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ADHD

Utilizing Neuroplasticity to Manage ADHD

Neuroplasticity could help reduce a teen's dependency on ADHD medication.

Key points

  • ADHD stimulants may raise heart risks long-term, but overall cardiomyopathy risk remains low.
  • Neuroplasticity-based cognitive interventions could help reduce ADHD medication dependency over time.
  • Cognitive training improves brain functions related to attention, impulse control, and working memory.

Attention-deficit/hyperactivity disorder (ADHD) has long been treated with stimulant medications like Adderall and Ritalin. These medications have been effective in improving focus and managing impulsivity for many people. However, recent findings suggest that prolonged use of stimulant medications may carry health risks, particularly concerning the heart. A study presented at the American College of Cardiology’s Annual Scientific Session found that young adults prescribed stimulants were at a higher risk of developing cardiomyopathy, a condition characterized by a weakening of the heart muscle. While the overall risk remains low, the findings underscore the need to explore alternative treatment options that can reduce dependency on medication, especially for long-term management of ADHD.

Neuroplasticity—the brain's ability to reorganize itself by forming new neural connections—offers an exciting opportunity to help manage ADHD through non-pharmacological interventions. By harnessing neuroplasticity through cognitive training and other behavioral therapies, individuals could improve attention, self-regulation, and impulse control, potentially reducing their reliance on stimulant medications. In this post, we will explore how neuroplasticity-based interventions could be used to manage ADHD and why it may be important to consider these approaches in light of the recent concerns about stimulant medications.

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A teenage student taking pills.
Source: Snizhana/Adobe Stock

Understanding the Risks of Long-Term Stimulant Use

The recent study presented at the American College of Cardiology’s Annual Scientific Session revealed that people prescribed stimulant medications for ADHD were significantly more likely to develop cardiomyopathy compared to those who were not prescribed stimulants. According to the study, individuals on stimulants were 17% more likely to develop cardiomyopathy after one year and 57% more likely after eight years. Cardiomyopathy, a condition that causes the heart muscle to weaken and pump less effectively, can result in fatigue and limited physical ability over time (Napoli, 2024).

While the overall prevalence of cardiomyopathy remains relatively low—affecting less than 1% of individuals prescribed stimulants—the findings raise important questions about the long-term safety of these medications. The study’s lead author, Pauline Gerard, emphasized that while the risk is small, clinicians should be aware of it when prescribing ADHD medications. Given that many patients begin taking stimulant medications in childhood and continue using them into adulthood, the study calls attention to the importance of considering non-pharmacological alternatives that can help reduce the need for long-term stimulant use.

Neuroplasticity as a Foundation for Cognitive Interventions

Neuroplasticity refers to the brain's ability to adapt and change throughout life. This adaptability is particularly important in managing ADHD, a condition often associated with cognitive deficits in attention, working memory, and impulse control. Cognitive interventions that leverage neuroplasticity have shown promise in improving these cognitive functions, offering a potential path toward reducing medication reliance.

A study by Pappas and Drigas (2019) explored how computerized cognitive training can enhance neuroplasticity and cognitive functioning in individuals with ADHD. Their research highlighted how targeted cognitive exercises designed to stimulate specific neural circuits can improve attention and working memory. These exercises encourage the brain to form new connections in areas related to executive function, which are often underdeveloped in individuals with ADHD. This cognitive training not only improves immediate performance on attention-related tasks but also promotes long-term structural changes in the brain that lead to lasting improvements in attention and impulse control.

By enhancing neuroplasticity through such cognitive training, individuals with ADHD can experience improvements in the same areas of functioning typically targeted by stimulant medications. Over time, the need for medication may decrease as these neural changes become more permanent, allowing individuals to better manage their symptoms without relying on external pharmacological support.

Cognitive Neuroscience and ADHD

The potential of neuroplasticity-based interventions for ADHD is further supported by research in cognitive neuroscience. Katya Rubia, a leading researcher in the field, has explored the neural underpinnings of ADHD and the brain regions affected by the disorder. Rubia's work emphasizes that ADHD is associated with functional deficits in areas such as the prefrontal cortex, which is responsible for attention, decision-making, and impulse control (Rubia, 2018).

Rubia’s research also highlights how cognitive training and behavioral therapies can stimulate activity in these brain regions, leading to neuroplastic changes that improve ADHD symptoms. By targeting the specific neural circuits that are underactive in individuals with ADHD, cognitive interventions can help restore normal brain function. This approach not only offers a non-invasive alternative to medication but also addresses the root causes of ADHD, rather than just masking the symptoms.

One of the key advantages of neuroplasticity-based cognitive interventions is that they can provide long-term benefits. While stimulant medications work by temporarily increasing the levels of neurotransmitters such as dopamine and norepinephrine in the brain, cognitive interventions foster structural changes that have lasting effects. For example, computerized cognitive training programs have been shown to improve neural connectivity in the prefrontal cortex, leading to better regulation of attention and impulse control even after the training has ended (Pappas & Drigas, 2019).

Reducing Medication Dependency With Cognitive Interventions

Given the potential risks associated with long-term stimulant use, such as the increased likelihood of cardiomyopathy, it is crucial to explore alternative treatments for ADHD. Neuroplasticity-based cognitive interventions offer a viable solution by helping individuals retrain their brains to manage symptoms more effectively. These interventions can be used in conjunction with or as an alternative to stimulant medications, depending on the individual’s needs.

While medications may provide quick relief from ADHD symptoms, cognitive interventions have the advantage of promoting long-term changes in brain structure and function. This makes them particularly appealing for individuals who are concerned about the long-term side effects of medication or who wish to reduce their dependence on pharmacological treatments.

Moreover, cognitive interventions are highly customizable and can be tailored to each individual’s unique cognitive profile. For example, individuals who struggle with working memory can benefit from targeted training exercises designed to enhance their ability to hold and manipulate information. Similarly, those who experience difficulties with impulse control can engage in cognitive exercises that strengthen their ability to delay gratification and make more thoughtful decisions.

Conclusion

The recent findings on the potential heart risks associated with long-term stimulant use for ADHD highlight the importance of exploring alternative treatments. Neuroplasticity-based cognitive interventions offer a promising solution by helping individuals retrain their brains to manage symptoms more effectively. Research by Pappas and Drigas (2019) and Rubia (2018) supports the idea that cognitive training can lead to lasting improvements in attention, working memory, and impulse control by promoting structural changes in the brain.

While stimulant medications may still play a role in managing ADHD, especially in the short term, cognitive interventions may provide a viable pathway toward reducing medication dependency. By harnessing the brain’s natural ability to adapt and change, individuals with ADHD can develop the skills they need to manage their symptoms more effectively and improve their long-term cognitive functioning.

References

Napoli, N. (2024, March 27). ADHD stimulants may increase risk of heart damage in young adults: While likelihood of cardiomyopathy grows over time, the overall risk remains low. American College of Cardiology. https://www.acc.org

Pappas, M. A., & Drigas, A. S. (2019). Computerized training for neuroplasticity and cognitive improvement. International Journal of Engineering Pedagogy (iJEP), 9(4), 50-62. https://doi.org/10.3991/ijep.v9i4.10285

Rubia, K. (2018). Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation. Frontiers in Human Neuroscience, 12, 100. https://doi.org/10.3389/fnhum.2018.00100

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