You Didn’t Give Up on Me

I did a Risking Connection training in Louisville, Kentucky this past week. In one section we ask participants to share success stories, as a way of reaffirming the worth of the work we do and combating vicarious traumatization. One person shared a letter he had recently received from a client, expressing her gratitude for the program’s help and the changes she and her son had made. The letter started, as such letters often do, with the phrase: "most of all, you didn’t give up on me."

Perhaps the most important thing we do for clients is not to give up on them. Sticking with them- staying around- something many of our kids and families have not experienced. Our kids have been in so many placements, so many families, and so many treatment facilities. In addition to undermining healing relationships, all these moves underscore the basic message- you are such a terrible person that no one is able to stay around you for any length of time.

In order for any of our techniques to work, we have to keep the kid with us. And many times I have experienced situations in which we had completely given up on a kid, and we were sure we could not help him. However, the child welfare system being what it is, the child did not leave. And guess what- time passed, and he got better.

So maybe we should pay more attention to exactly what makes it possible for us to keep a child. And when we are struggling with a particular child, maybe we should have a meeting specifically focused on enhancing our ability to keep her.

And what could we do to increase our stamina? Some ideas are:

1. Increase staff stamina by dividing the responsibility for the child among several staff every night. If (as we do) you have a concept of a "primary" staff (we call them team mates) then maybe a certain child needs two or three team mates. Maybe we should plan that any one who deals with this child for a long period gets a break off the unit.
2. If there is a particular horrid task (such as cleaning the room of a child with hygiene issues) let’s do it in teams, not one staff alone.
3. Let’s keep a note book of any signs of hope we see.
4. We must articulate clearly that even if we do not (yet) see any change, our not kicking this child out is a victory in itself, and we should congratulate each other for that.
5. Let’s regularly review what happened to this child, and how we understand her symptoms- what problems are they solving for her? How are they adaptive- helpful in the short term, even if they have negative long term consequences?
6. Let’s make sure we have a treatment theme (such as: Jeff is learning to trust adults) that everyone on the team including the child and family knows, and that we use this theme to frame all events and interventions.
7. Let’s plan some ideas for restorative tasks before the child is in crisis, during our treatment team. Each task should be an opportunity for the child to practice one small skill that he would need to develop to give up his current symptoms.
8. We can make sure to compliment each other lavishly whenever anyone is particularly caring, giving or helpful to this child.
9. Administration can attend meetings and praise the treatment team for their stamina.
10. Is there anything we can do to make the child feel more safe and connected?
11. Can we deliberately do something fun together, to acknowledge the effort we are making- a pot luck lunch, little presents, chocolate?

12. The most important thing is to acknowledge both how difficult and how valuable what we are doing is. If we can stick with the child, his or her entire life may be different.

This is not to say that children should never leave our programs, or that children never need a different form of care. That happens- but not as often as we think. More often, we are frustrated by the pain the child is feeling, and by his ways of making sure we feel the same pain. We think, if only she were gone, the unit would go so well. But if we do succeed in ejecting a child, another one always steps into the role.

Let’s talk actively about our feelings about the child, how hard working with her is, how much chaos she creates for us and others, and how tempted we are to get rid of her. Let’s talk about our feelings of sadness, of inadequacy, anger and frustration. Let’s remember how she got this way, how we understand her, and let’s make sure we have a strong team plan.

And then let’s re-engage with the child and hang in there. Then after he gradually starts to get better, and finally achieves that positive discharge, and does fairly well, we will get one of those letters:

Dear staff,
I just wanted to let you know I am doing well at my new home. I really miss you guys! I want to thank you for not giving up on me...

read more...

Do I Need to Stop My Acne Skin Care Regimen During Pregnancy?

Pregnancy usually brings along with it a host of medical concerns which prompt behavioral and lifestyle changes. It is common knowledge that pregnant women should avoid smoking and drinking, not to mention some excessively physical activities. But there are also a host of other medicines and procedures which should be avoided during pregnancy. So, the question is, how does pregnancy affect acne skin care regimens?

Many acne medicines are quite explicit about the fact that you should not use them during pregnancy. Roaccutane and Accutane are certainly among these. For those of us that have used the products, the medicine packaging picturing a pregnant woman with an ‘X’ over her sent a strong message that they should not be used if you are, or might become pregnant. There are other medicines, such as Tetracycline tablets and topical retinoids such as Tretinoin and Adapalene which can have detrimental effects on the bones and teeth of developing fetuses. While these medicines should clearly be avoided because of the detrimental effects they have on your baby, there are other medicines which should potentially be stopped simply because they are no longer appropriate when pregnant.

Pregnancy is often associated with a period of drier than normal skin. As a result, a number of acne medicines which are designed specifically to dry out the skin, namely benzoyl peroxide cream or gel may no longer be appropriate.

But does this mean that there are no acne skin care regimens that can be followed? Absolutely not. There are in fact a number of milder and often natural solutions which can contribute to healthier acne free skin which either have no, or even positive effects on your child. To replace harsh creams or gels designed to dry out the skin, an excellent alternative is tea tree oil. A milder facial wash can also provide the cleansing effect of an acne wash without over-drying your skin, which is naturally drier due to pregnancy. But because you may be giving up some of the acne fighting power by switching over to a milder wash, it is a good idea to supplement your acne fighting regimen with some natural clay masks such as Kaolin and Bentonite which will absorb oil and clear blocked pores naturally.

The second avenue through which pregnant women can clear up their skin while positively affecting the health of the child, is through their diet. By consuming higher quantities of raw vegetables, whose antioxidant properties serve to take free radicals (also referred to as bacteria) out of your system, you can cut down on the amount of bacteria released through your pores. In addition, by cutting back on the quantity of sugars and refined carbohydrates that you eat, you will naturally cut down on the amount of sebum or oil that your body produces. This will keep your pores clearer and allow the bacteria which passes through your pores to come out cleanly and without causing infection and acne. These approaches, in addition to providing you with clearer skin, are a safe and healthy alternative to acne fighting while simultaneously improving the health of your child.

read more...

Modafinil: An alternative treatment for ADHD and comorbid substance abuse?

Can Modafinil (Provigil) Replace Stimulant Medications in Adult ADHD where stimulant drug abuse is a concern?

It is a Catch-22 of the ADHD world. An individual is suffering from severe ADHD symptoms and appropriate stimulant medications may help remedy some of the negative side effects of the disorder. However, due to the high prevalence of substance abuse in ADHD (some officials put the rate of comorbid substance abuse as high as to 30% in the ADHD population), including stimulant medications such as amphetamines, treatment of ADHD symptoms via stimulant medications cannot, by nature of the comorbid substance abuse disorder, be a treatment option.

The appearance of (relatively) novel non-stimulant medication alternatives such as Strattera (atomoxetine), have offered individuals with ADHD another treatment alternative. However, the results are often mixed. Strattera often works well with the inattentive-dominated forms of the disorder, but the positive results are often not as pronounced for the more hyperactive or impulsive forms of ADHD, especially if comorbid disorders such as conduct-related issues surface.

Another alternative may be a completely different type of drug, which, while not a stimulant in its own right, can act on or exhibit pseudo-stimulant properties. It appears that in at least some cases, Modafinil (Provigil) may be the type of drug we're looking for in these cases.

**Blogger's note: The extent of the study highlighting this case for Modafinil treatment for ADHD and comorbid amphetamine abuse is intended for adult treatment only. Given the relative scarcity of research on medication options for adult ADHD symptoms (compared to those designed more for children), this post is designed for offering a possible treatment alternative for ADHD in adults. Nevertheless, some recent studies have shown promising results of Modafinil as an ADHD treatment method for children and adolescents.

