter — run in reverse. The result of that miswiring is that the brain acts as if amphetamines are always present, the researchers say.

Randy Blakely, one of the study's authors, and Allan D. Bass, professor of pharmacology and psychiatry at Vanderbilt University Medical Center, talk about the findings and what they might mean for ADHD treatment.


So, the dopamine transporters in these two brothers run backwards and that causes their ADHD? That could explain a lot, as too much dopamine leads to anxiety and nervousness and hyperactivity. The studies could lead to some breakthroughs in treatment for ADHD. It also explains the workings of Ritalin and Concerta and other central nervous system stimulants. They cause the dopamine tranporters to reverse their actions which, in the case of the two brothers, means that they are shifted from reverse into forward. Weird, eh?

Both my kids have ADHD. When we first put our son on Ritalin at the tender age of five, his pediatric psychiatrist admitted that scientists didn’t understand why Ritalin worked – it just did. Not exactly what parents want to hear when their five-year-old is being given a drug on the DEA’s list of Schedule II controlled substances, just one step down the scale from heroin, Quaaludes, magic mushrooms and LSD (also, inexplicably, marijuana).

So here are some new clues to the workings of ADHD medications.

I’ve written a lot about our family’s experience with ADHD. One of my early published essays on the subject in the now-defunct Northern Lights magazine was named "Hummingbird Minds" after a description of ADHD by hypertext pioneer Ted Nelson. He had ADHD in a big way and said that he and my son and millions of others had "hummingbird minds." That phrase became the title of my web site and later on my blog. In the beginning, I wrote a lot about ADHD but not so much any more. My son is 23 and in college. My daughter is about to enter high school. My son Kevin no longer takes medication for ADHD as he’s come up with other coping skills. It may be that ADHD is losing some of its sting as he ages. Not sure.

Some of my published work about ADHD can be found on my web site. Go to the "Writing" section on the sidebar and click on "On ADHD." Here’s an excerpt from my essay "We Are Distracted" published, in a slightly different form, in the 1996 book In Short: A Collection of Brief Creative Nonfiction by W.W. Norton and co-edited by Judith Kitchen and Mary Paumier Jones:

Physicians have been prescribing Ritalin (a.k.a. methylphenidate) for more than 30 years for a condition that has been known as Minimal Brain Damage (MBD), Minimal Brain Dysfunction in Children (MBDC), Attention Deficit Disorder (ADD), and ADD with Hyperactivity (ADHD). If some progressive therapists and groups such as CHADD (Children and Adults with Attention Deficit Disorder) have their way, the official designation may one day be changed to Attention Deficit Syndrome with hyperactivity (ADHS). This alphabet soup can be confusing. Once, on his first day at a new school, my son announced in front of the class that he had ADHD. The next day, several very nervous parents called the school, concerned about the new student who had AIDS. Being a "hyper" kid turns you into one type or pariah; AIDS carriers get special mistreatment. It was weeks before the confusion was straightened out. But the impression had been made. Kevin was different; different is bad.

1 comment:

mpage225 said...

Mike, interesting reading on a Saturday night. And based on my experience, it makes sense. We put Sam on Ritalin during the last half of first grade and it made an immediate difference. We had an advantage in that Sam is 4-5 years younger than Kevin and ADD was better recognized and accepted by then. Our school was also very good to work with and we tried other ways before using Ritalin.

Sam gave it up in grade school, 5th grade, then asked to go back on it. He gave it up for good when he entered HS. But it definitely helped.

I did some, um, independent research on amphetamines during my youth and was struck by the fact that it slowed me down and did not speed me up. No doubt where Sam got his ADD gene, though it also runs on Debbie's side of the family.

Your writings of ADD were the first I read that gave another side to the issue. I read "We Are Distracted" more than once. I thank you for the research and for the insight you provided that helped me better understand Sam's ADD. The idea that it may have been an advantage at one time still gives me pause.

Anyway, thanks for efforts in helping others to better understand a complex subject, and to realize that it is considered a disorder primarily because it does not fit into what has been defined as the norm.

Bob

Bob