How to cope with ADHD? Whether it’s for you or your child, therapy and meds may work well. But we can’t ignore complementary interventions. For instance, brown noise.
’If you are drowsy (low arousal) or panicked (high arousal), then your attention and focus will be poor. Arousal has to be just right to maximize performance.’
Hot on the trail of new and helpful subject matter, a recent Psychology Today article grabbed my attention.
”Brown Noise and ADHD: What’s the Scoop on the Latest Buzz?”, was written by Joel T. Nigg, PhD. A clinical psychologist, researcher, and author, Dr. Nigg is a world-renowned expert on attention-deficit/hyperactivity disorder (ADHD).
Let’s have a look at his take on the impact of brown noise on ADHD.
By the way, I’m thinking you know it affects adults as well as children.
What is brown noise?
Dr. Nigg begins by noting the recent buzz over reports touting the benefits of brown noise for ADHD.
Okay, but what is it?
Interesting: “brown” has nothing to do with color. Brown noise is the sound created by Brownian motion, discovered by 19th century Scottish botanist Robert Brown.
It’s also referred to as Brownian noise and red noise.
According to Nigg, brown noise is full-spectrum, meaning it contains all frequencies in equal measure across the spectrum of audible sound.
In that regard, it’s similar to white noise, but the sound is lower and richer.
Brown noise bennies
It’s said that brown noise facilitates a calm and focused mental state for tasks like studying and writing. And it’s believed to induce relaxation because of its fit with the brain at rest.
For anxiety disorder sufferers – frequently on the lookout for threats – brown noise may support calming, sleep, and concentration in the midst of all the external and internal alarm hubbub.
And research has shown that brown noise can also soothe ringing in the ears, even to the extreme of tinnitus.
Wanna’ hear it? Here’s an hours’ worth from Arianna Elizabeth’s YouTube channel, Bright & Salted Yoga…
ADHD and brown noise: The science
We’re going to review some important and interesting information, so let’s handle a few definitions first…
Cortical: having to do with the brain’s cortex – the thin gray matter outer layer of the brain responsible for intelligence, personality, planning and organizing, processing sensory input, and more.
Arousal: the state of physiological activation or cortical responsiveness associated with sensory stimulation.
Attention: a state in which cognitive resources are focused on certain aspects of the environment rather than others, and the central nervous system is in a state of readiness to respond to stimuli.
Yerkes-Dodson law: performance increases with physiological or mental arousal, but only to a point. When levels of arousal become too high, performance decreases.
Optimal arousal theory
Okay, among the scientific theories behind why brown noise may help with ADHD, Dr. Nigg submits that the optimal arousal theory is the only one that’s ADHD-specific.
He explains that the notion of optimal cortical arousal for attention and performance dates back to the Yerkes-Dodson law in 1908.
The bottom-line: optimal performance depends on optimal arousal. Nigg simplifies…
If you are drowsy (low arousal) or panicked (high arousal), then your attention and focus will be poor. Arousal has to be ‘just right’ to maximize performance.
Makes sense, right?
Individual variation in stimulation sensitivity
It also makes sense that the optimal level of arousal isn’t a universal constant – it can’t be the same for everyone.
That means it’s about the nature of the task and individual variation in stimulation sensitivity.
There was a time when psychologists ran with the idea that individual differences in arousal dependency were attributable to the personality types extrovert and introvert.
Though it didn’t stick, it led to a vigilance regulation model to conform to knowledge of the neural bases of attention and alertness.
As a result, Nigg points out, a large body of electrophysiological work has suggested that many children with ADHD are characterized by low cortical arousal.
And when it’s addressed, their attention and behavior come into focus.
The frontal cortex
Frontal lobe: the approx 3 mm outer layer is the frontal cortex
The scene of the action is the brain’s frontal cortex. Dr. Nigg suggests we think of it as the driver of a car. When it’s tired, the car weaves on the road.