It is important to note, that while not initially designed as an ADHD-specific medication (and not a stimulant in its own right), Modafinil does share at least some degree of overlap with several stimulant agents for ADHD treatment. One is its regulation of catecholamines (important neuro-signaling chemical agents, whose balance in and out of neuronal cells is crucially important for regulating attention, hyperactive and impulsive behaviors, and locomotor control). As far as its mode of action and metabolism (clinical pharmacokinetics of Modafinil) are concerned, drug-drug interactions between Modafinil and several ADHD stimulant medications such as methylphenidate or dexamphetamine (Dexedrine) appear to be limited.

A background note on addiction potentials of ADHD drugs: This section is an aside, and is meant to serve as some background information and to clear up potential confusion surrounding ADHD medications and their addiction potentials. The next four paragraphs may be skipped if you are pressed for time.

While I cannot stress enough the importance of regulating neuro-chemical balance for both the onset of ADHD as well as drug addiction (which are affected by pharmacological agents such as ADHD medications, in varying forms), it is the rate of action for which these chemical changes take place which typically drives a particular drug's addiction potential.

Unfortunately, this last fact is often lost in much of the literature surrounding ADHD treatment (especially those which promote non-pharmaceutical treatments for the disorder). For example, many "natural" ADHD treatment books and websites frequently start out by asserting (erroneously) that methylphenidate is the equivalent of crack cocaine, and promotes later drug abuse and addiction.

While this blogger is a personal advocate for natural approaches to treating ADHD whenever possible (and without compromising overall treatment effectiveness in ADHD treatment), he wants to make it clear that significant differences do exist between ADHD medications and stimulant street drugs. One of the most telling signs of this is the rate of uptake and clearance of drug-like agents into and out of the brain, respectively. In general, the quicker a substance is taken up into the central nervous system and the faster it clears the brain, the more likely this chemical agent will elicit a "high" and an increased tendency towards substance dependence.

ADHD medications like Ritalin, while having some degree of overlap in structure and net effects of action as cocaine, are specifically designed to have a much slower rate of release and clearance, significantly reducing their abuse potential compared to cocaine. We have previously discussed Ritalin (methylphenidate) vs. cocaine addiction potentials in earlier posts.


Modafinil: Modes of action and addiction potential:

The reason I am providing all of this information is the fact that the successful regulation and softening of rapid spikes and clearances of chemical peaks is a crucial component to curbing the drug addiction process. It is believed that modafinil may work so well at reducing drug cravings by targeting this very mechanism. Unlike many stimulant medications which can produce some type of "high" (especially if abused by snorting or injection, or taken at abnormally high doses), Modafinil has a low abuse potential, and offers several other advantages over methylphenidate.

Modafinil does have a relatively positive track record for mitigating substance abuse disorders. For example, the administration of Modafinil can attenuate cocaine dependence. In contrast, methylphenidate (Ritalin, Concerta, Metadate, Daytrana), while being very effective as an ADHD treatment, does little to curb comorbid substance abuse disorders in ADHD patients. Unfortunately, the effectiveness of Modafinil on treating comorbid substance abuse disorders in individuals with ADHD may be limited to specific drugs. For example similar positive effects of Modafinil on nicotine dependence appear to be less pronounced.

Modafinil may also offer advantages over traditional stimulants as well. As a cognitive enhancement type of pharmacological agent, modafinil may be useful in improving the work performance of adults with ADHD by improving short-term memory and visual recall, impulse control, and spatial skills (all of which are frequent deficits in children and adults with ADHD). Additionally, similar improvements were seen in individuals with schizophrenia, suggesting the diversity of modafinil's range of performance in cognitive improvement. These improvements are typically not seen in individuals unaffected by psychological disorders, further supporting the evidence that modafinil is less likely to be abused recreationally in the general population.

The potential implications of modafinil for ADHD treatment may be further reaching than the details outlined in the original article (and basis of this post, highlighting the effects of modafinil on amphetamine abuse in adult ADHD). For example, modafinil, as a vigilance-promoting medication, can offset an afternoon dip in arousal state (which has implications on many of the shorter-acting stimulant medications, which begin to wear off around this time). This may be useful for individuals with sleep disorders (which are common in ADHD), as well as regulating circadian rhythms. In a post earlier this month, we investigated the relationship between ADHD and seasonal affective disorders, and hinted at the association between ADHD and disruption in circadian rhythms.


Potential future implications of Modafinil as an ADHD treatment alternative:

Additionally, while Modafinil may offer benefits for the whole ADHD spectrum, this blogger hypothesizes that it may be most useful for treating the inattentive subtype of the disorder. Some reasons for this are as follows:

• Activity patterns and circadian rhythms may often be associated with ADHD subtype. For example, "morning people" with ADHD may have a tendency to fall into the more hyperactive/impulsive group, while "eveningness" is more of an inattentive ADHD trait, suggesting more of a disruption in the circadian rhythms of inattentive ADHD'ers.
• Additionally, non-stimulants often have somewhat of a better track record with the inattentive subtype of ADHD compared to the more hyperactive/impulsive subtypes. The uses of the non-stimulant atomoxetine (Strattera), highlight this general trend. While atomoxetine treatments often result in drastic improvements in all ADHD subtypes, negative side effects are often less seen in the inattentive subtype.
• Compared to stimulants, non-stimulant medications for ADHD often do a better job at not exacerbating comorbid disorders such as obsessive compulsive or anxiety disorders (which are often more common to the ADHD inattentive subtype). Additionally, Modafinil treatment can be useful in treating adults with ADHD and a history of mood disorders.
• Modafinil offers advantages over methylphenidate as far as fewer side effects including appetite suppression, sleep disturbances and heart rate dysfunction (orthostatic tachycardia, which essentially is significant changes in heart rhythms based on postural changes, such as standing up quickly from a seated position).
• Anecdotal evidence, as noted by the Modafinil and amphetamine abuse study mentioned earlier, also suggests that Modafinil may be a useful treatment method for "refractory" cases, or individuals who have consistently shown poor response to other treatment medications and interventionary measures.
  
• Finally, it is important to note (and this was also touched on in the Modafinil and amphetamine abuse study), that Modafinil treatment may be better suited for the more "controlled" abusers of stimulants. In other words, better effects might be seen for adults who regularly take illegal stimulant drugs such as amphetamines as a conscious effort to "self-medicate" for their ADHD, as opposed to an out-of-control drug addict who craves the drugs on a non-scheduled basis.

Given the high propensity of comorbid disorders when deciding on treatment for ADHD, as well as practicality issues concerning the administration of medicinal agents for treatment of the disorder in adults, I see a fair amount of potential for Modafinil's "off-label" usage as a treatment alternative to stimulants in adults with ADHD.

read more...

Beauty Fact: Pale Skin Ages Faster than Darker Skin

Darker skin has more melanin which naturally protects it from sun damage. That’s why darker skin won’t show signs of aging as early as fair skin. Another incentive to wear that sunscreen regularly!However, there are many other factors that determine the rate at which we age. Take a look at my post Age FactorsPhoto by musZicluvher at Flickr.com

read more...

Does Blood Type Affect ADHD?

This blog has often discussed the wide range of genetic influences on ADHD and related disorders. Some of the ADHD genes we have previously investigated include:

• DAT1 gene (often referred to simply as "DAT", possibly related to Tourette's and eating disorders such as bulimia)
• MAOA gene (likely has gender-specific effects, also tied to autism, bipolar and anxiety disorders)
• COMT gene (can affect dosage levels of ADHD stimulant medications, and possibly have an impact on brain regions responsible for attentional control)
• SLC6A2 gene (also called "NET" or "norepinephrine transporter gene", may affect the response to Strattera, also related to posture and eating disorders such as anorexia)
• SLC6A4 gene (often has a greater potential effect on males with ADHD, associated with autism)
• Protogenin gene (possibly related to ADHD and reading disabilities)
• DRD4 gene (also may be related to schizophrenia, alcoholism, and resistance to Parkinson's)
• Fatty acid desaturase genes (may play a role in deficiencies in omega-3 levels in ADHD)
• CREM gene (may be related to hormonal regulation, including the sleep-related melatonin)
• Serotonin receptor 1B gene (may be more associated with the inattentive subtype of ADHD)

Additionally, some of these genes may work together in combo. For example, a combination of specific variations in the DAT1 gene and the DRD4 gene may associate with IQ and behavioral disorders as they relate to ADHD.

