Sound Medicine -- February 15, 2003

Hosts Barbara Lewis and Dr. Kathy Miller talk to researchers about:

How behavior influences the brain

ADHD and a new drug treatment

How behavior influences the brain

We usually think of the brain as directing our behavior. But in fact our thoughts and actions -- whether they be learning or social interactions -- affect our brain's function. To discuss the implications of this relationship, we meet Dr. Susan Ball and Dr. William Kronenberger, both associate professors of clinical psychology in the Department of Psychiatry at the IU School of Medicine. They'll speak on this topic Tuesday, Feb. 18, at the IUSM Mini Medical School.

For the past 10 years, researchers have been able to use functional neuro-imaging technologies that allow them to study the brain in action, to actually see how different activities "light up" different parts of the brain. Dr. Ball explains how behaviors can develop and cement neural pathways in the brain. She describes how "behavior therapy" works to teach the brain, and specifically how it works for treating anxiety disorders, often in combination with medication.

In his research on influences of the media, Dr. Kronenberger has been studying adolescents and violent video games. He describes how functional Magnetic Resonance Imaging (fMRI) imaging works and the protocols used for testing kids while playing the games. The results? In aggressive children, playing the violent video game produced less activity in the frontal lobe, the area of the brain that inhibits aggressive, inappropriate behavior. He reports that even non-aggressive children showed the same trend of lower activity in the frontal lobe. Even short exposure to violent video games can increase aggressive behavior, he says. With retraining, however, there can be improvement.

Dr. Ball explains why it is easier to develop a new behavior than change an old one, and she explains how punishment can be ineffective as a learning tool. Although she emphasizes that anyone can learn new behaviors, she and Dr. Kronenberger discuss the special vulnerability of youngsters to experiences and behaviors that influence the brain.

Resources:

Read more about the violent video games study Dr. Kronenberger describes.

For understanding learning principals and behavior therapy, Dr. Ball recommends the book Don't Shoot the Dog, by Karen Pryor. Read excerpts at Amazon.com.

"The effects of media violence on society." (PDF file) Anderson, C.A., & Bushman, B.J. (2002). Science, 295, 2377-2379.

"Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: A meta-analytic review of the scientific literature." Anderson, C.A., & Bushman, B.J. (2001). Psychological Science, 12, 353-359.

"Impact of media on children and adolescents: A 10 year review of the research" By Villani, S. (2001). Journal of the American Academy of Child and Adolescent Psychiatry, 40, 392-401.

ADHD and a new drug treatment

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that appears in childhood and manifests itself inattention, lack of concentration, hyperactivity, distractibility and impulsivity. We talk about ADHD and its treatment with Dr. David Dunn, associate professor of psychiatry at the IU School of Medicine, who treats ADHD in children and adolescents.

Dr. Dunn defines the historical terminology for ADHD as well as its specific symptoms. He says 3 - 5% of school-age children have symptoms of the disorder. Many learn to compensate for the problem, but 20 - 30% need continued therapy as adults. He says many people might see symptoms of ADHD in their children or themselves, but symptoms only become problematic when they seriously interfere with schoolwork and relationships. He advises parents to enlist a child psychologist or psychiatrist to evaluate their child in order to rule out other conditions.

In discussing treatment, he recommends medication and a more structured lifestyle for the child. He also explains how stimulants (counterintuitively) inhibit impulsivity and allow for a longer attention-span. He also recommends techniques for "tapering off" the drug as the child grows older.

Dr. Dunn also talks about a new drug, atomoxetine, sold under the name Straterra. Under strict clinical trials the medication proved very effective, he reports. Although atomoxetine is more similar to an antidepressant than a stimulant, like a stimulant, it works on a neurotransmitter to relieve symptoms. Compared with Ritalin, the most commonly stimulant used to treat ADHD, atomoxetine has fewer side effects, such as loss of appetite and insomnia. In addition, many ADHD patients suffer from secondary conditions -- such as Tourettes Syndrome -- which may benefit from the new drug.

Resources:

ADHD.com is a forum for families. As well as chatroom networking, it offers news, articles, physician directories, and book reviews.

The National Institute of Mental Health site offers an excellent Q&A factsheet on Attention Deficit Hyperactivity Disorder.

The American Psychiatric Association also provides an ADHD factsheet. (PDF file)

Read about the FDA's approval of Straterra in the ADDitude magazine.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

When we have symptoms of vomiting, nausea or diarrhea, we often blame it on something we ate. And rightfully so, with 76 million cases of food-borne illness occurring in the United States every year. Eating food contaminated with bacteria and viruses leads to serious conditions such as food poisoning, Hepatitis A and gastroenteritis. Which of the following foods is LEAST likely to breed bacteria and viruses?

A. Caesar Salad
B. Bread
C. Ice cream
D. Raw sea food

Find out!

Medical mystery — Why do we sneeze?

Some occur quickly in a single instant, and some occur in a series of three, four, five or more. Some sound like stifled coughs, and some sound like a wholehearted cathartic release from the nose. We're talking about sneezing. Sneezes come as reflex actions and almost before we know it, the deed is done. But why do we sneeze in the first place?

Find out!

The National Institute of Mental Health, the Centers for Disease Control, and the Diagnostic & Statistical Manual for Mental Disorders (DSM-IV) offer details about the common symptoms of ADHD.

• Inattention includes behaviors such as not being able to keep one's mind on tasks for more than a few minutes; not paying attention to details or making careless mistakes; trouble organizing activities; trouble listening even when spoken to directly; avoidance of activities that involve a lot of mental effort over a long period of time; forgetfulness of daily activities.
• Hyperactivity accounts for behaviors such as fidgeting with hands or feet or squirming in one's seat; getting up from one's seat when expected to sit; extreme restlessness; excessive talking or movement.
• Impulsivity. People who are overly impulsive are unable to curb their immediate reactions or seem unable to think before acting; often blurt out answers before question is finished; often have trouble waiting for their turn.
• These behaviors must appear early in life, before age 7, and continue for at least 6 months.
• In children, they must be more frequent or more severe than in other children of the same age.
• The behaviors must create a real handicap in at least two areas of the person's life, such as work, school or home.