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December 27, 2021
According to Dexing Zhang et al., writing in the British Medical Bulletin, "Mindfulness is a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. ... These practices can be formal (e.g. breathing, sitting, walking, body scan) or informal (e.g. mindfulness in everyday life).... Mindfulness is rooted in Buddhist traditions. However, it has become popular in recent years among various secular populations in healthcare, educational, and workplace settings: from pre-schoolchildren to older adults across the world." The two most widely adopted mindfulness-based interventions (MBIs) are mindfulness-based stress reduction and mindfulness-based cognitive therapy (Zhang, 2021).
An Italian research team recently conducted a comprehensive search of the peer-reviewed literature to identify studies exploring the efficacy of mindfulness-based treatments for ADHD. It found 31 studies that qualified for review, ten of which met the criteria for meta-analysis, with a total of 596 participants.
A meta-analysis of seven studies with a combined total of 489 participants found MBIs reduced ADHD symptoms with medium effect size and no sign of publication bias. When split into subgroups with and without active controls - in this case, psychoeducation and skills training groups -the outcomes diverged. In the three studies with non-active controls (187 participants), there was a large reduction in ADHD symptoms. In the four with active controls (302 participants), there was no significant difference.
A meta-analysis of ten studies with 596 participants found MBIs reduced inattention symptoms, with a medium-sized effect. Pooling the five studies without active controls (261 participants) produced a very large reduction in inattention symptoms. Once again, in the five studies with active controls (335 participants), there was no significant difference.
After adjusting for publication bias, a third meta-analysis of nine studies with 563 participants found no significant effect of MBIs hyperactivity symptoms. However, when limited to the five studies with-active controls (261 participants), it found a large reduction in hyperactivity symptoms.
After adjusting for publication bias, the fourth meta-analysis of four studies with a combined 243 participants found no significant improvement in executive function.
After adjusting for publication bias, a fifth meta-analysis combining six studies with 449 participants reported a moderate improvement in mindfulness skills. There was no significant improvement when looking only at the three studies with active controls (262 participants).
The team concluded that MBIs seemed to be effective in treating ADHD, but no more so than psychoeducation and skills training groups.
Yet they cautioned that the use of a waiting list for non-active controls muddies that conclusion: "It could be suggested that any intervention seems to have a significantly higher effect than WL [waiting list]in improving ADHD symptoms." This is a known hazard of using waiting lists as control groups (Cunningham, 2013).
Noting "the low general methodological quality," they stated, "From a clinical standpoint, according to the poor available evidence, we cannot conclude that MBIs are superior to other active [psychological] interventions in ameliorating all the considered outcomes, suggesting a role complementation and not as a replacement of the psychoeducation in the management of patients with ADHD, consistently with some guidelines' recommendations."
Francesco Oliva, Francesca Malandrone, Giulia di Girolamo, Santina Mirabella, Nicoletta Colombi, Sara Carletto, Luca Ostacoli, "The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression," Journal of Affective Disorders(2021), vol. 292,475-486, published online,https://doi.org/10.1016/j.jad.2021.05.068.
Dexing Zhang, Eric K P Lee, Eva C W Mak, C Y Ho, and Samuel S Wong, "Mindfulness-based interventions: an overall review," BritishMedical Bulletin (2021), vol. 138, issue 1, 41-57, published online, https://doi.org/10.1093/bmb/ldab005.
John A Cunningham, KyprosKypri, and Jim McCambridge, "Exploratory randomized controlled trial evaluating the impact of a waiting list control design," BMC Medical Research Methodology (2013), vol. 13, article 150, published online, https://doi.org/10.1186/1471-2288-13-150.
Refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision due to irregular curvature of the eye or lens), are common worldwide. These conditions affect 12%, 5%, and 15% of children, and rise significantly in adults to 26.5%, 31%, and 40%. Additionally, strabismus (misalignment of the eyes) and amblyopia (reduced vision in one eye from uneven image formation, often linked to strabismus) occur globally at rates of 2% and 1.4%, respectively.
Visual impairment can affect children’s concentration in school, and studies suggest a link between eye disorders and ADHD.
To investigate this relationship, two researchers – one based in the US and the other in Israel –carried out a nationwide retrospective cohort study using electronic medical records of all insured individuals aged 5 to 30 who were part of Maccabi Health Services, Israel’s second largest health maintenance organization, between 2010 and 2022.
Of over 1.6 million insured members (2010–2020), inclusion/exclusion criteria and propensity score matching for age and sex were applied, along with a one-year wash-out period between the first eye diagnosis and ADHD diagnosis. In total, 221,707 cases were matched with controls without eye disorders at a 1:2 ratio, resulting in a cohort of 665,121 participants.
