ADHD: On the Left?

[James Brody]

Not entirely, but...

Research articles can be like tea leaves: you pick through and find patterns. And it seems likely that you do so with your pattern-maker on your right side and accept stuff that lines up with what your left side already believes. Such is true for me in regard to the following remarks from Barbara Geller that discuss atomoxetine (Strattera) and methylphenidate (Ritalin) for ADHD treatment.

My impression has been that atomoxetine often improves moods more than concentration: the little guys are less annoyed by directions and corrections, and perhaps, less annoying to teachers. (Atomoxetine will also, in a few of my small gang, trip off weight loss, sleep disturbance, and aggression: a result I interpret as bipolar disorder.)

1) Geller's conclusions (and my anecdotes) are consistent with Elkhonon Goldberg's notion that the right half of your mind manages novelty and your left works with it to turn novelty into familiarity.

A little history: Russ Barkley's inspiration from the mid- late-'90s was that executive functions (mental behaviors that take charge of other behaviors) arise from mental inhibition and mental rehearsal. Stimulants (most of them) increase sustained attention to task and, therefore, favor development of executive functions. Barkley has been and remains one of my heroes: I think, however, that the notion of "executive function" is about to undergo significant revision. And it may be that stimulants suppress impulsiveness best in situations for which the student already has routines. (Thus, the kids who, when overdosed, frequently sound robotic, exacting, repetitive.)

Barbara Geller concludes from a review of Newcorn et al (2008) that

"Both are more effective than placebo, but the stimulant remains the first-line choice.

"Atomoxetine is the only norepinephrine reuptake inhibitor currently approved in the U.S. for treating ADHD. In a rigorously designed, two-part study, researchers compared atomoxetine with the standard drug methylphenidate (MPH)."

2) I have to wonder if the studies demonstrating effectiveness of atomoxetine for academic work depend on the intake of novel material, particularly in math! (I think I remember such but wouldn't bet my salary on it!)

References
Geller, B. (2008) "Atomoxetine vs. Methylphenidate for ADHD. Journal Watch for Psychiatry. April 14. You can have her remarks free at http://psychiatry.jwatch.org/cgi/con...ull/2008/414/1
Newcorn JH et al. Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: Acute comparison and differential response. Am J Psychiatry 2008 Feb 15; [e-pub ahead of print]. (http://dx.doi.org/10.1176/appi.ajp.2007.05091676)

Left/Right data and stories:
Barkley R. (1997) ADHD and the Nature of Self Control. NY: Guilford.

Goldberg, E. (2001) The Executive Brain: Frontal Lobes and the Civilized Mind. NY: Oxford University Press.
Goldberg, E. (2006) The Wisdom Paradox: How Your Brain Can Grow Stronger As You Grow Older. NY: Gotham. (Start here, read his earlier one later!)

Brody J (2008) Rebellion: Physics to Personal Will. Lincoln, NE: iUniverse. Goldberg's notions of the sync between, and specializations of, the left and right cortex are consistent with Rudy Raff's description of how DNA sequences evolve (duplicate, compartmentalize, vary, and test) and with how Chuck Darwin might have put it: inherit, vary, and test! http://www.rebellionphysicstopersonalwill.blogspot.com/

PS: The bipolar effects from atomoxetine are also consistent with Goldberg's observations and theory! These are GREAT times to be a scientist and storyteller!