The main point of all of these examples was not to overwhelm anyone, but rather to highlight the intricate relationship between genetics and ADHD heritability.

Adding to this extensive list may be a new set of genes related to blood types and ADHD.

**For a quick synopsis of blood types, please consult the italicized paragraphs below. Otherwise you may skip to the next paragraph highlighting a new study on blood type and ADHD.

Human blood types are often classified by the "ABO" system. "A" and "B" refer to immune-regulating factors and play a major role in blood transfusions. These blood types are acquired from our parents and can come in dominant and recessive forms. Genes for blood type can be found on the 9th human chromosome.

They are the two main (or dominant) forms of immune-regulating blood factors. Additionally, A and B can be "codominant", that is an individual can have a mixture of the two. For these "codominant" individuals, their blood type is labeled "AB". If an individual has neither "A" nor "B", he or she is labeled as an "O".

In essence, if you have a specific letter(s), you can donate blood to individuals who share your same letters (there are actually other important factors and donor restrictions besides this, such as the "Rh factor", but for sake of simplicity, we will just discuss "ABO" for the moment). For example, a person with type "A" blood could donate to another person who has "A" or "AB" because both "A" and "AB" would recognize the "A" component. They could not donate to a "B" or an "O" blood type because these individuals' bodies would not be able to recognize the "A", resulting in a severe immuno-rejection problem.

An "O" could donate to and "A", a "B", an "AB", or another "O" (again, there are detailed exceptions to this generalization), because "O" does not have either of the "A" or "B" markers on it, so the recipient's body would not see anything "foreign" about this. This makes "O" carriers better candidates for blood donation. On the flip side, and individual with type "AB" could take blood from and "A", a "B", an "AB" or an "O" since their blood already recognizes the "markers". This makes AB candidates better recipients for blood.

In addition to an individual's blood type governing the blood transfusion process, blood types may also confer resistance or susceptibility to certain bodily dysfunctions or diseases. For example, type "A" individuals may be naturally more prone to cancers of the digestive system, and individuals with type "O" are more prone to cholera, plagues, or even malaria (interestingly, they may be more prone to be preferred targets of mosquitoes, compared to the other blood types).

Overview of an original study on ADHD and blood types:
Returning to our main discussion, it appears that certain blood types may also be related to an increased likelihood of childhood ADHD or related disorders. A Chinese study recently came out which sought to investigate whether certain blood types were actually more likely to be affiliated with ADHD. The results, while preliminary, should nevertheless pique some interest on the topic among professionals.

Here are some of the major highlights of the study:

• Blood types (using the "ABO" format) were taken from 96 children and their parents, to determine the heritability patterns of blood types.
• Both ADHD and non-ADHD children were observed in the study, and their blood types were broken down.
• The study found that children who did have ADHD were more likely to have inherited either the "A" or "O" type blood from their parents.
• Conversely, children who inherited the type "B" blood (which would include either the "B" or "AB" form) were less likely to be diagnosed with ADHD.

** A caveat concerning the findings and reproducibility of this study: It is important to note that the study population was relatively small, especially for a study of this magnitude which seeks to identify general trends between blood types and their relative association with co-existing disorders. Some blood types can be relatively rare, for example, in the United States, only around 10% of the population has type "B" blood and only about 15% has the "B" in any form (types B or AB). Although blood types vary extensively all over the world, certain types tend to predominate, which requires large populations to be studies to ensure all groups are sufficiently represented. Thus, small population studies can easily produce skewed results. Nevertheless, I personally believe this study was a good starting point.

**Blogger's personal notes/opinions on these findings:

I found this study to be interesting. Unfortunately, I could not read the whole article (the majority is in Chinese!), but the possibility of blood typing being related to ADHD would be a major breakthrough, if these results are able to be consistently replicated with larger population studies.

My first thought was that maybe some nearby gene related to ADHD might be influencing the blood type/ADHD connection, but no significant genes associated with ADHD exist on the 9th chromosome (at least to the best of my knowledge after conducting a search of OMIM for the term "ADHD", a national database which ties down diseases and disorders to known genetic regions). However, genes which are located far apart from each other, even on completely different chromosomes can also work in tandem, so genetic relationships between ADHD genes and blood type genes cannot be ruled out entirely.

Another option may be some type of indirect connection between blood type and ADHD. For example, the article notes that individuals who have the "O" or "A" blood type alleles are more prone to ADHD. Other sources note that individuals with type "O" are more prone to developing intestinal and gastric ulcers, and that individuals with type "A" are more prone to cancers of the digestive system (such as cancers of the esophagus, pancreas and stomach). This may signify that these blood types (compared to those who have "B" or "AB" blood) may be more prone to digestive problems.

Digestive disorders can result in poor nutrient absorption (we have discussed nutrient deficiencies in ADHD in number of previous posts), which may leave one more prone to ADHD symptoms. Additionally, digestive dysfunctions can actually lead to an increased likelihood of developing food allergies, as potential allergens are less likely to be broken down or "chewed up" than by a properly-functioning digestive system. Furthermore, we have also explored the possibility that acid accumulation can make its way into the brain regions and have an impact on neurological symptoms including ADHD-like behaviors. This was discussed in a recent post investigating the high prevalence of ADHD in children who suffer from frequent ear infections.

While these possibilities are strictly hypothetical at the moment I firmly believe that we should further explore the possibility of specific blood types as possible underlying causes or risk factors for developing ADHD.

read more...

Beauty Tip: Don’t Wear Mono Fragrance

Different people react to smells differently. One and the same fragrance for two people can mean pleasure or headache. That’s why aroma-psychologists recommend to never use a mono-fragrance, especially if your ultimate goal is to attract and seduce. The more complicated your fragrance cocktail, the higher is the chance it will turn your date or lover on ;-) Some people prefer to mix several

read more...

ADHD and Balance Impairment: Visual and Inner Ear Deficiencies

Balance dysfunctions and visual or vestibular deficiencies: Uncommon comorbids in the ADHD spectrum:

When we think of comorbid disorders to ADHD, we often envision disorders which can be diagnosed psychiatrically. Common examples such as depression, anxiety, Obsessive Compulsive Disorders (OCD), oppositional defiant disorders, and conduct disorders often come to mind. In addition, it is perhaps no surprise that learning disabilities are relatively common in children and adults with ADHD. If we do delve into physical comorbid disorders, things like Tourette's and tics may come to mind. For those skilled in the diagnosis and treatment of ADHD, even non-trivial comorbids such as bedwetting and sleep disorders may be apparent.

However, there is another impairment that often goes along with the ADHD population, especially in children. Sensory processing disorders are often seen in the ADHD population, especially in children. This includes more "physical" dysfunctions including the ability of the child to maintain balance and equilibrium. To the frustrated parent of coach of an ADHD child, this may introduce another complication with regards to sports or other activities which involve coordination and balance, such as basketball, baseball, tennis, soccer, gymnastics, musical instruments, dance, etc.

