GUEST POST: Does Attention (or Inattention) Begin in Our Brains?!
Mary Kathryn Cancilliere is a 4th year clinical psychology graduate student at the University of Rhode Island, and a student in Megan Smith’s graduate Cognition course. Her research interests focus on clinical interventions, including their fidelity and effectiveness when disseminated to community mental health and integrated health care settings; improving child and adolescent treatment engagement and outcomes; and pediatric anxiety disorders.
Learning difficulties - particularly attention deficit hyperactivity disorder (ADHD) - are often remedied by efforts focusing on academic accommodations, identified studying techniques, and sometimes medications. However, research has found that for some people, their physiology may be what needs some tweaking.
ADHD is a brain disorder that contains a combination of difficulties including inattention and/or hyperactivity/restlessness and impulsive behavior (1). It is a common problem that can occur in children and may continue into adulthood. ADHD can interfere with academic and job performance (e.g., the ability to stay focused while reading, pay attention during lectures and meetings, or be on time for important events); impair social, peer, or family relationships; and increase risk-taking behaviors.
While genetic factors are known to be one of the primary causes of ADHD, there are other things that contribute, such as the interactions with environmental and socioeconomic factors (a complicated puzzle!). It has also been indicated that ADHD can be caused by a person’s physiology, namely low iron and low ferritin, which stores iron inside the cells for later use. Over the past few years, research has demonstrated a strong relationship between low iron, low ferritin and ADHD as well as poor cognitive development and/or behavioral problems (2).
In fact, in a study conducted in 2014, Bener and colleagues were one of the first to investigate blood levels of iron, ferritin, vitamin D, magnesium, calcium, and phosphorus, and ADHD with its associated risk factors. The researchers found that children with ADHD had lower levels of iron and lower levels of ferritin than those without ADHD.
Their study looked at 630 children aged 5-18 with ADHD and a control group of 630 non-ADHD children matched on age, gender, and ethnicity. The results indicated that low iron and low ferritin levels are associated with ADHD and therefore must be assessed when a child (or adult) is struggling with academic problems resulting from inattention alone or in combination with hyperactivity/restlessness.
Iron is an important mineral for human neurological functioning and development. Actually, studies have shown that low iron increases the risk of psychiatric disorders, attention deficit hyperactivity disorder, and developmental disorders (3, 4). Surprisingly, low iron is the most common nutritional deficiency in the U.S. (5).
To get the iron we need, we have to consume it in the food we eat, such as red meats, chicken, fish, as well as dark green leafy vegetables including spinach, iron fortified cereals and pastas, and dried fruit such as raisins and prunes (6). Sometimes, however, people need to take iron as a supplement (in the form of a pill) – but iron supplements, especially for children, need to be recommended and monitored by a doctor, because too much iron is poisonous!
Since diet is the safest way to get the iron you need, here is a little more information regarding the two types of iron found in our food – heme and non-heme iron (6).
Heme iron is found in animal products, like meats, poultry, and fish, and is absorbed much more efficiently than non-heme iron. Non-heme iron is found in fortified cereals, whole grains, vegetables, legumes, and some fruits. One thing to try to avoid is eating dairy products at the same time that you consume iron, as eating them together compromises iron absorption. On the other hand, absorption can be increased if you eat your iron-rich foods with foods high in vitamin C (found in oranges or broccoli).
You may be wondering: “How does iron affect my attention? I thought it was just a mineral that assists my red blood cells in carrying oxygen to my muscles and organs?” Well, iron does a lot in our bodies! It plays an important role in the brain, affecting the production of a key neurotransmitter named dopamine. Dopamine is a neurotransmitter that is responsible for our regulation of emotional responses and taking action to achieve specific rewards (and lower levels of dopamine are also associated with symptoms of ADHD).
In addition, low iron/ferritin may be a factor in Restless Legs Syndrome (RLS), a sleep problem often found in people with ADHD. RLS causes an uncomfortable restlessness, tingling, or crawling “I need to move” feeling in the legs, compromising the ability to get to sleep. In 2007, the journal Sleep Medicine reported that low iron and low ferritin in children was associated with RLS and ADHD (7).
So how can you know whether you ADHD, inattention (which may be experienced as “fuzzy brain” or excessive sleepiness) or restlessness are caused by your physiology – particularly low iron and low ferritin? A visit to your primary care provider (PCP) is the first step. Then, a visit to a sleep specialist may be the next step. Regardless, blood labs need to be considered to determine whether there are markedly low iron and low ferritin levels in your blood. Meanwhile, eating a balanced diet and consulting with your doctor can only help your mental and physical health!
References:
(1) Subcommittee on attention-deficit/hyperactivity disorder, steering committee on quality improvement and management. (2012). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128, 1007-1022.
(2) Bener, A., Kamal, M., Bener, H., & Bhugra, D. (2014). Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Annals of Medical and Health Science Research, 4, 291-297.
(3) Chen, M., Su, T., Chen, Y., Hsu, J., Huang, K., Chang, W.,…Bai, Y. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry, 13, 1-8.
(4) Dosman, C., Witmans, M., & Zwaigenbaum, L. (2012). Iron’s role in paediatric restless legs syndrome – a review. Paediatric Child Health, 17, 193-197.
(5) World Health Organization. (2008). Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. Geneva: World Health Organization.
(6) Miller, J. (2013). Iron deficiency anemia: a common and curable disease. Cold Spring Harbor Perspectives in Medicine, 3, 1-13.
(7) Konofal, E., Cortese, S., Marchand, M., Mouren, M.C., Arnulf, I., & Lecendreux, M. (2007). Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children. Sleep Medicine, 8, 711-715.