NEUROPLASTICITY

AND ADHD
Connecting with ADHD:
3rd Annual ADHD Symposium
Chesapeake Bay Academy
February 25, 2017

Scott W. Sautter, PhD, FACPN

www.HamptonRoadsNeuropsychology.com
 DISCLOSURES

1) Independent Private Practice.

2) Board Certified Neuropsychologist.
2) Qualified Cogmed Provider.
3) Certified ImPACT Consultant
3) Chair, Table Tennis Charity Foundation.
4) Not an ADHD expert
 LEARNING GOALS
1. Gain an understanding of Neuropsychology.
2. Appreciate the unique contributions of
Neuropsychology to Brain Fitness.
3. Describe neuroplasticity and functional
neuroanatomy of ADHD.
4. Recognize evidence-based interventions
promoting neuroplasticity.
WHAT IS NEUROPSYCHOLOGY?
 DIFFERENTIAL DIAGNOSTICS
AND MONITORING OUTCOME

• Normal function versus dysfunction of cognition.

• Delineate unique strengths and weaknesses
within functional domains for treatment planning.
Monitor changes across time.
• Assess functional outcome of treatments.
HOW IS NEUROPSYCHOLOGY
RELATED TO BRAIN FITNESS?
BRAIN FITNESS AND NEUROPLASTICITY

• Diet, exercise, stress, sleep, mentally

challenging activities and social engagement.

• Resulting brain dynamics vary across

individuals and are modified by genetic
predisposition, environmental influences, life
experiences and age.
 ADHD STATISTICS AND BEHAVIOR
• Preschool onset
• 3-9% incidence, with 3x more males
• 3 Types ADD, ADHD & Combined
• Co-morbidity: lower achievement, LD, subtle cognitive deficits,
conduct disorder, poor social relations, increased anxiety and
depression
• Behavioral disinhibition
• Executive dysfunction (affectively and cognitively)
Behavioral inhibition and attention
Self-regulation, working memory, planning, cognitive flexibility
 NEUROANATOMY OF ADHD

• Frontostriatal Network contributing to the

pathophysiology of ADHD
• Network involves dopaminergic pathways
• Lateral pre-frontal cortex
• Dorsolateal anterior cingulate gyrus
• Caudate and putamen
• Other cortical regions and cerebellum
 NEUROSCIENCE MODEL OF ADHD
• Widespread volume reduction throughout cerebrum and cerebellum.
• Functional imagery showed more diffuse activation compared to
controls during cognitive tasks.
• Reduction in volume
• Total cerebrum volume
• Pre-frontal cortex
• Basal ganglia and striatum
• Dorsal anterior cingulate cortex
• Corpus callosum
• Cerebellum
 NEUROSCIENCE MODEL OF ADHD
• Hypoactivation
• Dorsal anterior cingulate cortex
• Frontal cortex
• Basal ganglia and striatum
• Paradigms used in the fMRI imaging tasks
• Motor inhibition (similar to the Gordon Diagnostic System)
• Interference and attention
• Luria Go No-Go
• Stop-Signal
• Stroop Effect
Brain Fitness Myth Busters
 MYTH BUSTER #1

Genes determine the fate of our brains.

Fact: Lifelong brain plasticity means that

our lifestyles and behaviors play a role in
our brain and therefore our minds
physically evolve.
 MYTH BUSTER #2
Medication is the main hope for cognitive
health and enhancement.

Fact: Non-invasive interventions can have

comparable and more durable benefits, and
are also free of side effects.
 MYTH BUSTER #3
Brain training does not work.