Overall, those with any previous eye diagnosis were 40% more likely to have a subsequent ADHD diagnosis. This was slightly higher for females (45%) than for males (35%). It was also slightly higher for children and adolescents (42%) than for adults (37%).
More specifically:
The authors concluded that eye disorders are associated with ADHD. They noted these associations were more marked in females and children and adolescents, although, as noted above, those differences were small. They recommended that primary care providers and neurologists consider risk stratification for early screening, and that ophthalmologists refer high-risk patients for ADHD evaluation.
Acid-suppressive medications, including proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists, are often prescribed during pregnancy to treat heartburn and gastroesophageal reflux disease.
Research shows changes in the gut microbiome can negatively affect neurodevelopment. Since acid-suppressive medications alter gut microbiota, maternal use during pregnancy may impact offspring’s neurodevelopment. Because PPIs and H2 receptor antagonists readily cross the placental barrier, they could potentially influence fetal neurodevelopment.
The link between prenatal exposure to acid-suppressive medications and major neuropsychiatric disorders is not well understood. With the use of these medications during pregnancy rising, it is important to assess their impact on children's long-term neurodevelopment. This study examined whether maternal use of acid-suppressive drugs is associated with increased risk of neuropsychiatric disorders in children, using a large, nationwide birth cohort from South Korea.
South Korea operates a single-payer health insurance system, providing coverage for over 97% of its citizens. The National Health Insurance Service (NHIS) maintains a comprehensive database with sociodemographic details, medical diagnoses, procedures, prescriptions, health examinations, and vital statistics for all insured individuals.
A Korean research team analyzed data from over three million mother-child pairs (2010–2017) to assess the risks of prenatal exposure to acid-suppressing medications. They applied propensity scoring to adjust for maternal age, number of children, medical history, and outpatient visits before pregnancy, to minimize confounding factors. That narrowed the cohort to just over 800,000 pairs, with half in the exposed group.
With these adjustments, prenatal exposure to acid-suppressing medications was associated with 14% greater likelihood of being subsequently diagnosed with ADHD.
Yet, when 151,737 exposed births were compared to the same number of sibling controls, no association was found between prenatal exposure and subsequent ADHD, which suggests unaccounted familial and genetic factors influenced the preceding results.
The Take-Away:
Evidence of these medications negatively affecting pregnancies is mixed, mostly observational, and generally reassuring when these medications are used appropriately. Untreated GERD and gastritis, however, have known risks and associations with the development of various cancers. With no evidence of an association with ADHD (or for that matter any other neuropsychiatric disorder), there is no current evidence-based reason for expectant mothers to discontinue use of acid-suppressing medications.
For years, a persistent concern has shadowed the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD): Does the medication eventually stop working? Patients often report that their symptoms seem to return despite consistent use, leading to "dose escalation" or "medication holidays." A new systematic review from Sam Cortese’s team published in CNS Drugs finally puts these concerns to the test by synthesizing decades of empirical research.
Before diving into the findings, you must understand two often-confused phenomena:
The review analyzed 17 studies covering over 10,000 individuals, and the results provide a much-needed reality check for the clinical community.
The researchers found preliminary evidence that acute tolerance (tachyphylaxis) can occur within a 24-hour window.
The most important finding is that tolerance does not commonly develop to the therapeutic effects of ADHD medication in the long term. In one landmark study following children for up to 10 years, only 2.7% of participants lost their response to methylphenidate without a clear external explanation. Doses, when adjusted for natural body growth, remained remarkably stable over years of treatment.
Consistent with the lack of therapeutic tolerance, the body does not become tolerant to the physical side effects of stimulants. Increases in heart rate and blood pressure typically persist for as long as the medication is taken. This underscores why clinicians must continue monitoring cardiovascular health throughout the entire duration of treatment.
If it’s Not Tolerance, What Is It?
If "tolerance" isn't real, why do some patients feel their medication is failing? The review suggests clinicians look at these alternative explanations:
Why This Matters
These results provide clinicians the confidence to tell patients that their medication is unlikely to "wear out" permanently. Rather than immediately increasing a dose when symptoms flare, the first step should be a "clinical deep dive" into the patient's lifestyle, stress levels, and adherence.
For researchers, the review highlights a major gap: most existing studies are small, dated, or of low quality. There is a dire need for robust, longitudinal studies that track both the brain's response and the patient's environment over several years.
For people with ADHD, while your body might get "used to" the initial "buzz" of a stimulant within hours, its ability to help you focus and manage your life remains remarkably durable over the years.
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