Adhd

“Smart” drugs might NOT always help with focus

Stimulant medications like methylphenidate, dextroamphetamine, and related drugs are often prescribed for adhd (attention defecit hyperactivity disorder).

For individuals with adhd, these medications can be useful, particularly when combined with addressing other mental and physical health conditions that could be impacting focus, and reasonable nutrition, sleep, activity level, study/organizational skills, and healthy ways of using technology.

A recent set of studies looked at whether these  medications help if you do NOT have adhd.

What were the studies? (1)

  • Elizabeth Bowman and colleagues  four double-blinded, randomized  trials, each a week apart, the same 40 healthy participants took one of three popular ‘smart’ drugs (methylphenidate, modafinil, or dextroamphetamine) or a placebo (1).
  • They were assessed on how they performed in a test designed to model the complex decision-making and problem-solving present in everyday lives (1).
  • The exercise known as the Knapsack Optimisation Problem.  In this test, they were given a virtual knapsack with a set capacity, and a selection of items of different weights and values (1).
  • The participants had to figure out how to best allocate items to the bag, to maximize the overall value (1).

What were the results? (1)

  • Overall, participants without adhd and taking methylphenidate, dextroamphetamine, modafinil, and related medications:
  • Small DECREASE in accuracy and efficiency (1).
  • Large INCREASE in time and effort, relative to their results when not taking the medications (1).
  • When given methylphenidate non adhd participants took around 50% longer on average to complete the knapsack problem as when they were given a placebo (1).
  • Participants without adhd became less productive when given methylphenidate (1).
  • The study authors found that, while motivation increased, it led to more erratic thinking (1).

Additional thoughts:

  • Further research is needed on the cognitive effects and performance impact of adhd medications on people without adhd.
  • Whether or not one has adhd, adequate sleep, nutrition, activity level, and organizational skills can help improve  cognitive/academic performance.
  • In my experience, addressing co-existing physical and mental health conditions can also help improve focus and if you also have adhd, potentially reduce how much medication you need while maximizing benefit.

The following post discusses strategies to improve attention:

https://u.osu.edu/emotionalfitness/2021/03/30/strategies-to-improve-attention/

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

 

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

Reference:

  1. Elizabeth Bowman et al. ,Not so smart? “Smart” drugs increase the level but decrease the quality of cognitive effort.Sci. Adv.9,eadd4165(2023).DOI:10.1126/sciadv.add4165

 

Strategies to improve attention

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

“A clear vision, backed by definite plans, gives you a tremendous feeling of confidence and personal power.”
Brian Tracy, author Focal Point.

With increased time spent on remote and hybrid work/school environments many people are increasingly experiencing more difficulties with attention/focus.

In the book Answers to Distraction, Dr Edward Hallowell and Dr John Ratey discuss several strategies to improve focus.  Some of them include the following, with my comments in “[italics]”:

  1. Establish a structure, and routine. [Consider incorporating breaks, and a variety of tasks periodically throughout the work period].
  2. Make use of frequent lists [To do, and NOT to do lists can be helpful].
  3. Color code your physical environment, files, text, schedules etc. this can help make things more memorable.
  4. Rituals [Or routines around work/studying can be helpful for some people].
  5. Reminders [Using calendars, sticky notes, timers etc].
  6. Develop a filing system [This can help minimize clutter in your work space, as clutter can be distracting].
  7. When possible, only handle it once (OHIO), this can be helpful with small tasks because an ever expanding to do list can increase guilt, anxiety, resentment in some people.
  8. Build in some buffer time for projects and obligations to account for the unexpected.
  9. Embrace challenges. [If the work you are doing is not interesting enough, identify an activity, task, or project of your own choosing to spend some time on each day. This pre planned time can help reduce excessive social media usage, web browsing, email/message checking etc].
  10. Make deadlines. [In some instances, make them ahead of external deadlines, in other instances create them, this can help focus. I often suggest to students to ask themselves, “what is one thing (outside of daily routine/obligations) that you choose to do today that will help you  feel accomplished?”].
  11. Break down large tasks into smaller ones WITH deadlines attached to them.  Larger tasks can feel overwhelming, which can lead to anxiety  and procrastination. [For a student struggling to work on a paper due next week, a smaller goal of writing a paragraph each morning may be more doable].
  12. Prioritize rather than procrastinate. [When you get the feeling that you have a lot to do, identify the most important activity you need to do today or most pressing deadline, can help you channel your focus].
  13. Identify the physical environment, and conditions where you do your work best. [For some this may be a noisy café, or while listening to background music, for others, it may be a decluttered, quiet, space with little background noise].
  14. Identify tasks or activities that you are good at doing, and those you enjoy. [This could help you identify roles in team projects, type of job you choose, types of classes to take, selecting an appropriate major, etc].
  15. Take breaks. [Taking frequent breaks during the day to look at your schedule, and re-organize for the next time block can be helpful.  One such strategy is the POMODORO technique].
  16. Having a notepad [or a note taking app readily available whenever possible] taking notes on a fleeting thought or idea that comes to mind can help clear the mind to improve focus.
  17. Taking notes when reading can help improve focus but also reduce the “cascade of “other” thoughts”.

Other strategies to improve attention/focus:

Additional resources:

  • Answers to distraction Dr Edward Hallowell and Dr John Ratey
  • Focal point, by Brian Tracy
  • The Productivity Project: Accomplishing More by Managing Your Time, Attention, and Energy by Chris Bailey
  • Free to Focus by Michael Hyatt
  • Taking charge of adult adhd by Dr Russell Barkley

Campus resources:

  • Consider improving study skills through the OSU Dennis Learning center.
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Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

 

Meditation for attention, stress, and anxiety

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Life transitions can be times of increased stress and anxiety; which can also impact your attention and focus.  One of those transitions includes moving to campus, preparing for the beginning of the fall semester, adjusting to new routines, campus life, etc.

While there are many strategies to help with the transition process, meditation may be the 1 thing to consider because it can be quick, easy, and has low potential for side effects; and has the potential to benefit everyone.  It is practiced by some of the most successful people in the world.

A review of 13 studies showed improvement in ADHD symptoms with mindfulness meditation (1).

41 trials show mindfulness meditation helped improve stress related outcomes such as anxiety, depression, stress, positive mood, etc. (2)

A review of 14 clinical trials shows meditation being more effective than relaxation techniques for anxiety (3).

What are come caveats?

  • While there are many types of mediation techniques, mindfulness-based meditation is the most studied.
  • Different people may benefit from different types of meditation, and this area is being further researched.
  • Practicing regularly may lead to improved benefits.

How to learn meditation?

  • Various apps, books, videos, classes, and guides may be a useful introduction to meditation.

What else might help improve attention, anxiety, and stress related to the beginning of the semester?

What are some helpful resources?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Behavioural neurology, 2019, 5682050. doi:10.1155/2019/5682050
  2. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-Being [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Jan. (Comparative Effectiveness Reviews, No. 124.)Available from: https://www.ncbi.nlm.nih.gov/books/NBK180102/
  3. Montero-Marin, J., Garcia-Campayo, J., Pérez-Yus, M., Zabaleta-del-Olmo, E., & Cuijpers, P. (n.d.). Meditation techniques v. relaxation therapies when treating anxiety: A meta-analytic review. Psychological Medicine,1-16. doi:10.1017/S0033291719001600