A recent article in the New York Times, which has been circulating among therapists suggests the benefits of “exercising the mind” to treat ADHD. While this idea is tremendously appealing, if only we could strengthen the brain rather than rely on drugs to treat ADHD, the evidence continues to be remarkably lacking to support these approaches.
In his recent New York Times article, “Exercising the Mind to Treat Attention Deficits” Daniel Coleman, suggests that there now is: “a growing stream of research [which] suggests that that strengthening this mental muscle [the brain] ………may help children and adults cope with ADHD.” Unfortunately this is not true. There is no real evidence to support the conclusion that brain training or mental exercises can help with ADHD.
A close examination of Coleman’s articles suggests that there really is no solid evidence to support his hopefulness/enthusiasm for braining training. First, Coleman discusses research which identifies how adolescents with ADHD in Finland are far less likely to be treated with medication. While interesting, this shows only that there are differences in treatment approaches and medication use, nothing about the relative benefit or utility of any type of treatment. Second, he goes on to site a study suggesting the limited benefit of ADHD medication, in addition to quoting several professionals who further comment on the limits of medication treatment. However, noting the limits of medication treatment (for the record, nearly all medication treatment of nearly all disorders has limitations) does not mean it is of no value or that cognitive exercises are beneficial. Third, the article sites a study in the on-line journal Clinical Neurophysiology which purports that adults with ADD benefited from mindfulness combined with cognitive therapy. An examination of this article, clearly reveals that this research does not show the benefits of mindfulness for ADHD: the type of treatment used with a combined cognitive therapy and mindfulness approach so what the key ingredient of the treatment that helped (if it indeed had any benefit) is unclear, e.g., mindfulness exercises or CBT components (there is research by Solanto, Ramsey and others that does show the benefits of CBT in adults with ADHD); the treatment was compared to a waiting list control group so it is unclear if the benefit of being in treatment was all that had any impact; and most importantly the only benefits shown from the study where in terms of neuropsychological measures of braining function so it is unclear if there is any real world value to this treatment. A final point while, Coleman suggests that this study showed that benefits of the mindfulness training were similar to medication, there is no examination of medication treatment in this article. Fourth, Coleman sites research in the Frontiers in Human Neuroscience, an on-line open access journal, and suggests that the study in question supports how mindfulness may strengthen the ability to attend. However, this is quite a leap of faith. The article in Frontiers focused on adult “meditators” and did not examine persons with ADHD. Thus, while the findings might be of interest in understanding the role meditation in brain functioning, it is a great leap to suggest that looked at brain functioning in 14 healthy adults (who meditated regularly) means that meditation is going to help change ADHD symptoms.
Overall, the NY Times article raises an intriguing idea: maybe some type of cognitive exercise might help ameliorate deficits associated with ADHD and other disorders. However, the evidence that cognitive exercises are of any value for persons with ADHD continues to lack any real evidence to support its use. In fact, there seems to be a dearth of evidence to support the use of brain training type programs (despite their being marketed with an increased vigorousness – anyone who is on line for any time is sure to have viewed the ad from Lumosity). Specifically, an analysis of 23 of the best studies on brain training, by the researcher Monica Melby-Lervag, concluded that while players do get better, the increase in skill hasn’t been shown to transfer to other tasks.
It would be nice if there was evidence to support the use of non-invasive side-effect free interventions in the treatment of ADHD, and other disorder. However, the absence of evidence continues to suggest that these activities are likely nothing more than a pleasant way to spend time (if you enjoy this type of activity).
Exercising the Mind to Treat Attention Deficits. By DANIEL GOLEMAN, May 12, 2014
Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder. Clinical Neurophysiology, Volume 125, Issue 7 , Pages 1407-1416, July 2014
Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach by J. Russell Ramsay , Anthony L. Rostain
Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction by Mary V. Solanto PhD
Effects of meditation experience on functional connectivity of distributed brain networks. Front. Hum. Neurosci., 01 March 2012 | doi: 10.3389/fnhum.2012.00038
Monica Melby-Lervag, sited in a N.Y. Times article