By

Bob Gottfried PhD

Keywords: attention deficit disorder, stress, ADD, ADHD, learning disabilities, ACEclinics, Adderall, Ritalin, Concerta, Biphentin, cortisol, stress management

More than 80% of the children diagnosed with ADHD inherited this neurological disorder from a close relative. For a parent with mild symptoms of ADHD, who has learned to manage the disease over the years, the stress of raising a child with ADHD may revive their condition and inflame their relationships. These parents may react to their child’s inattention or rebellious behavior with exaggerated negative reactions. Recent studies showed that the symptoms of rebellion (oppositional behavior) in ADHD children are worse when the parents exhibit stressful emotions (i.e. low warmth, criticism or hostility) [1, 2]. Even parents not affected by ADHD may find the challenge of raising a child with learning disabilities particularly stressful, which may impeach on the quality of their interactions and worsen the child’s condition. Consequently, family therapy is many time needed to break the cycle of stressful interactions, and to avoid the serious long-term health complications of a stressful life for you and your child.

What Stress Does to Your Brain

During stressful situations, the hormone named cortisol is secreted from the adrenal glands to mobilize sugar (glucose) into the blood as a quick source of energy to face the “alarm” situation. It also creates a small memory of the danger that caused the stress to avoid it in the future. Essentially, cortisol is a 'fight or flight' hormone to keep us out of arms’ way.

Symptoms of ADHD are associated with anomalies in the regulation of cortisol during stress situations [3, 4]. While the directionality was debated for years, we are now discovering that each subtype of ADHD disrupts the regulation of cortisol differently. Studies were conducted on school-age children with ADHD to compare the impact of stress on cortisol regulation in ADHD driven by anxiety or inattention and ADHD driven by defiant or aggressive behaviors. The levels of cortisol were measured in saliva before and after a stressor, such as blood collection or a timed intellectual task. Whereas anxious children responded to stress by an exaggerated increase in cortisol level, those prone to disruptive behaviors exhibited a blunt cortisol production [5, 6].

Long Term Complications of Excess Cortisol

The production of cortisol is only supposed to increase transiently during a “life-threatening” or “stress” situation. The long-term consequences of low cortisol responses to stress in ADHD children with aggressive behavior have not been documented. On the other hand, the frequent release of excess cortisol in the blood and brain tissue of anxiety-driven ADHD individuals is problematic. These individuals are particularly at risk of developing severe complications, including:
• Impaired child development
• Type 2 Diabetes
• Brain Damage
The enormous amount of glucose required to respond to a stress situation is mobilized very quickly by any means necessary, including muscle degradation [7, 8]. This situation is particularly critical for adolescents who are growing rapidly, and often experience loss of appetite as a side-effect of the common medications (i.e. Ritalin) [9]. This is why parents often elect not to give medication to their ADHD children during the weekend to stimulate their appetite. In addition, the frequent rises in cortisol level may predispose ADHD patients to Type 2 diabetes because it mobilizes glucose into the blood [10, 11]. This form of diabetes generally develops in healthy adults after years of poor nutritional habits [12]. Finally, high glucose levels impairs reasoning [13, 14] and causes brain damage [15]. For these reasons, learning to manage stress should be a priority at school and at home.

How to Manage Stress as a Family


Avoid Stressful Situations: Minimize the stressors, like limiting the social activities of an ADHD child to only one friend at a time.

Relaxation Techniques: Chose a technique that fits your lifestyle and personality (meditation, yoga, prayer) and devote the same time daily. The anticipation of a relaxation period can also reduce stress levels during the day.

Put Your Child in Charge: Unexpected events are very stressful for a child with ADHD. The child should be involved in planning homework, chores and play periods. By controlling their activities, they will learn to take responsibility, and they will build self-esteem through their accomplishments.

Healthy Lifestyle: The best stress control technique remains prevention. Regular exercise prevents the build up of anxiety and stress, and improves sleep quality. A healthy diet which minimizes the intake of stimulants (nicotine, caffeine) and processed food was also proven to considerably reduce anxiety and inattention in children and adults with ADHD [16].

ADHD Long Term Solutions and Treatment

In addition to using stress management techniques, using medication such as Ritalin, Concerta, Biphentin or Adderall, has been the most popular way of treating ADHD. However, with the increased awareness of the potentially harmful side effects, many parents are avoiding giving their children these medications. On the other hand, Neuro cognitive training has shown excellent results treating attention deficit disorders and learning disabilities with marked improvement on all levels. One such program developed at the ACE clinics in Toronto, Canada, consists of improving brain regulation combined with developing all core skills such as such as visual processing, auditory processing, divided attention, multitasking, working memory and so on. Training the frontal lobes of the brain to improve engagement improves general attention as well as improving executive functions, including organization, prioritizing, inhibition control, decision-making, time management and motivation. This type of multi-level neuro cognitive training can contribute to significant gains in cognitive performance and strong reduction in ADHD related symptoms.)

