What’s the difference between ADD and ADHD?
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Around one in 20 people has attention-deficit hyperactivity disorder (ADHD). It’s one of the most common neurodevelopmental disorders in childhood and often continues into adulthood.
ADHD is diagnosed when people experience problems with inattention and/or hyperactivity and impulsivity that negatively impacts them at school or work, in social settings and at home.
Some people call the condition attention-deficit disorder, or ADD. So what’s the difference?
In short, what was previously called ADD is now known as ADHD. So how did we get here?
Let’s start with some history
The first clinical description of children with inattention, hyperactivity and impulsivity was in 1902. British paediatrician Professor George Still presented a series of lectures about his observations of 43 children who were defiant, aggressive, undisciplined and extremely emotional or passionate.
Since then, our understanding of the condition evolved and made its way into the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. Clinicians use the DSM to diagnose mental health and neurodevelopmental conditions.
The first DSM, published in 1952, did not include a specific related child or adolescent category. But the second edition, published in 1968, included a section on behaviour disorders in young people. It referred to ADHD-type characteristics as “hyperkinetic reaction of childhood or adolescence”. This described the excessive, involuntary movement of children with the disorder.
In the early 1980s, the third DSM added a condition it called “attention deficit disorder”, listing two types: attention deficit disorder with hyperactivity (ADDH) and attention deficit disorder as the subtype without the hyperactivity.
However, seven years later, a revised DSM (DSM-III-R) replaced ADD (and its two sub-types) with ADHD and three sub-types we have today:
- predominantly inattentive
- predominantly hyperactive-impulsive
- combined.
Why change ADD to ADHD?
ADHD replaced ADD in the DSM-III-R in 1987 for a number of reasons.
First was the controversy and debate over the presence or absence of hyperactivity: the “H” in ADHD. When ADD was initially named, little research had been done to determine the similarities and differences between the two sub-types.
The next issue was around the term “attention-deficit” and whether these deficits were similar or different across both sub-types. Questions also arose about the extent of these differences: if these sub-types were so different, were they actually different conditions?
Meanwhile, a new focus on inattention (an “attention deficit”) recognised that children with inattentive behaviours may not necessarily be disruptive and challenging but are more likely to be forgetful and daydreamers.
Why do some people use the term ADD?
There was a surge of diagnoses in the 1980s. So it’s understandable that some people still hold onto the term ADD.
Some may identify as having ADD because out of habit, because this is what they were originally diagnosed with or because they don’t have hyperactivity/impulsivity traits.
Others who don’t have ADHD may use the term they came across in the 80s or 90s, not knowing the terminology has changed.
How is ADHD currently diagnosed?
The three sub-types of ADHD, outlined in the DSM-5 are:
- predominantly inattentive. People with the inattentive sub-type have difficulty sustaining concentration, are easily distracted and forgetful, lose things frequently, and are unable to follow detailed instructions
- predominantly hyperactive-impulsive. Those with this sub-type find it hard to be still, need to move constantly in structured situations, frequently interrupt others, talk non-stop and struggle with self control
- combined. Those with the combined sub-type experience the characteristics of those who are inattentive and hyperactive-impulsive.
ADHD diagnoses continue to rise among children and adults. And while ADHD was commonly diagnosed in boys, more recently we have seen growing numbers of girls and women seeking diagnoses.
However, some international experts contest the expanded definition of ADHD, driven by clinical practice in the United States. They argue the challenges of unwanted behaviours and educational outcomes for young people with the condition are uniquely shaped by each country’s cultural, political and local factors.
Regardless of the name change to reflect what we know about the condition, ADHD continues to impact educational, social and life situations of many children, adolescents and adults.
Kathy Gibbs, Program Director for the Bachelor of Education, Griffith University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Never Too Old?
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Age Limits On Exercise?