Fact: Brain training, when it meets certain

conditions, has been shown to improve
brain functions in ways that enhance real-
world outcomes.
 CONTRIBUTIONS TO THE FRAMEWORK
OF NEUROPLASTICITY

• Dr. Lambert’s Clinical Neuroscience and

neurobiological homeostasis
• Dr. Antonovski’s Theory of Salutogenesis
• Sir William Osler’s quote on illness
• Sharp Brain’s guide to brain fitness
 NEUROBIOLOGICAL HOMEOSTASIS

• Brain-Body Balance (toward healthy brain fitness)

• Establishing neurobiological homeostasis
• Balance of these systems involves how the body and
brain respond to stress
• Disruption of these internal systems by stress or illness
• Maintaining homeostasis in light of these events
requires adaptation
 BRAIN FITNESS AND NEUROPLASTICITY

• Innovative experimental paradigms can access cortical

plasticity across the lifespan.
• Changes in brain plasticity may prove maladaptive
• Aberrant plasticity may represent an approximate cause of
neurodevelopmental disorders such as ADHD
• However, optimizing activity within and across brain
structures promoting brain health would sustain cognitive
function and well-being.
 BRAIN HEALTH MATTERS

• Disability after a brain insult is the consequence of

neuroplasticity.
• Neurostimulation, including non-invasive brain stimulation
techniques provide an opportunity to capitalize on
modulating plastic brain networks in controlled and
specific manners.
• There is a growing body of evidence supporting this, and
one leader in the field is www.SharpBrains.com.
 BIOPSYCHOSOCIAL MODEL
• Recognition that many health problems have not
only a biological component, but psychological
and social ones as well.

• Prescient 18th Century Physician, Sir William Osler

said it was as important to know the man who has
an illness, as to know the illness that a man has.
 ILLNESS AND HEALTH

• Pathogenesis
• Disease processes
• Refers to negative health

• Salutogenesis
• Latin for health or well-being
• Refers to the processes of positive health
 RELATED TERMS OF SALUTOGENESIS

• Sense of coherence • Social support

• Hardiness • Religion and Faith
• Coping • Happiness
• Optimism • Humor
• Gratitude • Love
NEUROSCIENCE OF BRAIN FITNESS

Neuroplasticity
Enriched and Stimulating
Environments
Challenging Activities
 COMPLIMENTARY FACTORS
AFFECTING NEUROPLASTICITY

• Heart Health Diet

• Quality Sleep Hygiene
• Stress Reduction
• Avoiding toxic substances
• Socialization
• Education
 NEW AND PROMISING TECHNOLOGIES

• Task specific neurofeedback

• Better meditation and mindfulness practice
• Non-invasive cognitive enhancement through
targeted exercises
• Sensorimotor and physiological improvements via
virtual reality
 NEUROSTIMULATION

• Lumosity (cognitive training)

• Headspace (mindfulness)
• BrainHQ (Double Decision, speed of information
processing)
• Cognifit (cognitive training)
• Emotiv (EEG)
• Cogmed (working memory training)
THE KEY TO BRAIN TRAINING

Cognitive Skill
of Working
Memory
Neuroplasticity Neuroplasticity makes
Working Memory training
possible

The brain can physically

change in response to
focused repeated
intensive activity -
training

Improved working memory

generalizes to other
cognitive abilities and
behavior
 COGMED RESEARCH FINDINGS
60+ published articles in peer reviewed journals
70+ research studies currently underway
Improved neuropsychological test performance
Increased frontal lobe activity in the brain
Improved concentration and math skills
Improved reading comprehension

More info and free trial: www.MyCogmed.com

WHY IS CROSS TRAINING YOUR BRAIN IMPORTANT?

Aerobic exercise
Solving challenging mental problems
Stress management
Quality sleep hygiene
Nutritional diet
Social connections and relationships
 AEROBIC EXERCISE
EFFECT ON THE BRAIN

Colcombe, S.J. et al. (2006) Aerobic exercise

training increases brain volume in aging adults.
Journal of Gerontology, Vol 61A (11), 1166-1170.
 BREDESEN (2014) REVERSAL OF COGNITIVE
DECLINE: A NOVEL THERAPEUTIC PROGRAM.
AGING, VOL. 6, NO. 9, 707-717

• Diet, reduce stress, optimize sleep, exercise,

brain stimulation, hormone balance, blood
labs, vitamins, anti-oxidents
 PHYSICAL ACTIVITY AND BRAIN PLASTICITY
JINS 2015 SPECIAL ISSUE

• Basso, J.C. et al. Acute exercise improves prefrontal cortex.