Bob Gottfried PhD is the clinical director of ACEclinics located in Toronto, Canada. WWW.ACEclinics.com
He specializes in neuro-cognitive treatment to treat ADD, ADHD, LD and other neuro-cognitive disorders.



References

1 Stadler, C., Kroeger, A., Weyers, P., Grasmann, D., Horschinek, M., Freitag, C. and Clement, H. W. (2011) Cortisol reactivity in boys with attention-deficit/hyperactivity disorder and disruptive behavior problems: the impact of callous unemotional traits. Psychiatry Res 187, 204-209
2 Christiansen, H., Oades, R. D., Psychogiou, L., Hauffa, B. P. and Sonuga-Barke, E. J. (2010) Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)? Behav Brain Funct. 6, 45
3 McCarthy, A. M., Hanrahan, K., Scott, L. M., Zemblidge, N., Kleiber, C. and Zimmerman, M. B. (2011) Salivary cortisol responsivity to an intravenous catheter insertion in children with attention-deficit/hyperactivity disorder. J Pediatr Psychol. in press
4 van de Wiel, N. M., van Goozen, S. H., Matthys, W., Snoek, H. and van Engeland, H. (2004) Cortisol and treatment effect in children with disruptive behavior disorders: a preliminary study. J Am Acad Child Adolesc Psychiatry. 43, 1011-1018
5 Maldonado, E. F., Trianes, M. V., Cortés, A., Moreno, E. and Escobar, M. (2009) Salivary cortisol response to a psychosocial stressor on children diagnosed with attention-deficit/hyperactivity disorder: differences between diagnostic subtypes. Span J Psychol. 12, 7077-7714
6 Hastings, P. D., Fortier, I., Utendale, W. T., Simard, L. R. and Robaey, P. (2009) Adrenocortical functioning in boys with attention-deficit/hyperactivity disorder: examining subtypes of ADHD and associated comorbid conditions. J Abnorm Child Psychol. 37, 565-578
7 Djurhuus, C. B., Gravholt, C. H., Nielsen, S., Pedersen, S. B., Møller, N. and Schmitz, O. (2004) Additive effects of cortisol and growth hormone on regional and systemic lipolysis in humans. American Journal of Physiology - Endocrinology And Metabolism 286, E488-E494
8 Çakır, B., Kasımay, Ö., Kolgazi, M., Ersoy, Y., Ercan, F. and Yeğen, B. Ç. (2010) Stress-induced multiple organ damage in rats is ameliorated by the antioxidant and anxiolytic effects of regular exercise. Cell Biochem Funct 28, 469-479
9 Lee, J., Grizenko, N., Bhat, V., Sengupta, S., Polotskaia, A. and Joober, R. (2011) Relation between therapeutic response and side effects induced by methylphenidate as observed by parents and teachers of children with ADHD. BMC Psychiatry 11, 70
10 Dinan, T. G. (2004) Stress and the genesis of diabetes mellitus in schizophrenia. Br J Psychiatry Suppl. 47, S72-S75
11 Anagnostis, P., Athyros, V. G., Tziomalos, K., Karagiannis, A. and Mikhailidis, D. P. (2009) The pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metab 94, 2692-2701
12 Klein, S., Sheard, N. F., Pi-Sunyer, X., Daly, A., Wylie-Rosett, J., Kulkarni, K. and Clark, N. G. (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. Diabetes Care 27, 2067-2073
13 Lane, S. J., Reynolds, S. and Thacker, L. (2010) Sensory over-responsivity and ADHD: differentiating using electrodermal responses, cortisol, and anxiety. Front Integr Neurosci. 4, 8
14 Shin, D. W. and Lee, S. H. (2007) Blunted hypothalamo-pituitary-adrenal axis reactivity is associated with the poor intelligence performance in children with attention-deficit/hyperactivity disorder. Neuropediatrics 38, 298-303
15 Carrion, V. G., Weems, C. F. and Reiss, A. L. (2007) Stress predicts brain changes in children: a pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus. Pediatrics 119, 509-516
16 Pelsser, L. M., Frankena, K., Toorman, J., Savelkoul, H. F., Dubois, A. E., Pereira, R. R., Haagen, T. A., Rommelse, N. N. and Buitelaar, J. K. (2011) Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet 377, 494-503