In Tuesday’s newsletter, we asked you your opinion on whether we should exercise less as we get older, and got the above-depicted, below-described, set of responses:
- About 42% said “No, we must keep pushing ourselves, to keep our youth“
- About 29% said “Only to the extent necessary due to chronic conditions etc”
- About 29% said “Yes, we should keep gently moving but otherwise take it easier”
One subscriber who voted for “No, we must keep pushing ourselves, to keep our youth“ wrote to add:
❝I’m 71 and I push myself. I’m not as fast or strong as I used to be but, I feel great when I push myself instead of going through the motions. I listen to my body!❞
~ 10almonds subscriber
One subscriber who voted for “Only to the extent necessary due to chronic conditions etc” wrote to add:
❝It’s never too late to get stronger. Important to keep your strength and balance. I am a Silver Sneakers instructor and I see first hand how helpful regular exercise is for seniors.❞
~ 10almonds subscriber
One subscriber who voted to say “Yes, we should keep gently moving but otherwise take it easier” wrote to add:
❝Keep moving but be considerate and respectful of your aging body. It’s a time to find balance in life and not put yourself into a positon to damage youself by competing with decades younger folks (unless you want to) – it will take much longer to bounce back.❞
~ 10almonds subscriber
These will be important, because we’ll come back to them at the end.
So what does the science say?
Endurance exercise is for young people only: True or False?
False! With proper training, age is no barrier to serious endurance exercise.
Here’s a study that looked at marathon-runners of various ages, and found that…
- the majority of middle-aged and elderly athletes have training histories of less than seven years of running
- there are virtually no relevant running time differences (p<0.01) per age in marathon finishers from 20 to 55 years
- after 55 years, running times did increase on average, but not consistently (i.e. there were still older runners with comparable times to the younger age bracket)
The researchers took this as evidence of aging being indeed a biological process that can be sped up or slowed down by various lifestyle factors.
See also:
Age & Aging: What Can (And Can’t) We Do About It?
this covers the many aspects of biological aging (it’s not one number, but many!) and how our various different biological ages are often not in sync with each other, and how we can optimize each of them that can be optimized
Resistance training is for young people only: True or False?
False! In fact, it’s not only possible for older people, but is also associated with a reduction in all-cause mortality.
Specifically, those who reported strength-training at least once per week enjoyed longer lives than those who did not.
You may be thinking “is this just the horse-riding thing again, where correlation is not causation and it’s just that healthier people (for other reasons) were able to do strength-training more, rather than the other way around?“
…which is a good think to think of, so well-spotted if you were thinking that!
But in this case no; the benefits remained when other things were controlled for:
❝Adjusted for demographic variables, health behaviors and health conditions, a statistically significant effect on mortality remained.
Although the effects on cardiac and cancer mortality were no longer statistically significant, the data still pointed to a benefit.
Importantly, after the physical activity level was controlled for, people who reported strength exercises appeared to see a greater mortality benefit than those who reported physical activity alone.❞
See the study: Is strength training associated with mortality benefits? A 15 year cohort study of US older adults
And a pop-sci article about it: Strength training helps older adults live longer
Closing thoughts
As it happens… All three of the subscribers we quoted all had excellent points!
Because in this case it’s less a matter of “should”, and more a selection of options:
- We (most of us, at least) can gain/regain/maintain the kind of strength and fitness associated with much younger people, and we need not be afraid of exercising accordingly (assuming having worked up to such, not just going straight from couch to marathon, say).
- We must nevertheless be mindful of chronic conditions or even passing illnesses/injuries, but that goes for people of any age
- We also can’t argue against a “safety first” cautious approach to exercise. After all, sure, maybe we can run marathons at any age, but that doesn’t mean we have to. And sure, maybe we can train to lift heavy weights, but if we’re content to be able to carry the groceries or perhaps take our partner’s weight in the dance hall (or the bedroom!), then (if we’re also at least maintaining our bones and muscles at a healthy level) that’s good enough already.
Which prompts the question, what do you want to be able to do, now and years from now? What’s important to you?
For inspiration, check out: Train For The Event Of Your Life!
Take care!
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A Supplement To Rival St. John’s Wort Against Depression
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Do You Feel The SAMe?
S-Adeonsyl-L-Methionone (SAMe) is a chemical found naturally in the body, and/but enjoyed widely as a supplement. The main reasons people take it are:
- Improve mood (antidepressant effect)
- Improve joints (reduce osteoarthritis symptoms)
- Improve liver (detoxifying effect)
Let’s see what the science says for each of those claims…
Does it improve mood?
It seems to perform comparably to St. John’s Wort (which is good; it performs comparably to Prozac).
Best of all, it does this with fewer contraindications (St. John’s Wort has so many contraindications).
Here’s how they stack up:
This looks very promising, though it’d be nice to see a larger body of research, to be sure.
Does it reduce osteoarthritis symptoms?
The good news: it performs comparably to ibuprofen, with fewer side effects!
