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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Sprout Your Seeds, Grains, Beans, Etc
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Good Things Come In Small Packages
“Sprouting” grains and seeds—that is, allowing them to germinate and begin to grow—enhances their nutritional qualities, boosting their available vitamins, minerals, amino acids, and even antioxidants.
You may be thinking: surely whatever nutrients are in there, are in there already; how can it be increased?
Well, the grand sweeping miracle of life itself is beyond the scope of what we have room to cover today, but in few words: there are processes that allow plants to transform stuff into other stuff, and that is part of what is happening.
Additionally, in the cases of some nutrients, they were there already, but the sprouting process allows them to become more available to us. Think about the later example of how it’s easier to eat and digest a ripe fruit than an unripe one, and now scale that back to a seed and a sprouted seed.
A third way that sprouting benefits us is by reducing“antinutrients”, such as phytic acid.
Let’s drop a few examples of the “what”, before we press on to the “how”:
- Enhancement of attributes of cereals by germination and fermentation: a review
- Sprouting characteristics and associated changes in nutritional composition of cowpea (Vigna unguiculata)
- Phytic acid, in vitro protein digestibility, dietary fiber, and minerals of pulses as influenced by processing methods
- Effects of germination on the nutritional properties, phenolic profiles, and antioxidant activities of buckwheat
- Effect of several germination treatments on phosphatases activities and degradation of phytate in faba bean (Vicia faba L.) and azuki bean (Vigna angularis L.)
Sounds great! How do we do it?
First, take the seeds, grains, nuts, beans, etc that you’re going to sprout. Fine examples to try for a first sprouting session include:
- Grains: buckwheat, brown rice, quinoa
- Legumes: soy beans, black beans, kidney beans
- Greens: broccoli, mustard greens, radish
- Nuts/seeds: almonds, pumpkin seeds, chia seeds
Note: whatever you use should be as unprocessed as possible to start with:
- On the one hand, you’d be surprised how often “life finds a way” when it comes to sprouting ridiculous choices
- On the other hand, it’s usually easier if you’re not trying to sprout blanched almonds, split lentils, rolled oats, or toasted hulled buckwheat.
Second, you will need clean water, a jar with a lid, muslin cloth or similar, and a rubber band.
Next, take an amount of the plants you’ll be sprouting. Let’s say beans of some kind. Try it with ¼ cup to start with; you can do bigger batches once you’re more confident of your setup and the process.
Rinse and soak them for at least 24 hours. Take care to add more water than it looks like you’ll need, because those beans are thirsty, and sprouting is thirsty work.
Drain, rinse, and put them in a clean glass jar, covering with just the muslin cloth in place of the lid, held in place by the rubber band. No extra water in it this time, and you’re going to be storing the jar upside down (with ventilation underneath, so for example on some sort of wire rack is ideal) in a dark moderately warm place (e.g. 80℉ / 25℃ is often ideal, but it doesn’t have to be exact, you have wiggle-room, and some things will enjoy a few degrees cooler or warmer than that)
Each day, rinse and replace until you see that they are sprouting. When they’re sprouting, they’re ready to eat!
Unless you want to grow a whole plant, in which case, go for it (we recommend looking for a gardening guide in that case).
But watch out!
That 80℉ / 25℃ temperature at which our sprouting seeds, beans, grains etc thrive? There are other things that thrive at that temperature too! Things like:
- E. coli
- Salmonella
- Listeria
…amongst others.
So, some things to keep you safe:
- If it looks or smells bad, throw it out
- If in doubt, throw it out
- Even if it looks perfect, blanch it (by boiling it in water for 30 seconds, before rinsing it in cold water to take it back to a colder temperature) before eating it or refrigerating it for later.
- When you come back to get it from the fridge, see once again points 1 and 2 above.
- Ideally you should enjoy sprouted things within 5 days.
Want to know more about sprouting?
You’ll love this book that we reviewed recently:
The Sprout Book – by Doug Evans
Enjoy!
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Mental Health Courts Can Struggle to Fulfill Decades-Old Promise
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GAINESVILLE, Ga. — In early December, Donald Brown stood nervously in the Hall County Courthouse, concerned he’d be sent back to jail.