The aim of this post is to investigate and discuss impairments in balance function in children with the disorder, We will be citing and highlighting some key studies in the overlap between ADHD and balance dysfunctions (especially relating to functions derived from visual and tactile signals) and look for possible underlying causes and treatment methods:

Brain regions involved in Balance Dysfunction in the ADHD Child:

Most experts often cite specific "hot spot" regions of the brain for the ADHD patients. Among these, the prefrontal cortex part of the brain often receives the most attention. Less pronounced, however, are the studies associating the cerebellum, and their implications on ADHD. For a reference to the Prefrontal Cortex and Cerebellum brain regions, please consult the brain diagrams below:

Shown above is a human brain. The Cerebellum region, which plays a major role in governing balancing functions and may be compromised in a significant subsection of ADHD children, is shown in purple in the top picture. The area highlighted in orange in the bottom drawing roughly corresponds to the prefrontal cortex region of the brain, which plays a major role in impulse control. Deficiencies in blood flow and overall activity of this prefrontal cortex region of the brain are often seen in children (and adults) with ADHD, and may be responsible for some of the difficulties in filtering out comments and actions for appropriateness.

The inter-relationship between attention and balance/coordination: The strong association of the prefrontal cortex and cerebellum regions of the brain:

Many studies involving brain regions and ADHD often miss this connection. The relationship between these brain regions may go a long ways in explaining ADHD comorbid disorders as well, especially the more "physical" ones such as speech complications, developmental coordination disorders, etc. While perennial "hot spot" brain regions, such as the prefrontal cortex, are frequently mentioned in studies involving brain activity in ADHD, this particular brain region is actually intricately interconnected with the cerebellum (as well as another key brain region, the basal ganglia. The role of the basal ganglia in kids with ADHD has been discussed previously in other postings, but in general, the basal ganglia tell how fast a person "idles". 'Type A' personalities, such as workaholics, individuals with OCD and overly focused individuals typically have overactive basal ganglia, whereas many with ADHD often exhibit underactive basal ganglia.).

We have already mentioned that the balance-governing regions of the brain (the cerebellum) is interconnected with a key impulse-control region of the brain (the prefrontal cortex or PFC). We also mentioned that impulsivity is a characteristic of the Hyperactive-impulsive and Combined ADHD subtypes (as opposed to the more inattentive forms of the disorder). Interestingly, the prevalence of balance dysfunction cases seems to predominate in the combined subtype of ADHD (main paper as reference source). This correlation lends further credence to the hypothesis that the balance-governing and impulse-governing regions of the brain may be "co-affected" in the case of the balance-deficient, hyper-impulsive ADHD child.

Key points concerning balance related deficiencies and ADHD:

• ADHD is often associated with developmental delays. Indeed, studies highlighting a delay in cortical maturation in children with ADHD suggests that children and teens with the disorder may fall "behind the curve". By its own very nature, the vestibular system often does not fully develop until the age of 15, so immature development in this brain region may result in deficiencies in this system throughout almost the entire span of childhood in an individual with ADHD.


• Additionally, EEG and imaging studies have also demonstrated relative deficiencies in both size and activity (by measuring blood flow patterns) in various brain regions of ADHD children. These include the cerebellum and the caudate nucleus. Both are interconnected and associate with the "ADHD region" of the prefrontal cortex (PFC). This PFC region plays a major role in the impulse-control process and deficiencies in its function can result in a weak self-regulatory system of impulsive behaviors (which are hallmark characteristics of ADHD, especially in the hyperactive/impulsive and Combined subtypes).


• The cerebellum gathers input from visual, vestibular (inner ear), and somatosensory (mainly tactile senses, such as perceived through the skin and internal organs) systems. As we can imagine, a defect in one or more of these information-obtaining sensory systems, and the cerebellum (as well as the interconnected region of the PFC) may be compromised. Thus ADHD and sensory deficits may be intricately related.


• Taking this one step further, we may wish to explore the link between ADHD and sensory disorders, including processing disorders and sensory integration disorders. One thing is for sure, however: ADHD is not simply limited to deficits in the PFC!


• The vestibular system also plays a crucial role in what is known as "gaze stabilization" (i.e., stabilizing the focus on a particular fixed object when you yourself are moving). The very nature of "gazing" obviously has visual implications as well, so a deficiency in the vestibular component of gaze stabilization may also affect visual input success as well. Interestingly (an perhaps not surprisingly), visual input deficiencies are also seen at high rates in children with ADHD.
  
  This may actually serve as one of the key contributing factors as to why maintaining attention (to, say, a teacher), may be so difficult for ADHD kids, because they literally are having trouble focusing their visual attention (gaze) on their target of interest (i.e. a teacher standing up in class giving a lecture), especially if the child is already fidgeting around in their seat. In other words, there may be some inherent deficiency in this particular component of the attention span, and needs to be addressed further in the near future.

Investigating the sources of balance impairment in children with ADHD:
In order to clarify where I am coming from on this, I will highlight an extremely recent publication in the Journal of Pediatrics by Shum and Pang. This study investigated the different systems of balance in children, including somatosensory (balance governed by tactile features), visual, and vestibular (inner ear and the sense of equilibrium). They tested approximately 50 children (ages 6-12) with ADHD for balance discrepancies by isolating each of the three systems listed above to test sensory organizations of balance. A highlight of the study can be seen below:

Instruments/Methods of the study:

1. A platform which can induce a feeling of motion on a child who stands upon it (this disrupts the somatosensory component of balance, forcing the child to use their visual or vestibular functions to compensate for the somatosensory impairment).
2. Surrounding scenery which can visually give the illusion of motion. This forces the child to use their vestibular and somatosensory methods of equilibrium, as the visual sense is disrupted. Another variation of this is to have the child perform with their eyes closed.
3. A combination of the two methods above will isolate the vestibular component of balance, as both the somatosensory and visual sources of balance are now both compromised.
4. A total of six different environmental conditions were performed to isolate one or more senses of balance. The researchers noted which of the three modes of balance were most likely to be compromised in the ADHD children. The findings are highlighted below:
   

While balance-related issues can stem from visual discrepancies, somatosensory issues (i.e. the sensations of touch and pressure from the skin and even internal organs), and vestibular (inner ear) imbalances, it appears that ADHD children are most likely to suffer from visual imbalances. This is closely followed, however, by deficits in vestibular function. Somatosensory difficulties appear to occur in ADHD children as well, but the role of this system is likely to be much smaller than for the other 2.

Possible academic implications of balance dysfunction and ADHD: Does the source of an ADHD child's balance deficiency affect his or her sensory learning style? The following points are simply the result of this blogger thinking out loud. Nevertheless, these might be some good topics of future study, as balance difficulties may be useful in evaluating academic strategies.

• These findings on balance may even extend to the classroom and affect the learning environment of an ADHD child. Given the above, abnormalities in these areas may even affect a child's mode of learning and learning style. While these assertions simply remain personal hypotheses of this blogger, a child with visual discrepancies leading to balancing difficulties may also be deficient in visual perception and therefore struggle in a visual-dominated learning environment. He or she may gravitate towards a more auditory or kinesthetic style of learning.
  

• Conversely, it is also possible that vestibular-regulated balance dysfunctions, which stem from the inner ear may actually extend to a child's auditory learning capabilities. Again, this remains a hypothesis, but given the fact that severe childhood ear infections can affect both balance and hearing (as well as ADHD symptoms, see previous post on childhood ear infections and ADHD), a child with vestibular-related balance deficiencies may also have more difficulty in a predominantly auditory-based learning environment. This may spell bad news if an ADHD child's teacher engages in more auditory discussions or as the child moves up to high school and college courses where an auditory lecture is the more common form of teaching and communication.
  

• A double-whammy?: Given the fact that children with ADHD may suffer from both vestibular and visual (and even somatosensory) information processing for balance, it leads us to wonder if the child may also have learning deficits in 2 of the 3 major forms of learning (visual, auditory or kinesthetic). If this is the case, trying to accommodate an ADHD child's education could be extremely difficult, if he or she must heavily rely on only one predominant mode of acquiring and processing information.
  
