Meditation and Hamburgers For ADHD?
Research shows that alternative treatments for ADHD might help improve focus and memory. Learn how meditation, Omega-3s, protein, and connecting with nature can boost performance at school and home.
Evidence suggests that alternative ADHD treatments like meditation and working-memory training can improve attention and focus in both adults and children.
The ability to pay careful attention isn’t important only for students and air-traffic controllers. Researchers are finding that attention is crucial to a host of other, sometimes surprising, life skills: the ability to sort through conflicting evidence, to connect more deeply with other people, and even to develop a conscience, for example.
Still, attention remains one of the most poorly understood human faculties. Neither a subject nor a skill, precisely, attention is often seen as a fixed, possibly inborn, faculty that cannot be taught.
Now scientists are rapidly rewriting that notion. Fresh advances in neuro-imaging and genetics have powered decades of research, leading to a much clearer picture of attention. Many scientists have come to see attention as an organ system, like circulation or digestion, with its own anatomy, circuitry, and chemistry.
Building upon this understanding, researchers are discovering that skills of focus can be bolstered with practice in both children and adults, including those with attention-deficit disorders. In just five days of computer-based training, the brains of six-year-olds begin to act like those of adults on a crucial measure of attention, one study found. Another study suggested that boosting short-term memory seems to improve children’s ability to stay on task.
We do not yet know how long these gains last, or the best methods for developing attention. But the demand is clear: Dozens of schools nationwide are already incorporating some kind of attention training into their curricula. And as this new arena of research helps overturn long-standing assumptions about the malleability of this essential human faculty, it offers intriguing possibilities for a world of overload.
“If you have good attentional control, you can do more than just pay attention to someone speaking at a lecture, you can control your cognitive processes, control your emotions, better articulate your actions,” says Amir Raz, Ph.D., a cognitive neuroscientist at McGill University, who is a leading attention researcher. “You can enjoy and gain an edge in life.”
How We Pay Attention
Scientists now use advances in genetics and imaging technologies to map brain activity to formulate more detailed theories of what, exactly, attention is. It has been compared to a filter, a mental spotlight, and a tool for allocating our cognitive resources. Increasingly, however, attention is viewed as a complex system comprising three networks, or types of attention: focus, awareness, and “executive” attention, which governs planning and higher-order decision-making. According to this model, first proposed by University of Oregon neuroscientist Michael I. Posner, Ph.D., the three attentional networks are independent, yet work closely together.
Armed with an improved sense of how attention works, Posner and others have begun researching whether attention can be trained. And their findings are intriguing. After years of research into how attention networks develop, Posner and colleague Mary K. Rothbart, Ph.D., began experimenting a few years ago with training children’s attention. They targeted children six and under, since executive attention develops rapidly between ages four and seven. Inspired by computer-learning work with monkeys, Posner and Rothbart created a five-day computer-based program to strengthen executive-attention skills, such as working memory, self-control, planning, and observation.
After the training, Posner and Rothbart reported that six-year-olds showed a pattern of activity in the anterior cingulate-a banana-shaped brain region that is ground zero for executive attention-similar to that of adults, along with slightly higher scores on IQ tests and a marked gain in executive attention. The children who were the most inattentive gained the most from the program. The results were published in the Proceedings of the National Academy of Sciences, and have since been replicated in similar experiments by Spanish researchers.
“We thought this was a long shot,” says Posner. “Now I’ve changed my mind.” Though small-scale, the results, from his lab and others, have been so remarkable that he and Rothbart are now calling on educators at conferences, and in their book, Educating the Human Brain, to consider teaching attention in preschool.
Improving Executive Attention
A parallel line of investigation is based on the close link between attention and memory. Working memory is the short-term cognitive storehouse that helps us recall a phone number or the image of a landscape; this type of memory is integral to executive attention. Tapping into this link, cognitive neuroscientist Torkel Klingberg, M.D., Ph.D., of Sweden’s Karolinska Institute, devised software to improve executive attention by training working memory in children and teens with attention-deficit hyperactivity disorder.