The 55-year-old struggles with depression, addiction, and suicidal thoughts. He worried a judge would terminate him from a special diversion program meant to keep people with mental illness from being incarcerated. He was failing to keep up with the program’s onerous work and community service requirements.
“I’m kind of scared. I feel kind of defeated,” Brown said.
Last year, Brown threatened to take his life with a gun and his family called 911 seeking help, he said. The police arrived, and Brown was arrested and charged with a felony of firearm possession.
After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he’d be connected to services and avoid prison time. But if he didn’t complete the program, he’d possibly face incarceration.
“It’s almost like coercion,” Brown said. “‘Here, sign these papers and get out of jail.’ I feel like I could have been dealt with a lot better.”
Advocates, attorneys, clinicians, and researchers said courts such as the one Brown is navigating can struggle to live up to their promise. The diversion programs, they said, are often expensive and resource-intensive, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are booked into U.S. jails each year.
People can feel pressured to take plea deals and enter the courts, seeing the programs as the only route to get care or avoid prison time. The courts are selective, due in part to political pressures on elected judges and prosecutors. Participants must often meet strict requirements that critics say aren’t treatment-focused, such as regular hearings and drug screenings.
And there is a lack of conclusive evidence on whether the courts help participants long-term. Some legal experts, like Lea Johnston, a professor of law at the University of Florida, worry the programs distract from more meaningful investments in mental health resources.
Jails and prisons are not the place for individuals with mental disorders, she said. “But I’m also not sure that mental health court is the solution.”
The country’s first mental health court was established in Broward County, Florida, in 1997, “as a way to promote recovery and mental health wellness and avoid criminalizing mental health problems.” The model was replicated with millions in funding from such federal agencies as the Substance Abuse and Mental Health Services Administration and the Department of Justice.
More than 650 adult and juvenile mental health courts were operational as of 2022, according to the National Treatment Court Resource Center. There’s no set way to run them. Generally, participants receive treatment plans and get linked to services. Judges and mental health clinicians oversee their progress.
Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess longer-term impacts” of the programs “beyond one year after program exit,” said a 2022 policy brief on mental health courts.
The courts work best when paired with investments in services such as clinical treatment, recovery programs, and housing and employment opportunities, said Kristen DeVall, the center’s co-director.
“If all of these other supports aren’t invested in, then it’s kind of a wash,” she said.
The courts should be seen as “one intervention in that larger system,” DeVall said, not “the only resource to serve folks with mental health needs” who get caught up in the criminal justice system.
Resource limitations can also increase the pressures to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help might not feel they have alternatives.
“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized folks,” she said.
Other court skeptics wonder about the larger costs of the programs.
In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found participants were sentenced to longer time under government supervision than if they’d gone through the regular criminal justice system.
“The bigger problem is they’re taking attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.
When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun charges in Queens in May 2021, she thought he would be an ideal candidate for the New York City borough’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health conditions.
She estimated she spent tens of thousands of dollars to prepare Difrancisco’s case for consideration. Meanwhile, her son sat in jail on Rikers Island, where she said he was assaulted multiple times and had to get half a finger amputated after it was caught in a cell door.
In the end, his case was denied diversion into mental health court. Difrancisco, 22, is serving a prison sentence that could be as long as four years and six months.
“There’s no real urgency to help people with mental health struggles,” Vergara said.
Critics worry such high bars to entry can lead the programs to exclude people who could benefit the most. Some courts don’t allow those accused of violent or sexual crimes to participate. Prosecutors and judges can face pressure from constituents that may lead them to block individuals accused of high-profile offenses.
And judges often aren’t trained to make decisions about participants’ care, said Raji Edayathumangalam, senior policy social worker with New York County Defender Services.
“It’s inappropriate,” she said. “We’re all licensed to practice in our different professions for a reason. I can’t show up to do a hernia operation just because I read about it or sat next to a hernia surgeon.”
Mental health courts can be overly focused on requirements such as drug testing, medication compliance, and completing workbook assignments, rather than progress toward recovery and clinical improvement, Edayathumangalam said.
Completing the programs can leave some participants with clean criminal records. But failing to meet a program’s requirements can trigger penalties — including incarceration.