  For example, if a child were to undergo a study similar to the one listed above, and it turns out that he or she is weak in both the visual and vestibular forms of balance, and (this is a big "if" and is only hypothetical at the moment) the whole balance governing/learning style hypothesis holds true, he or she may have to rely on a predominantly kinesthetic form of learning. While this child may succeed in hands-on learning subjects (i.e. frog dissection or wood shop class), he or she may have an exceedingly difficult time in other subjects such as algebra or history where hands-on-learning opportunities are more difficult to implement.
  
  

• The role of balance and sensory stimulation may have even greater-reaching academic implications. Another study just came out recently investigating the role of posture stability (i.e. how well a person stabilizes their center of balance) on ADHD and dyslexia. The study found that comorbid ADHD symptoms greatly influenced the effects of posture stability in dyslexic individuals, which may even have implications to affecting the reading environment of the individuals with dyslexia. It's important to keep in mind that this study involved adults instead of children, but the fact that ADHD may play such an integrated role into sensory modulation of other disorders into adulthood may signify the deep level of inter-relationship between cognitive function and sensory motor stimulation.
  

Vestibular Stimulation as an alternative form of ADHD Treatment?: As an interesting aside, there has been some pronounced effect on treating ADHD symptoms with a non-pharmaceutical alternative method called vestibular stimulation. We will be addressing the validity of these findings and their potential for practical usage in a later discussion.

read more...

Beauty Review: Givenchy Rouge Interdit Shine

I should have called this review a story about my first perfect red lipstick! Packaging:Beautiful, elegant and unusual. I am not sure what you’re supposed to do with the little hook at the end… maybe just pull on it… but if you were wondering, I don’t think you can use it as a key chain :-) Shade:# 10 – Sun Shine (red with light orange undertones and golden shimmer)Scent:Light sweetStay-on Power:

read more...

Beauty Inspiration: Giselle Bundchen

Donatella Versace once said about Giselle: “What I love about her is her sensuality and energy”Agree completely: not only Giselle has gorgeous body but also a vibrant open magnetic personality. I really like Giselle! She inspires me. She is one of the models that makes me pause over a photo and have a closer longer look and then open magazine again and have another look. Giselle has this great

read more...

Facebook and Twitter

Do any of you people reading this blog Twitter? Do you have a Facebook page? I am considering using these services to further connect us, the people trying to do trauma informed treatment of children. It is hard to work this way- it is hard to start doing it, and hard to keep doing it. It will help if we support each other. Would you be interested in Twitter and/or Facebook connections? Let me know by clicking "comment" at the bottom of this post. Thanks!

read more...

Beauty Talk: Sun Damage in Kids and Young People

This post was inspired by a couple recent articles I read on UV damage and UV protection. One of them talked about sun-bedding and attempts to introduce age restrictions on sun bed use in New Zealand and Australia (nzherald.co.uk). Why age restriction? Because very often due to complete unawareness (or maybe wrong priorities) people under 18 bake themselves to a crisp in sun beds as well as on

read more...

Childhood Ear Infections and ADHD: Why the link?

When we scan the literature for statistics on ADHD and search for early warning signs or tip-offs that a young child may be prone to the disorder, a few common trends seem to pop up again and again. One of these is the high rates of ADHD and attentional difficulties in kids suffering infection of the middle ear (Otitis Media) in early childhood.

During early childhood, the actual positioning of the ear canal is still adjusting, the pathway into the middle part of the ear is actually at a flatter angle than in a mature adult. This difference in positioning actually makes younger children much more prone to ear infections than older children or adults. Unfortunately, these infections may increase the risk of further complications down the road, including an increased onset of attentional difficulties, including ADHD. Here is what some of the literature has to say about the ADHD/ear infection connections:

Relationship between middle ear infections and inattention: The basis for inattentive ADHD?

The main culprit for attentional deficits is often believed to be the result of hearing loss (even mild), early in a child's life due to complications with the middle ear, including infections, allergy-related causes or build-up of fluids in the canal. As a result, the child begins to miss out on verbal cues, and does not develop the same level of response to an adult voice. Auditory deficiencies (including auditory processing disorders) may stem from this key development period, even if the hearing difficulties are only temporary.

Not surprisingly, there is a wealth of data associated with hearing loss due to middle ear complications can lead to language processing difficulties. We have seen how auditory processing disorders can often occur as a comorbid factor in ADHD, and may be linked to seemingly unrelated behaviors including comorbid anxiety and conduct-related disorders.

It is important to note, however, that other early childhood studies have not seen a link between infection and attentional difficulties (observed by parents, teachers, or clinicians).

Interestingly, environment may play a huge role in explaining this discrepancy between study results. One study found that children who had middle ear complications early on along with poor home environments were significantly more likely to develop attentional difficulties (along the lines of what would be classified as ADHD). Therefore, the effects of early ear infections on compromised attentional difficulties may be significantly reduced if a supportive home environment is maintained for a child. This is good news for parents of children with ear infections. But what about the hyperactive component of ADHD?

The link between hyperactive behaviors and middle ear complications: The basis for hyperactive/impulsive or combined subtype ADHD?

While it seems more intuitive that ear infections could lead to auditory problems and subsequent attentional difficulties (especially to auditory cues), the relationship between ear infections and hyperactivity is less inherently obvious. This association would be more relevant to the hyperactive/impulsive and combined subtypes of ADHD.

For over 30 years, researchers have linked high rates of ear infections and hyperactivity (this study used the term "minimal brain dysfunction", a phrase which this blogger has personal objections, nevertheless, it is a relatively common term in the literature). Later studies confirmed these findings, including one which reported the majority of children medicated for hyperactivity had a past history of 10 or more childhood ear infections. These numbers were in sharp contrast to the prevalence of ADHD in non-hyperactive children.

One thought may be that ADHD which includes a significant hyperactive component (as opposed to the more inattention-dominated form of the disorder) is more likely to be associated with comorbid disorders that correspond to ear infections. We have seen previously that comorbid disorders to ADHD are often related to particular subtypes.

For example, anxiety and depressive-like symptoms are often more likely to co-exist with primarily inattentive ADHD, while conduct disorders are more likely to co-exist if there is a high hyperactive/impulsive behavior (especially in the combined subtype). In general, the prevalence of more severe learning disabilities is often more associated with the inattention-dominant form of ADHD, while motor tics are more likely to be a hyperactive/impulsive trait. Carrying these associations in mind, are the studies linking early ear infections to hyperactivity simply due to associations with hyperactive subtype-dominated comorbid disorders?

One particular study found that children with hyperactivity vs. children with learning disabilities (and not hyperactivity, remember, learning disabilities are often seen at higher rates in the inattentive forms of the disorder) had similar numbers of total childhood ear infections. However, the timing of the infections did seem to matter. Children with hyperactivity experienced more recent ear infections (within the previous year) compared to the learning disability kids.

In other words, the question surrounding hyperactivity and ear infections may be more of a "when" question than a "how many" question. This may also suggest the possibility that hyperactivity due to middle ear troubles may be more of a temporary condition (this is supported by trends as an individual with ADHD ages, typically, the hyperactive symptoms of the disorder begin to subside as a child gets older and reaches adulthood, while the inattentive symptoms are more likely to plateau) as opposed to inattentive problems stemming from ear infections. Severity of the infections may also be a triggering cause or associated warning sign of an increased risk of developing hyperactive behaviors. The same study found that earaches and upper respiratory tract infections were higher in the hyperactive group than in the less-hyper learning disability group.

So what's going on with the connection between ear infections and ADHD-like hyperactivity?:
Although none of the above studies mentioned this possibility, as a blogger I have a few ideas on the subject. One of the most probable reasons for the ear infection/hyperactivity correlation may be due to the treatment process of ear infections. Let me explain:

Ear infections are typically treated with antibiotics. While these drugs work wonders for most infections, they also can disrupt the healthy bacterial counts in the digestive tract (that is, they kill off many of the "good" bacteria in our digestive systems in addition to the "bad" bacteria which may be causing our infections).