The bad news: it also performs comparably to placebo!
Read into that what you will about ibuprofen’s usefulness vs OA symptoms.
Read all about it:
S-Adenosylmethionine for osteoarthritis of the knee or hip
If you were hoping for something for OA or similar symptoms, you might like our previous main features:
- Avoiding/Managing Osteoarthritis
- Managing Chronic Pain (Realistically!)
- The 7 Approaches To Pain Management
- (Science-Based) Alternative Pain Relief
Does it help against liver disease?
According to adverts for SAMe: absolutely!
According to science: we don’t know
The science for this is so weak that it’d be unworthy of mention if it weren’t for the fact that SAMe is so widely sold as good against hepatotoxicity.
To be clear: maybe it really is great! Science hasn’t yet disproved its usefulness either.
It is popularly assumed to be beneficial due to there being an association between lower levels of SAMe in the body (remember, it is also produced inside our bodies) and development of liver disease, especially cholestasis.
Here’s an example of what pretty much every study we found was like (inconclusive research based mostly on mice):
S-adenosylmethionine in liver health, injury, and cancer
For other options for liver health, consider:
Is it safe?
Safety trials have been done ranging from 3 months to 2 years, with no serious side effects coming to light. So, it appears quite safe.
That said, as with anything, there are contraindications, such as:
- if you have bipolar disorder, skip this unless directed by your health care provider, because it may worsen the symptoms of mania
- if you are on SSRIs or other serotonergic drugs, it may interact with those
- if you are immunocompromised, you might want to skip it can increase the risk of P. carinii growth in such cases
As always, do speak with your doctor/pharmacist for personalized advice.
Summary
SAMe’s evidence-based qualities seem to stack up as follows:
- Against depression: good
- Against osteoarthritis: weak
- Against liver disease: unknown
As for safety, it has been found quite safe for most people.
Where can I get it?
We don’t sell it, but here is an example product on Amazon, for your convenience
Enjoy!
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Why We Remember – by Dr. Charan Ranganath
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As we get older, forgetfulness can become more of a spectre; the threat that one day it could be less “where did I put my sunglasses?” and more “who is this person claiming to be my spouse?”.
Dr. Ranganath explores in this work the science of memory, from a position of neurobiology, but also in application. How and why we remember, and how and why we forget, and how and why both are important.
There is a practical element to the book too; we read about things that increase our tendency to remember (and things that increase our tendency to forget), and how we can leverage that information to curate our memory in an active, ongoing basis.
The style of the book is quite casual in tone for such a serious topic, but there’s plenty of hard science too; indeed there are 74 pages of bibliography cited.
Bottom line: while filled with a lot of science, this is also a very human book, and a helpful guide to building and preserving our memory.
Click here to check out “Why We Remember”, and learn how to hold on to what matters the most!
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Demystifying Cholesterol
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All About Cholesterol
When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.
A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.
A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”
You can read more about that here:
Statins: His & Hers? ← we highly recommend reading this, especially if you are a woman and/or considering/taking statins. To be clear, we’re not saying “don’t take statins!”, because they might be the right medical choice for you and we’re not your doctors. But we are saying: here’s something to at least know about and consider.
Beyond HDL & LDL
There is also VLDL cholesterol, which as you might have guessed, stands for “very low-density lipoprotein”. It has a high, unhealthy triglyceride content, and it increases atherosclerotic plaque. In other words, it hardens your arteries more quickly.
The term “hardening the arteries” is an insufficient descriptor of what’s happening though, because while yes it is hardening the arteries, it’s also narrowing them. Because minerals and detritus passing through in the blood (the latter sounds bad, but there is supposed to be detritus passing through in the blood; it’s got to get out of the body somehow, and it’s off to get filtered and excreted) get stuck in the cholesterol (which itself is a waxy substance, by the way) and before you know it, those minerals and other things have become a solid part of the interior of your artery wall, like a little plastering team came and slapped plaster on the inside of the walls, then when it hardened, slapped more plaster on, and so on. Macrophages (normally the body’s best interior clean-up team) can’t eat things much bigger than themselves, so that means they can’t tackle the build-up of plaque.
Impact on the heart
Narrower less flexible arteries means very poor circulation, which means that organs can start having problems, which obviously includes your heart itself as it is not only having to do a harder job to keep the blood circulating through the narrower blood vessels, but also, it is not immune to also being starved of oxygen and nutrients along with the rest of the body when the circulation isn’t good enough. It’s a catch 22.