During a recent hearing in the Clayton County Behavioral Health Accountability Court in suburban Atlanta, one woman left the courtroom in tears when Judge Shana Rooks Malone ordered her to report to jail for a seven-day stay for “being dishonest” about whether she was taking court-required medication.
It was her sixth infraction in the program — previous consequences included written assignments and “bench duty,” in which participants must sit and think about their participation in the program.
“I don’t like to incarcerate,” Malone said. “That particular participant has had some challenges. I’m rooting for her. But all the smaller penalties haven’t worked.”
Still, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.
Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Court program, he got sober, started taking medication for anxiety and depression, and built a stable life.
“I didn’t know where to reach out for help,” he said. “I got put in handcuffs, and it saved my life.”
Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and has stayed sober because of HELP Court.
“I’ve learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.
Brown avoided jail that early December day. A hearing to decide his fate could happen in the next few weeks. But even if he’s allowed to remain in the program, Brown said, he’s worried it’s only a matter of time before he falls out of compliance.
“To try to improve myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”
KFF Health News senior correspondent Fred Clasen-Kelly contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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How To Get More Nutrition From The Same Food
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How To Get More Out Of What’s On Your Plate
Where does digestion begin? It’s not the stomach. It’s not even the mouth.
It’s when we see and smell our food; maybe even hear it! “Sell the sizzle, not the steak” has a biological underpinning.
At that point, when we begin to salivate, that’s just one of many ways that our body is preparing itself for what we’re about to receive.
When we grab some ready-meal and wolf it down, we undercut that process. In the case of ready-meals, they often didn’t have much nutritional value, but even the most nutritious food isn’t going to do us nearly as much good if it barely touches the sides on the way down.
We’re not kidding about the importance of that initial stage of our external senses, by the way:
- Food perception primes hepatic endoplasmic reticulum homeostasis via melanocortin-dependent control of mTOR activation
- Olfaction regulates organismal proteostasis and longevity via microRNA-dependent signalling
So, mindful eating is not just something for Instagrammable “what I eat in a day” aesthetic photos, nor is just for monks atop cold mountains. There is actual science here, and a lot of it.
It starts with ingredients
“Eating the rainbow” (no, Skittles do not count) is great health advice for getting a wide variety of micronutrients, but it’s also simply beneficial for our senses, too. Which, as above-linked, makes a difference to digestion and nutrient absorption.
Enough is enough
That phrase always sounds like an expression of frustration, “Enough is enough!”. But, really:
Don’t overcomplicate your cooking, especially if you’re new to this approach. You can add in more complexities later, but for now, figure out what will be “enough”, and let it be enough.
The kitchen flow
Here we’re talking about flow in the Csikszentmihalyi sense of the word. Get “into the swing of things” and enjoy your time in the kitchen. Schedule more time than you need, and take it casually. Listen to your favourite music. Dance while you cook. Taste things as you go.
There are benefits, by the way, not just to our digestion (in being thusly primed and prepared for eating), but also to our cognition:
In The Zone: Flow State and Cognition in Older Adults
Serve
No, not just “put the food on the table”, but serve.
Have a pleasant environment; with sensory pleasures but without too many sensory distractions. Think less “the news on in the background” and more smooth jazz or Mozart or whatever works for you. Use your favourite (small!) plates/bowls, silverware, glasses. Have a candle if you like (unscented!).
Pay attention to presentation on the plate / in the bowl / in any “serve yourself” serving-things. Use a garnish (parsley is great if you want to add a touch of greenery without changing the flavor much). Crack that black pepper at the table. Make any condiments count (less “ketchup bottle” and more “elegant dip”).
Take your time
Say grace if that fits with your religious traditions, and/or take a moment to reflect on gratitude.
In many languages there’s a pre-dinner blessing that most often translates to “good appetite”. This writer is fond of the Norwegian “Velbekommen”, and it means more like “May good come of it for you”, or “May it do you good”.
Then, enjoy the food.
For the most even of blood sugar levels, consider eating fiber, protein/fat, carbs, in that order.
Why? See: 10 Ways To Balance Blood Sugars
Chew adequately and mindfully. Put your fork (or spoon, or chopsticks, or whatever) down between bites. Drink water alongside your meal.