Keep in mind, when the frontal cortex is under-active, the entire brain isn’t well-regulated. There’s just too much chaos.
But when it “wakes up,” it can suppress the rest of the brain, allowing maximum attention to the task at hand.
Over-arousal
On the other side of the coin, Nigg says it appears a subset of children (and adults?) with ADHD are over-aroused. They would be expected to have their attention worsen with brown noise.
A few small studies have suggested children with ADHD may benefit from white noise. It could be an option for the over-aroused.
Dr. Nigg’s work suggests the arousal model works for a particular subset of children with ADHD who can be phenotypically (by observable traits, such as height, eye color, and blood type) characterized.
You can see why this type of clinical differentiation helps resolve discrepancies as to whether or not there is optimal arousal.
ADHD and brown noise: The doc’s final thoughts
Dr. Nigg acknowledges that actual studies of the effects of brown (and white) noise on ADHD are few and use small samples.
As a result, science can’t confirm if brown noise is a placebo effect or if it has a true attentional benefit.
That said, Nigg states that as long as ear damage doesn’t occur from the volume being too loud, the risks are low. So if it seems to help, he believes there’s little harm in using it.
Dr. Nigg looks forward to larger, more systematic studies of brown and white noise in ADHD, as well as individual differences studies regarding who benefits and who doesn’t.
The power of sound
How to cope with ADHD? We know the primary players, but we can’t turn our backs on complementary interventions – like brown noise.
Never downplay the power of sound when it comes to regulating the brain.
You’re easily distracted, can’t sit still, and you’re misplacing things. You’re sure it isn’t depression, bipolarity, or dementia. Fact is, you’re beginning to wonder if it’s ADHD. “But it can’t be, I’m an adult.” Actually, it’s possible…
…there’s growing evidence that ADHD symptoms can continue into adulthood. More than that, it seems ADHD symptoms may emerge for the first time in early adulthood.
Came upon an interesting article in Psychiatric Times I just had to share with you. “Adult Attention-deficit/Hyperactivity Disorder (aADHD)” was written by Rajesh R. Tampi, MD, Deena J. Tampi, MSN, and Manzoor Elahi, MD.
Discussing aADHD is well worth our time because it can look a lot like a mood or anxiety disorder. And when it comes to addressing our misery index, considering all options is important – especially one we may not know exists.
Tons of information in the Psychiatric Times piece to summarize. Let’s see what we can get to.
What is adult ADHD?
As you may know, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes, and includes diagnostic criteria for, three types of attention-deficit/hyperactivity disorder (ADHD): combined presentation, predominately hyperactive/impulsive, and predominately inattentive.
ADHD has always been considered a child and adolescent disorder; however, there’s growing evidence that ADHD symptoms can continue into adulthood. More than that, it seems ADHD symptoms may emerge for the first time in early adulthood.
For us to get our best view of ADHD I think it’s wise to turn to the DSM-5. What’s interesting is, it doesn’t assign a diagnostic code to aADHD, but professionals often use DSM-5 ADHD criteria to diagnose it.
Okay, our first step is to examine that criteria…
Inattention
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
Is often easily distracted
Is often forgetful in daily activities
Hyperactivity/Impulsivity
Often fidgets with or taps hands or feet, or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Is often “on the go” acting as if “driven by a motor”
Often talks excessively
Often blurts out an answer before a question has been completed
Often has trouble waiting his/her turn
Often interrupts or intrudes on others (e.g., butts into conversations or games)
“Can’t slow down. I gotta’ be on the go.”
To meet criteria for aADHD, an individual needs to have five or more of the nine symptoms of inattention and/or hyperactivity/impulsivity. These symptoms need to have persisted for at least six months.
Also, several inattentive or hyperactivity/impulsivity symptoms should have been present prior to the age of 12. These symptoms should be present in two or more settings, including home, school, or work. But let’s not forget about ADHD presenting for the first time in adulthood. Finally, there should be clear impairment with/or reduced quality of social, academic, or occupational functioning.