If the "good" digestive bacterial counts fall too low, the digestive process is compromised. The absorption and digestion process may suffer, as key nutrients may now be compromised (even if no major dietary changes occur). We have spoken extensively about nutrient deficiencies and ADHD as well as ADHD-related nutrition strategies in earlier posts.

Additionally, if good bacterial counts fall low, incomplete digestion results, which can lead to byproducts such as higher concentrations of organic acids, as well as incomplete breakdowns of potential allergens (which can increase sensitivity to food allergens, among others). These allergens and acids can actually begin to penetrate the blood brain barrier and show up in higher concentrations in the brain. Neurological disorders, including abnormal hyperactivity may actually be triggered by digestive imbalances (to a degree beyond what most of us realize). We are just beginning to recognize the huge degree of inter-relationship between the nervous and digestive systems, including brain-gut interactions.

There has been a longstanding "hot" discussion surrounding food allergies and ADHD (as well as possible connections between food allergies and disorders like fibromyalgia and chronic fatigue syndrome), and the disrupted bacterial balance in the digestive system due to frequent antibiotic usage for recurrent ear infections may be a governing factor. This seems to make sense, especially considering the fact that hyperactivity was more linked to recent ear infections (and resultant antibiotic treatment), while the more inattentive behaviors and learning disorders seem to be a more long-standing symptom. Since bacterial counts begin to re-stabilize following antibiotic treatment (if a proper diet is maintained), the food-related hyperactivity may begin to subside, but for recent infections and treatments, the digestive bacteria may still be imbalanced, triggering an onset of ADHD-like hyperactive behaviors.

Of course this is just the blogger's personal hypothesis, but it at least seems plausible that the actual treatment for ear infections may play an equally strong role on the high rate of occurrence between ADHD and ear infections.

read more...

Beauty Review: YSL Exfoliating Lip Balm

I have a bad problem with flaky lips. After failing miserably to resolve the problem with moisturizing balms I decided to give exfoliating treatments a try. Here is my review on YSL Exfoliating Lip BalmProduct Tag Line:This delicious lip balm instantly enhances the natural beauty of your lipsPromise:- gently exfoliates and moisturizes while providing a light veil of color- leaves lips soft,

read more...

Are the lasting effects of acne more than just skin deep?

The teen years are a trying time for any person. Although the worries and cares of adulthood are still far into the future, the teen is not exactly a happy and relaxed person. The carelessness and ignorance of childhood makes room for rebellion and questions about one’s values and place in the world. Looking for their own road through life teens feel insecure and, often enough, misunderstood. Unfortunately, if the search for a place under the sun is not enough, teenagers also have to deal with other problems, such as acne. This unsightly condition is the bane of many teenagers because of the effects it has at psychological level.

It doesn’t take a lot to foster a negative self image in a teenager. Most of them are at least somewhat insecure about their outward appearance because of various real or imaginary blemishes. But a real condition that causes true discomfort and mars a young face is something else altogether. The fragile self image and self respect of teenagers are hard pressed to cope with the pressure exerted by the opinions of others and the comparisons with various role-models that teenagers find for themselves. In extreme cases, the negative self image turns into self hatred and the disfiguring condition is seen as a cruel instrument of self punishment for failing to rise up to some standard or other.

Teenagers live in small worlds. Parents, friends and the amorphous group of half-familiar school mates are the limits of their social lives. Naturally, teenagers tend to attach more importance to the praise or criticism coming from their friends or school mates, on grounds that parents love you anyway and are fatally biased. But, since teens can be very cruel to each other, the criticism of school mates is frequently unkind and meant to hurt. This serves to increase the feelings of anxiety, insecurity and self hatred, resulting in withdrawal from the social environment into a private world of pain and shame.

Teenagers are terribly earnest about outward appearances and criticism. They are still away from the age when human beings come to terms with themselves and are no longer much interested in what others say or think. Hiding one’s body or face and feeling ashamed just because somebody else said that this is the thing to do is a mistake and teenagers should be helped to see this. Acne can be defeated with persistence and by using the right products. However, the psychological effects of acne must also be fought, or else they may never go away. The teenager who hated himself for having pimples on his face will turn into the adult who hates himself for being a little overweight or not making as much money as some co-worker.

The feeling of discomfort and shame with oneself does not always go away in time. Sometimes it just finds a new problem to act as its power source. This is the lasting effect of acne: a poor self image, a lack of confidence and a feeling of being at a disadvantage when comparing oneself to other people. These moods and mindsets can ruin anybody’s social life and often they also get in the way of professional development. Unfortunately, acne is not just skin deep.

read more...

Beauty Buy: Guerlain Meteorites

If you could see me right now, you would laugh at a little happy dance I’m doing over here! Singing “Finally it has happened to me!” I bought the famous Meteorites powder by Guerlain. It took me such a long time to finally lay my hands on this precious powder. I wanted to get Meteorites a looong time ago. First I had other priorities and then I couldn’t decide on the right shade. I started by

read more...

Beauty Review: Caress Evenly Gorgeous

One of my favorite parts of the day is a long hot morning shower. I know showers should be cool and short but this habit of mine is unbeatable. I get so much pleasure from those 20 minutes under the warm relaxing streams of water running down my skin… What can be better? I guess only a shower with a nice smelling bubbly body wash… There is a big choice of washes and shower gels out there and we

read more...

Ginkgo biloba for ADHD: A natural herbal treatment alternative?

A few weeks ago, I discussed the merits of ginseng for treating ADHD. What I did not mention is the fact that this special herb often works even better in tandem with another important "brain herb", Ginkgo biloba. It's benefits also extend beyond the nervous system, and the Ginkgo has been used to treat everything from increasing blood flow to Alzheimer's to glaucoma to hormone replacement to protection against neuronal degradation. While somewhat wary (personally) of using generalized "brain booster" nutrients for ADHD (it is a highly variable disorder of complex etiology and treatment methods), I am interested whenever new research publications arise on the topic. Just this week, a new paper came out on the merits of Ginkgo biloba as an ADHD treatment option.

Here are some of the major points of the publication:

• Irritability is an often overlooked side effect of ADHD. Medications, especially over-prescription with stimulants such as methylphenidate and amphetamines can increase this unwanted side effect. However, Ginkgo exhibited a positive mollifying effect on irritability for the individuals in the study.
  
  
• While one of the knocks against Ginkgo biloba is that it can sometimes result in sedative effects, the study found these to be extremely mild. However, to go along with the irritability-reducing benefits above, Ginkgo was able to improve the individuals' tolerance for frustration (to the degree that this behavior could be measured).
  
  
• We have seen previously that oppositional defiant behaviors are often comorbid to ADHD (which can often manifest themselves alongside seemingly unrelated disorders such as auditory processing disorders or even bedwetting). One of the strongest suits of Ginkgo biloba may actually be in curbing these oppositional behaviors. This suggests that Ginkgo may be effective for the more Hyperactive/Impulsive or Combined Subtypes of ADHD, where comorbid oppositional behaviors are more often seen (as opposed to the predominantly inattentive subtype of the Disorder).
  
  
• Nevertheless, Ginkgo biloba appeared to boost symptoms of attention and working memory as well. This may suggest Ginkgo's versatility, and that it could be used universally across the ADHD "spectrum", including for the 3 classic or traditional subtypes of the disorder.
  