Using a training program he calls RoboMemo, Klingberg has helped children improve their working memory and complex reasoning skills, according to studies published in the Journal of the American Academy of Child and Adolescent Psychiatry, among other publications. This appears to pay off in attention, as well: The children were also reported to be less impulsive and inattentive by their parents, although their teachers largely did not report such improvements.
A different line of research investigates the attention-boosting potential of something very different: the 2,500-year-old tradition of meditation. With a long history but little scientific data on its effects, meditation has begun to intrigue neuroscientists in labs around the country, who are measuring the success of meditative practices that boost focus and awareness.
Lidia Zylowska, M.D., assistant clinical professor in psychiatry at UCLA, co-founded the university’s Mindful Awareness Research Center, and is a pioneer in the study of meditation’s impact on human focus and attention.
In one study, Zylowska and colleagues reported that eight weeks of mindfulness meditation-a technique designed to improve attention and well-being largely by focusing on breathing-boosted powers of focus and self-control in 24 adults and eight teens with ADHD. The work was published in May in the Journal of Attention Disorders.
Focus in the Classroom
If focus skills can be groomed, as research has begun to hint, the important next question is whether, and how, attention should be integrated into education. Will attention become a 21st-century “discipline,” a skill taught by parents, educators, even employers? Already some educators are showing interest in attention training, mostly through the practice of meditation.
Susan Kaiser Greenland, a former corporate lawyer who started the nonprofit InnerKids Foundation, in 2001, to teach meditation practices in schools, says demand outstrips her staffing. The Santa Monica-based firm works with children, ages four to 12. But with the field of attention training still in its infancy, scientists don’t know whether any current teaching brings long-lasting gains-or, for that matter, which practices work best.
“Part of the problem in today’s society is that people are looking for extremely quick fixes. People are looking to lose 20 pounds before the wedding next week,” says Raz. “But attention training is a slow process.”
Nonetheless, with global use of ADHD medicines tripling since the early 1990s, and evidence mounting that attention can be strengthened, researchers are permitting themselves cautious excitement at the prospect that attention training could work.
“Attention is such a basic skill that children need, and to be able to impact that skill, to teach them how to redirect their attention and how to become more aware of themselves, their bodies, emotions, and thoughts-it’s an exciting thing,” says Zylowska. “It’s also critical.”
Maggie Jackson is the author of Distracted: The Erosion of Attention and the Coming Dark Age (Prometheus Books). The full version of this article originally appeared in The Boston Globe.
The Calming Benefits of Nature
The right foods and supplements can sharpen focus and regulate mood.
Doctors and ADHD experts rarely talk with parents about managing their child’s ADHD symptoms through diet. This is a mistake, says Ned Hallowell, M.D., author of Delivered from Distraction, because the quality of a child’s diet determines how effectively his brain operates. Poor nutrition can cause a child to become distracted, impulsive, and restless. “The treatment of ADHD must include diet as an essential component of a proper regimen,” says Hallowell. Here are tips on improving ADHD symptoms by improving diet:
Beef Up Your Protein Levels
It is more difficult for a child to pay attention or regulate mood when he’s not getting enough protein, says Vincent J. Monastra, Ph.D., author of Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach. Foods rich in protein are used to make neurotransmitters, the chemicals released by our brain cells to communicate with each other. Protein can also prevent surges in blood sugar, which increases hyperactivity. “Because the body makes brain-awakening neurotransmitters when you eat protein, it’s a good idea to start your day with a breakfast that includes it,” says Monastra. Common protein sources include beef, pork, poultry, fish, eggs, beans, nuts, and dairy products.