What if LDL is low and someone is getting heart disease anyway?
That’s often a case of apolipoprotein B, and unlike lipoprotein A, which is bound to LDL so usually* isn’t a problem if LDL is in “safe” ranges, Apo-B can more often cause problems even when LDL is low. Neither of these are tested for in most standard cholesterol tests by the way, so you might have to ask for them.
*Some people, around 1 in 20 people, have hereditary extra risk factors for this.
What to do about it?
Well, get those lipids tests! Including asking for the LpA and Apo-B tests, especially if you have a history of heart disease in your family, or otherwise know you have a genetic risk factor.
With or without extra genetic risks, it’s good to get lipids tests done annually from 40 onwards (earlier, if you have extra risk factors).
See also: Understanding your cholesterol numbers
Wondering whether you have an increased genetic risk or not?
Genetic Testing: Health Benefits & Methods ← we think this is worth doing; it’s a “one-off test tells many useful things”. Usually done from a saliva sample, but some companies arrange a blood draw instead. Cost is usually quite affordable; do shop around, though.
Additionally, talk to your pharmacist to check whether any of your meds have contraindications or interactions you should be aware of in this regard. Pharmacists usually know contraindications/interactions stuff better than doctors, and/but unlike doctors, they don’t have social pressure on them to know everything, which means that if they’re not sure, instead of just guessing and reassuring you in a confident voice, they’ll actually check.
Lastly, shocking nobody, all the usual lifestyle medicine advice applies here, especially get plenty of moderate exercise and eat a good diet, preferably mostly if not entirely plant-based, and go easy on the saturated fat.
Note: while a vegan diet contains zero dietary cholesterol (because plants don’t make it), vegans can still get unhealthy blood lipid levels, because we are animals and—like most animals—our body is perfectly capable of making its own cholesterol (indeed, we do need some cholesterol to function), and it can make its own in the wrong balance, if for example we go too heavy on certain kinds of (yes, even some plant-based) saturated fat.
Read more: Can Saturated Fats Be Healthy? ← see for example how palm oil and coconut oil are both plant-based, and both high in saturated fat, but palm oil’s is heart-unhealthy on balance, while coconut oil’s is heart-healthy on balance (in moderation).
Want to know more about your personal risk?
Try the American College of Cardiology’s ASCVD risk estimator (it’s free)
Take care!
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Altered Traits – by Dr. Daniel Goleman & Dr. Richard Davidson
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We know that meditation helps people to relax, but what more than that?This book explores the available science.
We say “explore the available science”, but it’d be remiss of us not to note that the authors have also expanded the available science, conducting research in their own lab.
From stress tests and EEGs to attention tests and fMRIs, this book looks at the hard science of what different kinds of meditation do to the brain. Not just in terms of brain state, either, but gradual cumulative anatomical changes, too. Powerful stuff!
The style is very pop-science in presentation, easily comprehensible to all. Be aware though that this is an “if this, then that” book of science, not a how-to manual. If you want to learn to meditate, this isn’t the book for that.
Bottom line: if you’d like to understand more about how different kinds of meditation affect the brain differently, this is the book for you.
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Once-A-Week Strategy to Stop Procrastination – by Brad Meir
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Procrastination is perhaps the most frustrating bad habit to kick!
We know we should do the things. We know why we should do the things. We want to do the things. We’re afraid of what will happen if we don’t do the things. And then we… don’t do the things? What is going on?!
Brad Meir has answers, and—what a relief—solutions. But enough about him, because first he wants to focus a little on you:
Why do you procrastinate? No, you’re probably not “just lazy”, and he’ll guide you through figuring out what it is that makes you procrastinate. There’s an exploration of various emotions here, as well as working out: what type of procrastinator are you?
Then, per what you figured out with his guidance, exercises, and tests, it’s time for an action plan.
But, importantly: one you can actually do, because it won’t fall foul of the problems you’ve been encountering so far. The exact mechanism you’ll use may vary a bit based on you, but some tools here are good for everyone—as well as an outline of the mistakes you could easily make, and how to avoid falling into those traps. And, last but very definitely not least, his “once a week plan”, per the title.
All in all, a highly recommendable and potentially life-changing book.
Grab Your Copy of “Once-A-Week Strategy to Stop Procrastination” NOW (don’t put it off!)
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