  
• The study highlights the relative success for co-treatment with methylphenidate and clonidine for individuals with ADHD and comorbid anxiety disorders. The authors suggest a functional comparison between Ginkgo and clonidine, and hint at its use as an alternative to clonidine/methylphenidate treatment (of course, it is also possible that Ginkgo may be used alongside lower doses of stimulant medications, which could be very useful in reducing unwanted side effects, which are often mild for low doses of stimulants, but typically begin to appear with greater frequency when stimulant dosing is increased). Thus, Ginkgo could possibly act as a side-effect-saving alternative to higher doses of medication.
  
  
• As a precautionary measure, due, in part to some of its anti-clotting properties, there is some concern about Ginkgo triggering internal cerebral bleeding. Indeed, other studies have also addressed this possible concern, highlighting issues such as haemmorrhage risks, as well as herb-drug interactions with Ginkgo and anti-coagulant medications.
  
  
• Keep in mind the extremely small nature of the study (only 6 individuals) should be met with healthy skepticism. However, the results were still notable. Statistically significant reductions in some of the trademark ADHD symptoms (fidgeting, restlessness, inattention, etc.) upon Ginkgo biloba treatment definitely highlight its potential as a more "natural" alternative treatment method for ADHD.
  

read more...

Beauty Buy: La Mer SPF 30 UV Protecting Fluid

With spring and summer comes the time to decide on a product for daily sun protection with a broad spectrum and a higher SPF of at least 30. Just when I was dwelling on what to use this summer... La Mer happened to come out with their new high-tech SPF 30 UV Protecting Fluid. Girl must guard her skin from sun damage, right? She doesn't have to spend so much money on it though... But I went for a

read more...

Why the Menstrual Cycle may affect ADHD Medication Dosing Levels

Do hormonal fluctuations result in variable ADHD medication dosage levels across the menstrual cycle?

We have investigated the impact of gender on ADHD in a number of earlier posts. We have covered topics such as:

• Gender Based Metabolic Differences in ADHD brains

• Gender Dependent ADHD Genes, including MAOA, SLC6A2, SLC6A4 and COMT

• ADHD subtypes and Comorbid Disorders

Clearly, there are a number of boy/girl differences in the root causes, diagnoses and treatment methods for the disorder.

However, we need to investigate whether intra-individual differences are also an important factor, especially where medication treatment and medication dosing levels are concerned. Based on a number of studies, it appears that women may actually require different medication dosing levels depending on where they are in their menstrual cycle. Additionally, post-menopausal drugs such as estradiol patches may also alter the drug effects of certain ADHD medications such as amphetamines. The main culprits are most likely fluctuating levels of estrogen and progesterone.

Here are brief summaries on some of the relevant studies and their findings. Wherever possible, I will include a link to the original studies:

• The link between Estradiol treatment and amphetamine medications: This study focused on whether pretreatment with estradiol played any role in the reaction to amphetamines. The drug used in this study was D-Amphetamine, which would correspond to the medication Dexedrine, however, this is also the predominantly active compound in medications such as Adderall or Vyvanse (once this "pro-drug" is metabolized). It is unclear at the moment whether chemical "cousins" to amphetamines, such as methylphenidate (Ritalin, Concerta, Daytrana, Metadate), also exhibit these fluctuations when combined with estradiol-releasing drugs.
  
  The study found that for females who took estradiol-supplementing treatments during the early follicular phase (pre-ovulation) of the menstrual cycle experienced an overall greater "stimulating" effect of the amphetamine medication (taken as 10 mg of amphetamine). This may suggest that a slightly lower dosage during this stage of the menstrual cycle might be warranted, and (as this blogger's personal hypothesis) may actually affect the addiction potential of ADHD stimulant drugs such as amphetamines.
  
  
• Another study by the same group found that estrogen may be responsible for some of the heightened euphoric effect felt from amphetamine-based drugs. However, the hormone progesterone may actually counteract some of this euphoria. During the luteal phase of the menstrual cycle (after ovulation), high levels of both estrogen and progesterone are seen (although levels of both of these taper off going into menstruation), so the effects of estrogen may be curbed. During the late follicular phase, where progesterone levels are low and estrogen levels begin to spike, the "high" may be at its peak, especially if stimulants are involved.
  
  
• A case study found that an increase in inattentive symptoms coincided cyclically with the menstrual cycle for a patient who was undergoing treatment for newly-diagnosed ADHD with a twice-daily dosing regimen of the stimulant medication Concerta.
  
  
• The findings from these two studies suggest the possibility that a slightly smaller dosing schedule with amphetamine-based ADHD medications (such as Adderall, Vyvanse or Dexedrine) may be warranted during the follicular phase. However, during the luteal phase, when progesterone levels are higher, the amphetamine-based effects are less pronounced. This may correlate to a slightly higher dosing regimen for amphetamine-based treatment for ADHD and related disorders.
  
  
• While there is a relatively good theoretical basis for this assertion above, practical consideration measures must also be considered. Based on the relative scarcity of studies (besides the 2 mentioned above) on the amphetamine-menstrual cycle interactions, it is unclear as to how pronounced the medication change should be.
  
  For instance, should someone taking 10 mg of Adderall during the follicular phase boost up to 15 mg for the luteal phase? 20 mg? 30 mg? Additionally, hormonal fluctuations vary during the phases themselves, such as the estrogen spike during the late follicular phase. Questions abound, especially when dealing with the brief ovulatory phase as well.
  
  

This blog post hopefully introduces what may be a new consideration to women who have ADHD and are currently taking stimulant-based medication treatments. Perhaps this posting simply confirms what you have already experienced.

Nevertheless, given the fact that administering variable levels of medication based on cyclical patterns such as time of day (like ramping up methylphenidate concentrations via controlled release formulations to offset "acute tolerance" based effects), and the fact that individuals with ADHD may experience seasonal variations in symptoms, at least suggests, that variable dosing of medications across the near-monthly period of the menstrual cycle may prove to be beneficial treatment strategy for females with ADHD.

read more...

Beauty Tip: Prevent Eye Wrinkles

* Skin around your eyes is very thin and fragile. Stretching, rubbing, tagging at eye skin can cause it to stretch and subsequently develop lines and crow's feet. It can also lead to breaking delicate blood vessels resulting in dark eye circles, dulling and thickening of the surrounding skin. Be especially careful not to tag or rub when applying makeup; removing makeup; after a long day staring

read more...

Long Wave Infrared Imaging: A new detection method for ADHD?

Detecting ADHD using the long-wave infrared spectrum:

I always enjoy covering new breakthroughs in the diagnosis and treatment methods in the medical field. A new study just came out which may have a number of potential applications to aid in the diagnostic process of ADHD, which I believe is worth sharing. Called Long-Wave Infrared Imaging, this method utilizes the infrared spectrum to detect biological activity (namely bloodflow patterns) via the differences in radiation emitted by these activities. The study, titled Sensitivity and Specificity of Longwave Infrared Imaging for Attention-Deficit/Hyperactivity Disorder, found that this method may be a surprisingly powerful way of separating ADHD from other related disorders, aiding in the always-difficult process of differential diagnosis.

The basics of Long-Wave Infrared Imaging:

The term "long-wave" is a relative term, of course, referring to wavelengths of approximately 10 nanometers (or only one one-hundred millionth of a meter). Differential bloodflow patterns can result in temperature differences by a full degree (Celsius), making this technology useful in tracking bloodflow disorders. A recent publication in the Journal of Medical Physics by Bagathaviappan and coworkers suggests describes how this long-wave infrared imaging can detect areas in the circulatory system where bloodflow activity is sluggish or reduced. Typically, these areas appear "cooler" on the spectrum, due to the lack of a new, replenishing blood supply.