Take Omega-3 Fatty Acids
Found in cold-water, fatty fish, such as sardines, tuna, and salmon, omega-3s are believed to be important in brain and nerve cell function. Omega-3s increase the level of dopamine in the brain. While omega-3 fatty acids seem to improve anyone’s mental focus, the compounds may be especially helpful to those with ADHD. One study, done in 2003, showed that omega-3s tend to break down more readily in the bodies of patients with ADHD than in those without the condition. Another study, from 2004, suggested that ADHD children were more likely to have low blood levels of omega-3 fatty acids than those with no symptoms. Hallowell, founder of the Hallowell Centers for ADHD, recommends that his patients take omega-3 supplements, and notes that “it seems to help with mental focus, not hyperactivity or impulsivity.”
Mind Your Minerals
Deficiencies of several minerals-zinc, iron, and magnesium-can worsen symptoms of inattention, impulsivity, and hyperactivity. Zinc is involved in the regulation of dopamine, a neurotransmitter that helps control mood. One study showed that zinc combined with ADHD medication-methylphenidate, specifically-improved symptoms of hyperactivity and impulsivity. Zinc is found in beef, turkey, chicken, pork, lamb, oysters, and beans.
Magnesium is involved in hundreds of enzyme activities. “Among the substances that are developed from magnesium are the myelin sheath that surrounds the brain cells and the neurotransmitters involved in attention and concentration,” says Monastra. Magnesium is found in meats, nuts, soybeans, and spinach.
The latest research suggests that low levels of iron can worsen ADHD symptoms in children with the condition. A 2004 study found that 84 percent of children with ADHD had significantly lower levels of iron, compared with 18 percent of kids without the condition. Iron plays an important role in the brain, affecting production of the key neurotransmitter, dopamine. If you suspect your child has low levels of iron, talk with your doctor about testing him. Diet, not supplements, is the safest way to increase your child’s iron levels.
Balance Your Diet
Hallowell encourages parents of children with ADHD to visualize their plates when preparing a meal. Half of the plate, he recommends, should be filled with fruits and vegetables, one-fourth with a protein, and one-fourth with carbohydrates. This combination will control swings in behavior caused by hunger or a shortfall of a particular nutrient. In addition to the balanced plate, Hallowell advocates eating several servings of whole grains each day, to prevent blood-sugar levels from spiking and later plummeting, and cutting back on foods that contain dyes and excess sugar. Several studies have suggested that artificial food coloring and sugar may increase hyperactivity in children with ADHD.
A daily dose of greenery, from a walk in the woods or by playing in a room full of plants, may reduce ADHD symptoms in adults and children.
As many parents and teachers well know, children diagnosed with ADHD have trouble paying attention, listening, following directions, and focusing on tasks. They may also be aggressive, antisocial, and susceptible to academic failure. From looking at high-tech images of the brain, some scientists report that ADHD children show altered levels of some neurotransmitters and slight shrinking in the part of the cerebral cortex that governs attention and impulse control. But scientists are not clear whether those differences indicate a cause for the disorder, which could be due to a genetic defect, or simply a manifestation of another cause or causes.
In ongoing studies by the Human-Environment Research Laboratory at the University of Illinois, researchers have discovered tantalizing evidence for a new view of the syndrome. In a 2004 study published in the American Journal of Public Health, the laboratory found that children as young as five showed a significant reduction in ADHD symptoms when they engaged with nature.
Parents and guardians were asked to identify after-school or weekend activities that left their children functioning particularly well or poorly. The study measured responses to two types of activities: those in green landscapes-such as grassy backyards, parks, and farmland-and those in indoor or paved recreation areas. The researchers designed the study to account for any effects of physical exercise, so they could measure only the influence of green settings. They also factored out age, gender, family income, geographic region, size of community, and the severity of diagnosis.
In 54 of 56 cases, outdoor activities in more natural settings led to a greater reduction in ADHD symptoms than activities in less natural areas. The only instances when symptoms worsened occurred in the artificial environments. In a related experiment, the laboratory found that children could focus on specific tasks better in green settings.