Yet more important information…
The prevalence of ADHD in childhood is 4-7%. It’s thought that symptoms may persist into adulthood in 15-65% of cases. The prevalence rate of aADHD is 2.5%.
Individuals with aADHD tend to have poor self-esteem and reduced quality of interpersonal and professional relationships. For instance, they’re twice as likely to be divorced.
Individuals with aADHD have greater rates of traffic violations, motor vehicle accidents, and ER and hospital admissions.
Some 80% of aADHD cases present with at least one other psychiatric disorder during their lifetime. Significant co-occurrence exists with the mood and anxiety disorders, as well as the substance use disorders.
aADHD tends to run in families.
How is adult ADHD treated?
Given the significant co-occurrence with other psychiatric disorders, those disorders, ideally, ought to be diagnosed and treated first. That way, the best treatment can be chosen for the core aADHD symptoms.
Okay, meds are the first line intervention for aADHD. Approved for use are stimulants, such as amphetamines – amphetamine and salts (Dyanavel, Adderall, Mydayis, Adzenys), dextroamphetamine (Dexedrine, ProCentra, Zenzedi), and lisdexamfetamine (Vyvanse) – and methylphenidate – methylphenidate (Ritalin, Concerta, etc.) and dexmethylphenidate (Focalin). Also approved is the non-stimulant atomoxetine (Strattera). Prescribed off-label are other meds, such as modafinil (Provigil), guanfacine (Intuniv), venlafaxine (Effexor), bupropion (Wellbutrin), and desipramine (Norpramin).
The amphetamines and methylphenidate have been found equally effective in the treatment of aADHD, with approximately 70% of individuals reporting immediate improvement in core symptoms within one hour after administration of the drug. But it’s important to mention that side effects and contraindications need to be considered. Also, stimulant meds are classified as Schedule II substances, as there’s abuse potential – especially among individuals with a substance use disorder.
And then there’s therapy. Published studies indicate cognitive behavioral therapy (CBT) is the most effective psychological treatment for aADHD. That includes the comorbid symptoms of anxiety and depression.
My experience says meds alone is a dicey proposition for any psych situation. Adding therapy is always a wise choice.
Time to move-on
Even though there’s so much more to review we’re going to have to move-on. But I’ll tell you what – you can dig-in to all the information you’d like by reading the original article on Psychiatric Times.
So adult attention-deficit/hyperactivity disorder (aADHD): lots of common ground with the mood and anxiety disorders. And that’s why we need to be aware of it.
Diabetes, hypothyroidism, anemia: if the lab results say you have it, you have it. The emotional and mental disorders? Uh, no. For instance, the symptoms, and their overlap, of ADHD, bipolar disorder, and borderline personality disorder. I mean, which is it?
And for an accurate differential diagnosis (distinguishing a disorder from others that present with similar clinical features), Marangoni recommends the clinician rely upon – you guessed it – signs and symptoms, age of onset…
What would any of us give to have our bipolar disorder, depression, or generalized anxiety diagnosis based upon lab work or imaging? Of course, interventions remain dicey, but at least we’d have a lock on what’s ailing us.
Now, I believe scientists are working on it; however, diagnosing the emotional and mental disorders can be a signs and symptoms, age of onset, family history, etc. guessing game.
And that’s a dark veil over an already troubling set of circumstances.
In an effort to resolve some confusion in one particular neck of the diagnostic woods, I’m going to summarize a fairly recent article from Psychiatric Times. “ADHD, Bipolar Disorder, or Borderline Personality Disorder” was written by Italian psychiatrist Ciro Marangoni. I’ll slip you a link at the end.
“Significance For Practicing Psychiatrists”
Dr. Marangoni begins his piece with a can’t miss yellow box with the heading, SIGNIFICANCE FOR PRACTICING PSYCHIATRISTS. In it, Marangoni emphasizes the high prevalence of ADHD, bipolar disorder (BD), and borderline personality disorder (BPD) in juveniles and young adults.