Applications for ADHD:

A number of studies have confirmed the hypothesis that individuals with ADHD have reduced bloodflow levels marking a recuction of activity to multiple key brain regions. Additionally, while several disorders have a number of overlapping symptoms (which can make the diagnostic process more complicated, especially if multiple comorbid disorders are present), differential blood flow patterns to the brain may be able to help make these distinctions. For example, blood flow patters to the brains of ADHD and OCD (Obsessive Compulsive Disorders) can show pronounced differences, which can aid the diagnostic process between these two disorders (while ADHD and OCD are often considered to be on "opposite" ends of the spectrum with regards to neuro-chemical signaling levels, these two disorders can often exhibit similar symptoms, such as a severe impairment in the response to verbal directions. This is especially true in younger children).

This technology may even be extended to measuring or predicting which medications may work for an individual diagnosed with ADHD, based on blood flow in specific localized brain regions. Cerebral blood flow patterns may help predict the response to common ADHD drugs such as methylphenidate (Ritalin, Concerta, Metadate, Daytrana). For example, a study by Cho and coworkers found increased blood flow in at least three different brain regions for individuals who showed poor response to methylphenidate treatment compared to their peers who did show improvements under the drug.

While the medication response study was done utilizing a different type of brain imaging device known as SPECT, which utilizes gamma rays and radioactive tracers to detect brain activity in 3-dimensional patterns. While SPECT has proven to be an extremely powerful and effectively safe method of detection (the radioactive isotope used in this method is relatively non-invasive and breaks down quickly, and the gamma rays are carefully controlled), concerned parents may still have an inherent fear of the terms "radioactivity" and "gamma rays" tend to shy away from this powerful detection method on their kids.

While this blogger personally has a very high opinion about the use of SPECT as a diagnostic tool for ADHD and related disorders, it is at least worth mentioning the possibility that long-wave infrared imaging methods may be a viable alternative method in at least some of these imaging cases (SPECT technology has been around for over 30 years, but the recent advances in computational power resurrected this technology in the very recent past, similar possibilities may abound by this infrared technology, which has been around even longer).

Keep in mind that the studies utilizing this range of infrared imaging technologies for detecting and differentiation disorders such as ADHD are still relatively scarce. Nevertheless, long-wave infrared imaging appears (at least in this blogger's personal opinion) to be a powerful diagnostic tool for ADHD and related disorders in the near future.

read more...

Beauty Buzz: Givenchy Makeup Collection Summer 2009

Givenchy makes summer brighter and hotter with their Summer Makeup Collection inspired by the sun. Enjoy warm shades of beige, copper, gold and some cool shimmery silver and blue.Glow to Wear Body Enhancer (Limited)Prismissime Mat & Glow Powder in Sun Caramel (Limited)Prisme Again! Compact Powder in Sun Mango and Sun Cinnamon (Limited)Prisme Again! Eyes in Sun Reflection (Limited)Pop Gloss

read more...

Risk of oral sexual acts

NEW YORK (Reuters Health) - Oral sex and open-mouthed "French" kissing increase the risk of acquiring oral infections of human papillomavirus, or HPV, a study shows.

"Performing oral sex is not without risks," Dr. Maura L. Gillison told Reuters Health.
It is associated with gonorrheal pharyngitis - a sexually transmitted infection of the tonsils and back of the throat that immediately causes symptoms, she noted, and now is associated with mouth HPV infections that are silent "yet may lead to oral cancer 10 to 20 years later."
Gillison from The Ohio State University, Columbus, and colleagues explored whether sexual behaviors were associated with the odds of oral HPV infection in 332 adults and in 210 college-aged men. They found that 4.8 percent of the adults and 2.9 percent of college-aged men had oral HPV infection.

Among adults, the odds of oral HPV infection were significantly elevated among current tobacco smokers and among individuals who reported having either more than 10 oral or more than 25 vaginal sex partners during their lifetime.

Similar risk factors applied to the college-aged men. For them, having at least six recent oral sex or open-mouthed kissing partners were independently associated with increased odds of developing oral HPV infection.

For the 28 percent of college-aged men who reported never having performed oral sex, having at least 10 lifetime or at least five recent open-mouthed kissing partners was associated with a significantly higher risk of developing oral HPV infection.

"Our data suggest that oral HPV infections that could predispose to cancer may be transmitted by very common behaviors such as open-mouth or 'French' kissing," Gillison concluded.
Given that the HPV vaccine does not have any therapeutic value against pre-existing HPV infections, "this may be relevant to the timing of administration of vaccination," Gillison said.
Although the CDC recommends that the vaccine be administered between the ages of 9 and 12 ideally, in practice, she noted, it is often administered to girls between the age of 14 and 16. Oral exposure to HPV may have occurred prior to that age.

SOURCE: The Journal of Infectious Diseases, May 1, 2009.

read more...

Beauty Review: Talika Eye Decompress

Product Tag Line:...the miracle solution to soothe it all in one go! Promise:Talika Eye Decompress refreshes, soothes, relieves congestion and revitalizes tired eyesClose-up on Active Ingredients:Water Sodium Laureth Sulfate – detergent/surfactantFD&C Blue N I/CI 42090 – diePhenoxyethanol – preservative, antiseptic, bactericide, solventPhenoxyethanol Nonoxynol-9 – surfactant (Classified as

read more...

Sarita’s Eyebrows

The door from the Girl’s Unit slammed open and Sarita erupted out, screaming: "I am not going to the...mall. I will not go to the mall. Every night he wants us to go to the mall. And I have to get my eyebrows done tonight. Someone needs to take me. Now. I am not going to the mall."

It was amazing how long and loud and with how many swears that girl could scream about not going to the mall. And I was in my office, working on a grant proposal, and I was on my last nerve just as she was. So the thoughts that were going through my mind were: "surely it can’t be required that she go to the mall. Would someone PLEASE come and tell her she doesn’t have to go to the mall so she will BE QUIET?!?!?"

It has since occurred to me that this was an illustration of a choice point for our treatment philosophy. How do we understand what is going on here?

One interpretation is that Sarita is a spoiled, demanding manipulative girl who just wants what she wants when she wants it. She wants everyone to forget about everything else except for what she needs. She freaks out every time any one says no to her. She thinks she’s special.

And that leads naturally to: well, she is going to have to learn. People can’t just drop what they are doing whenever she wants something. She will just have to wait her turn. We will have to teach her to stop yelling and disturbing people. That’s not going to get her what she wants. We won’t do one thing for her as long as she is making this kind of fuss.

Or...
Maybe there is another way to see it. Maybe, in fact, Sarita has very rarely gotten what she wants. In her life, few people have listened to her or cared about what she wants. She is not the center of any one’s universe. As she has grown up in situations of chaos, and then equally as she has lived in situations of congregate care, the only way she has been able to get anything has been to yell as loud as she can.

Maybe when she wants something (to get her eyebrows done) and someone else does not seem to be listening and is just proceeding with their plans (to go to the mall) the words in her head go something like this:
He is not listening.
If I don’t get my eyebrows down I will look ugly and no one will like me.
He does not hear what I need.
He does not care what I need.
No one hears or cares what I need.
I have no one, I have nobody.
I am no one.
I am nobody.

And then she starts to feel unbearable emotions- despair, hopelessness...
Which come out in the intensity and pressure of her speech.

Where would that thinking lead us?

It does not mean that it is okay for Sarita to scream and swear when ever she wants something. That would surely not give her a life worth living.

It does not mean that we should immediately drop everything and take her to get her eyebrows done in order to quiet her down.

But what it does mean is that we do not approach Sarita with lectures about how she should be quiet and stop bothering people and she can’t always get what she wants (which believe me, she knows).

Instead, we start with "Sarita, what is the matter?"

And then, our part of the conversation includes statements like:
You definitely do not want to go to that mall.
You have had it with that mall.
It’s very important to you to have your eyebrows done as soon as possible.
And where do you have to go to have that done?
So what you want to do is go to...
And you feel very strongly about this...

Because, in fact, Sarita will gradually stop screaming when she feels she is heard when she is talking.

And that is an experience we can give her.

read more...