Other researchers have found that engagement with nature buffers life stresses, which otherwise could aggravate ADHD. Although most of their studies focus on adults, an increasing number gauge the impact of green settings on children. A 2003 Cornell University study reported that the more nature a child encountered at home-including exposure to indoor plants and window views of natural settings-the less he or she was affected by negative stresses.
A 2003 study by researchers at the New York State College of Human Ecology reached similar conclusions. Nancy Wells, Ph.D., the lead researcher, said that exposure to nature resulted in “profound differences” in children’s attention capacities and that “green spaces may enable children to think more clearly and cope more effectively with life stress.” That, in turn, could strengthen a child’s attention and potentially decrease the symptoms of ADHD.
It’s not clear why exposure to nature would have such an apparently powerful influence on brain functions related to attention. One theory is that the experience simply engages a child mentally and physically in a “natural” way, consistent with how humans have evolved. In an earlier hunting and gathering or agricultural society-which is to say, during most of humankind’s history-young people were more likely to engage in physically demanding, mentally relaxing activities that immersed most of their sensory receptors: climbing, hunting small animals, baling hay, splashing in the swimming hole.
As recently as the 1950s, most U.S. youngsters still had some kind of agricultural connection. Even in towns or cities, kids played ball in sandlots or spent hours building forts in tangled and wild “vacant” lots. Their unregimented play was steeped in nature. That kind of exposure to nature has faded dramatically in recent decades, but our need for nature-possibly physiological-has not. “Neurologically, human beings haven’t caught up with today’s over-stimulating environment,” says Michael Gurian, a family therapist and author of The Wonder of Boys. “The brain is strong and flexible, so 70 to 80 percent of kids adapt fairly well. But the rest don’t.”
If ADHD has something to do with a lack of nature, the neurological mechanics could be explained by the attention-restoration theory developed by Stephen and Rachel Kaplan, husband-and-wife environmental psychologists at the University of Michigan.
In the early 1970s, the Kaplans studied the impact of a range of activities and found that too much directed attention (this could include computer tasks, homework, studying for a test) leads to what they call “directed-attention fatigue,” marked by impulsive behavior, agitation, irritation, and inability to concentrate. Directed-attention fatigue occurs because neural inhibitory mechanisms become overstressed by blocking competing stimuli. Subsequent research, including more than 100 studies linking exposure to nature to stress reduction, has supported the Kaplans’ theory-and the salutary influence of what they called “the restorative environment.”
The University of Illinois team, while not questioning the effectiveness of current ADHD treatment methods, has suggested that nature therapy could be a third option, in conjunction with prescription medications and behavioral therapy. They recount how one parent began taking her son to the local park for 30 minutes each morning before school, which she had indicated reduced his ADHD symptoms. “Come to think of it,” she told the researchers, “I have noticed his attitude toward going to school has been better, and his schoolwork has been better this past week.” Another parent of a boy with attention-deficit symptoms began engaging him regularly in outdoor activities, with similar results.
Nature Deficit: The Cause of ADHD?
If a greener environment can play a role in managing ADHD, few, if any, studies have explicitly examined whether the converse is also true: that ADHD may be a set of symptoms initiated or aggravated by lack of exposure to nature. By this line of thinking, many children may benefit from medications, but the real disorder lies in the society that has disengaged children from nature and imposed on them an artificial environment for which they have not evolved. Viewed from this angle, children and adults alike would suffer from what might be called nature-deficit disorder, not in a clinical sense, but as a condition caused by the cumulative human costs of alienation from nature, including diminished use of the senses, attention difficulties, and higher rates of physical and emotional illnesses.
If that’s the real ailment, a walk in the woods would be the ideal treatment: It’s not stigmatizing, has no serious side effects, and it’s free. But such reliance on greenery would underscore the need to scale back industrialism, redesign cities, and expand access to nature-which can’t be encapsulated in a pill, but could be equally powerful medicine.
Richard Louv has written for The New York Times and the Christian Science Monitor, and is a longtime columnist for the San Diego Union-Tribune. He is the author of seven books, including Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder (Algonquin Books), from which this piece was adapted with permission.