VOLUME 10, NO.12
NJ ADD/ADHD ADULT NEWSLETTER
ADD ADULT SELF HELP
SUPPORT GROUP
FOR ADD/ADHD ADULTS
AND THEIR SIGNIFICANT
OTHERS
MEETING: THE NEXT MEETING OF THE ADD ADULT SELF
HELP SUPPORT GROUP WILL BE ON DECEMBER 15, 2005 AT 7:30 PM AT MONMOUTH MEDICAL
CENTER, COMMUNITY MEETING ROOM , LONG BRANCH, NJ. GO TO THE MAIN RECEPTION DESK AND GET
DIRECTIONS. THE TOPIC WILL BE: JOIN US FOR SOME LAUGHTER, FRIENDSHIP AND JOY. B.Y.O.T. (BRING YOUR OWN TOPIC). CHRIS WILL FACILITATE THE GROUP. I MAY NOT BE ABLE TO ATTEND.
RESEARCH: Dagan, Y and Ayalon, L. have an article in the 2005, J.Amer.Acad. Child & Adolescent
Psychiatry, 44(12): 1271-1275, entitled: Case
Study: Psychiatric Misdiagnosis of Non-24-Hours Sleep-Wake Schedule Disorder
Resolved by Melatonin. This article may provide us with important information for understanding
and treating ADD. A 14 year old boy had
been having problems with inattention,
irritability, distractibility, impulsivity, and performance problems in school inspite of being intelligent with above average
abilities in verbal comprehension and abstract reasoning. Learning disability testing revealed difficulties with written language and poor visual and
auditory memory. (Seems like a classic ADD
picture...) For several years he had
gotten worse and had been described as introverted, narcissistic, with poverty
of thought, disturbed thinking, anxiety, social isolation, loss of pleasure and
in general had been described as a sleepy, passive
child especially in the mornings. (Now he seems depressed with ADD. Inspite of the ADD
picture, he was not diagnosed with ADD.)
Eventually he was hospitalized
because of the above symptom constellation.
A 24 hour sleep study was ordered, but not the typical one. An Actiwatch was fitted to his wrist for 24
hour monitoring of limb movement. The
device differentiates wakefulness from sleep from the body's perspective (movement). In addition brain melatonin level was assessed via a saliva kit; and oral
temperature (body perspective) was monitored every two hours for a 24 hour period. Melatonin levels were normal and circadian
(24 hour rhythms); but the oral temperature cycle which is normally 180 degrees
out of phase with the Melatonin cycle was disorganized. In addition, the Actiwatch revealed an
abnormal 26 hour rhythm. What this means
is that the child wanted to go to sleep two hours later each night. After one month of 5mg (nightly?) of
Melatonin, the Actiwatch revealed a 24 hour normal entrainment which remained
normal at six months. Oral temperature
was not measured after treatment with Melatonin. The behavioral and psychological changes in
the child after the melatonin treatment and the resultant 24 hour entrainment
and normalization of Actigraph scores were truly
dramatic. With improved brain body synchrony and
normalization of entrainment to the 24 hour rhythm, at the end of the first
semester of school his "report showed excellent results. His parents also reported an improvement in
the patient's relationship with his family and peers."
COMMENTS: This study
raises many important questions. Are we
missing a major problem that may be causing or aggravating ADD? Other studies using actigraph monitoring of
sleep and wakefulness have found correlations between sleep problems and the
following: working memory, school performance, aggression, attention, social
problems etc. (All ADD symptoms...)
Interestingly, one study found no difference in actigraphic monitoring of sleep
and the various subtypes of ADD. It is
very tempting to wonder if a core problem in all ADD is this problem with the brain to body to environment (entrainment)
inconsistency. Melatonin levels were normal;
yet adding the hormone normalized the synchrony...Why? Actigraph monitoring of the 24-hour-sleep wake
pattern is not typically done when patients are sent for a sleep study. Again, are we missing a very important
measure of the differences in the ADD system?
Many ADD clients report difficulty with sleep, particularly with wanting
to go to sleep and with morning sleepiness. These symptoms are found when the
sleep wake schedule is greater than 24 hours.
Actigraph patterns are probably highly
correlated with body temperature and a better measure of circadian rhythms than
many brain
measures of sleep such as sleep architecture.
The 24 hour sleep cycle and the 90 minute rest activity cycle may need
to be a focus of further research regarding ADD. It is very tempting to start our own research
looking at 24 hour body temperature and actigraph scores to assess these core
issues. For some of us regulating our sleep,
and brain to body to environment synchrony, may be more important than we realized. Wishing you a
synchronous holiday season with PEACE!!! Bob
This newsletter is
available free as an email at www.DrLoPresti.com. It is offered to readers only for
informational and educational purposes and does not constitute medical or
psychological advice; always consult your doctor.