• Reiter, K. et al. Improved cardiorespiratory fitness is associated with increased
cortical thickness in mild cognitive impairment.
• Alosco, M.L. et al. Daily physical activity is associated with subcortical brain
volume and cognition in heart failure.
• Barcelos, N. et al. Executive function improves with cognitive challenge while
exergaming
• Llamas-Velasco, S. et al. Physical activity as protective factor against dementia
 EXERCISE INCREASES SIZE OF HIPPOCAMPUS
AND IMPROVES MEMORY (ERICSON, 2010)

• Ericson et al (2010)
 COGNITIVE TRAINING MAY PROTECT
AGAINST ONSET OF DEMENTIA (NIH, 2016)

• 1. Speed-of-processing training reduced risk in developing cognitive decline.

• 2. Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)
nearly 3K participants randomized in 4 groups 1) memory training, 2)
reasoning training, 3) computerized speed-of-processing training, and 4) a
control group.
• 3) Speed-of-processing training was the only one to show a statistically
significant impact on cognitive decline at 10 years with a 33 percent reduction
in risk in developing dementia during the time of the study.
• 4) First time cognitive training intervention has been shown to protect against
dementia in a large, randomized and controlled design.
 EXERCISE, STRATEGIZE & SOCIALIZE

• What if you could combine known factors in promoting

neuroplasticity into one activity?
• Challenging speed of processing information.
• Mentally challenging task of strategizing and planning.
• Aerobic exercise improving cardiovascular efficiency.
• Balance and eye-hand coordination.
• Socialization and developing relationships.
 WHAT ABOUT PING PONG?
Kwano, Mimura & Kneko (1992) The effect of table
tennis practice on mental ability.
Mori & Sato (1997) The effectiveness of exercise
intervention on brain disease patients: Utilizing
table tennis as a rehabilitation program.
Sautter, et al. (2015). Ping Pong and Well-Being.
Campbell & Sautter (2015). Ping Pong and Math.
 Table Tennis Charity Foundation
Sports and Education Program

Increases concentration and alertness

Stimulates brain function
Develops tactical thinking skills
Develops eye-hand coordination
Provides aerobic exercise
Provides social and recreational interaction
 DR. AMEN’S PRESCRIPTION FOR BRAIN FITNESS
AND OPTIMIZING NEUROPLASTICITY

Reduce stress
Get plenty of sleep
Avoid substances that stress the brain
Take multivitamins
Counteract “internal ANT-eaters”
Regular exercise such as playing Ping Pong
“The Greatest Brain Sport”
 QUESTIONS TO CONSIDER
ABOUT BRAIN TRAINING

• Based on scientific research?

• Measurable claims and benefits?
• Ensures cross-training?
• Is it exercise or entertainment?
• Good fit for me?
 BASED ON SCIENTIFIC RESEARCH?

1. Are there scientists, ideally neuropsychologists, and a

scientific advisory board behind the program?

2. Are there published , peer-reviewed scientific papers

written by those scientists?
 MEASURABLE CLAIMS AND BENEFITS?

3. What are the specific benefits claimed for using this

program?
4. Does the program tell me what part of my brain or which
cognitive skill I am exercising, and is there an independent
assessment to measure my progress?
5. Is it a structured program with guidance on how many
hours per week and days per week to use it?
 ENSURES CROSS-TRAINING?

6. Do the exercises vary and teach me

something new?
 IS IT EXERCISE OR ENTERTAINMENT?

7. Does the program challenge and motivate me, or

does it feel like it would become easy once I
learned it?
 GOOD FIT FOR ME?

8. Does the program fit my personal goals?

9. Does the program fit my lifestyle?

10. Am I ready and willing to do the program, or would it be

too stressful?
 Promote Neuroplasticity by
Cross Training Your Brain:
Play Ping Pong!

Visit us at
www.PingPong.gives
www.HamptonRoadsNeuropsychology.com
www.MyCogmed.com