Try to take at least 20 minutes to enjoy your meal, and/but any time you go to reach for another helping, take a moment to check in with yourself with regard to whether you are actually still hungry. If you’re not, and are just eating for pleasure, consider deferring that pleasure by saving the food for later.
At this point, people with partners/family may be thinking “But it won’t be there later! Someone else will eat it!”, and… That’s fine! Be happy for them. You can cook again tomorrow. You prepared delicious wholesome food that your partner/family enjoyed, and that’s always a good thing.
Want to know more about the science of mindful eating?
Check out Harvard’s Dr. Lilian Cheung on Mindful Eating here!
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Kombucha vs Kimchi – Which is Healthier
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Our Verdict
When comparing kombucha to kimchi, we picked the kombucha.
Why?
While both are very respectable gut-healthy fermented products,
• the kombucha contains fermented tea, a little apple cider vinegar, and a little fiber
• the kimchi contains (after the vegetables) 810 mg sodium in that little tin, and despite the vegetables, no fiber.You may reasonably be surprised that they managed to take something that is made of mostly vegetables and ended up with no fiber without juicing it, but they did. Fermented vegetables are great for the healthy bacteria benefits (and are tasty too!), but the osmotic pressure due to the salt destroys the cell walls and thus the fiber.
Thus, we chose the kombucha that does the same job without delivering all that salt.
However! If you are comparing kombucha and kimchi out in the wilds of your local supermarket, do still check individual labels. It’s not uncommon, for example, for stores to sell pre-made kombucha that’s loaded with sugar.
About sugar and kombucha…
Sugar is required to make kombucha, to feed the yeast and helpful bacteria. However, there should be none of that sugar left (or only the tiniest trace amount) in the final product, because the yeast (and friends) consumed and metabolized it.
What some store brands do, however, is add in sugar afterwards, as they believe it improves the taste. This writer cannot imagine how, but that is their rationale in any case. Needless to say, it is not a healthy addition, and specifically, it’s bad for your gut, which (healthwise) is the whole point of drinking kombucha in the first place.
Want some? Here is an example product on Amazon, but feel free to shop around as there are many flavors available!
Read more about gut health: Gut Health 101
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Buckwheat vs Oats – Which is Healthier?
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Our Verdict
When comparing buckwheat to oats, we picked the oats.
Why?
First of all, for any thinking about the health concerns sometimes associated with wheat: buckwheat is not a kind of wheat, nor is it even in the same family; it’s not a grain, but a flowering plant. Buckwheat is to wheat as a lionfish is to lions.
That said, while these are both excellent foods, one of them is so good it makes the other one look bad in comparison:
In terms of macros, oats have more carbs, but also more protein and more fiber.
When it comes to vitamins, a clear winner emerges: oats have more of vitamins B1, B2, B5, B6, and B9, while buckwheat is higher in vitamin K and choline.
In the category of minerals, things are even more pronounced: oats are higher in calcium, iron, magnesium, manganese, phosphorus, potassium, and zinc. On the other hand, buckwheat is higher in selenium.
All in all: as ever, enjoy both, but if you’re picking one, oats cannot be beaten.
Want to learn more?
You might like to read:
The Best Kind Of Fiber For Overall Health?
Take care!
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Seven Steps to Managing Your Memory – by Dr. Andrew Budson & Dr. Maureen O’Connor
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First, what this is not: a “how to improve your memory” book of the kind marketed to students and/or people who want to do memory-themed party tricks.
What this book actually is: exactly what the title and subtitle claim it to be: seven steps to managing your memory: what’s normal, what’s not, and what to do about it.
Drs. Budson & O’Connor cover:
- which memory errors can (and usually do) happen at any age
- how memory changes with normal aging, and
- what kinds of memory problems are not normal.
One thing that sets this book aside from a lot of its genre is that it also covers which kinds of memory loss are reversible—and, where appropriate, what can be undertaken to effect such a reversal.
The authors talk about what things have (and what things haven’t!) been shown to strengthen memory and reduce cognitive decline, and in the worst case scenario, what medications can help against Alzheimer’s disease and other dementias.
The style is halfway between pop-science and a science textbook. The structure of the book, with its headings, subheadings, bullet points, summaries, etc, helps the reader to process and remember the information.
Bottom line: if you’d like to get on top of managing your memory before you forget, then this book is for you.
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