He goes on to say that comorbidity (coexistence) between the three is frequent, which impairs treatment response and recovery. And for an accurate differential diagnosis (distinguishing a disorder from others that present with similar clinical features), Marangoni recommends the clinician rely upon – you guessed it – signs and symptoms, age of onset, family psychiatric history, etc. – as well as locomotor activity and sleep pattern.
Okay, let’s get our business handled by cherry-picking Dr. Marangoni’s discussion of ADHD, BD, and BPD…
Attention-Deficit/Hyperactivity Disorder
Generally speaking, a diagnosis of ADHD, which persists into adulthood in 50% of cases, is based upon life-interrupting levels of inattention, hyperactivity, and impulsivity. But diagnosing ADHD becomes much more difficult when you toss in lesser known symptoms such as irritability, emotional dysregulation, frequent mood changes, low frustration tolerance, poor self-esteem, and sleep problems.
And keep in mind, hyperactivity is characterized by phenomena such as restlessness, fidgeting, talkativeness, poor inhibition, and engaging in risky behaviors. So, the diagnostic process can become complicated.
Already, can you see the symptom overlaps with what you believe you’d find in BD and BPD?
Now, before we move on to them, here’s an extremely informative and helpful table Dr. Marangoni included in his article. It’s definitely a keeper…
Bipolar Disorder
Dr. Marangoni begins his discussion of BD by noting its episodic nature. He observes that some patients experience chronic, unremitting symptoms, while others may go weeks or months with reduced or no symptoms at all. Thing is, the diagnostic requirement of recurring episodes (manic, hypomanic, major depressive) often results in misdiagnosis of patients with a chronic, non-episodic presentation.
I’m thinking most of us know the symptoms of depression, but that may not be the case for mania and hypomania. In making his point, Marangoni includes euphoric and mixed (manic and depressive) mood states, talkativeness, decreased need for sleep, impulsivity, irritability, hyperactivity, and risky behaviors.
Are you still on board with symptom overlap? Now to BPD…
Borderline Personality Disorder
The good doctor begins his BPD chat by observing that the DSM-5 says a BPD diagnosis shouldn’t be made before age 18. According to him, it’s acceptable if symptoms are clear and persistent.
So what does BPD look like? How ’bout this from Marangoni? It’s a chronic and pervasive pattern of instability in interpersonal relationships, mood, and self-esteem – with significant impulsivity. And then there’s ramped-up risk for self-harm, suicide, feelings of abandonment, anger/rage, and come-and-go stress-induced psychotic symptoms.
Marangoni goes on to emphasize the features of BPD that overlap with ADHD. These include a chronic course, emotional instability, impulsivity, and risk-taking behaviors.
In fact, patients with BPD may experience their own special kind of inattention as part of dissociative states when they’re feeling emotionally stressed. This particularly presents in response to feelings of rejection, failure, and loneliness. By comparison, symptoms of inattention in ADHD are often seen in situations that lack external stimuli (e.g., during boring, routine, or familiar tasks).
When it comes to alleviating stress and tension, those with BPD typically turn to self-injurious behavior. ADHD patients are more likely to regulate their emotions via extreme sports, novelty seeking, sexual activity, and aggression.
Finally, though not in the DSM-5, a combination of BPD and BD is now being recognized – and referred to as borderpolar.
All Set
I long for the day when diagnosing emotional and mental health disorders becomes as routine and reliable as identifying diabetes, hypothyroidism, and anemia. Someday, right?
In the meantime, we have to do the best we can with what we have, and trust that our clinicians stay informed and maintain a sharp eye. And we can help them by sharing specific details about what we’re experiencing.
If you’re dealing with ADHD, bipolar disorder, or borderline personality disorder – or wondering if you are – I hope this information is helpful.
Be sure to take a look at Dr. Marangoni’s article. No way could I squeeze everything into this piece, including his discussion of treatment.
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