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Quality of Life with Flotation Therapy for a Person Diagnosed with Attention Deficit Disorder, Atypical Autism, PTSD, Anxiety and Depression



The aim of this single-subject study was to report experiences from one and a half years of regular floating as described by a person with neuropsychiatric and mental health disorders. Floating, or Flotation Restricted Environmental Stimula- tion Technique, involves relaxation and sensory deprivation by means of resting in a tank with highly salted and body-tempered water. The subject, a 24-year-old woman diagnosed with attention deficit hyperactivity disorder, atypi- cal autism, post-traumatic stress disorder, anxiety and depression floated regularly for one and a half years. Interviews regarding her experiences were analyzed and the main findings involved a subjective sense of improved quality of life, wellbeing and healthy behavior. There were no negative effects from treatment. Results suggest that floating may have beneficial therapeutic effects on mental health. Further studies that evaluate the efficacy and possible effects of floating with regard to mental health are needed.
Open Journal of Medical Psychology, 2013, 2, 134-138
doi:10.4236/ojmp.2013.23020 Published Online July 2013 (
Quality of Life with Flotation Therapy for a Person
Diagnosed with Attention Deficit Disorder, Atypical
Autism, PTSD, Anxiety and Depression
Anette Kjellgren1*, Hanna Edebol2, Tommy Nordén3, Torsten Norlander4,5
1Department of Psychology, Karlstad University, Karlstad, Sweden
2Nutrition Gut Brain Interactions Research Centre, Örebro University, Örebro, Sweden
3Evidens Research and Development Center, Göteborg, Sweden
4Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
5Evidens Research and Development Center, Göteborg, Sweden
Email: *
Received April 4, 2013; revised May 11, 2013; accepted May 21, 2013
Copyright © 2013 Anette Kjellgren et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The aim of this single-subject study was to report experiences from one and a half years of regular floating as described
by a person with neuropsychiatric and mental health disorders. Floating, or Flotation Restricted Environmental Stimula-
tion Technique, involves relaxation and sensory deprivation by means of resting in a tank with highly salted and
body-tempered water. The subject, a 24-year-old woman diagnosed with attention deficit hyperactivity disorder, atypi-
cal autism, post-traumatic stress disorder, anxiety and depression floated regularly for one and a half years. Interviews
regarding her experiences were analyzed and the main findings involved a subjective sense of improved quality of life,
wellbeing and healthy behavior. There were no negative effects from treatment. Results suggest that floating may have
beneficial therapeutic effects on mental health. Further studies that evaluate the efficacy and possible effects of floating
with regard to mental health are needed.
Keywords: Flotation; Relaxation; Mental Health; Neuropsychiatric Disorders
1. Introduction
The rapid increment of mental disorders among younger
ages calls for new therapeutic approaches to mental
health. Current methods of treatment are not always use-
ful, and may inflict unpleasant side effects and be inef-
fective from a long-time perspective. Conditions of neu-
ropsychiatric and severe mood disorders with additional
psychiatric comorbidity are especially challenging to
treat with conventional methods and the illness is even
likely to escalate from ineffective treatment. For espe-
cially children and young adults with neuropsychiatric
disorders, non-effective treatments are strong predictors
of additional health and mental problems and cumulated,
these disorders may become even more difficult to treat
effectively [1]. For example, simultaneous and unsuc-
cessfully treated autism and Attention Deficit Hyperac-
tivity Disorder (ADHD) constitute a risk-factor for de-
velopment of Post-Traumatic Stress Disorder (PTSD),
substance use disorders, depression, anxiety [2-4], stress,
overweight, sleep disturbances and poor physical health
in general [5-7]. Mental illness and impairment are often
treated with single-target therapy aiming to alleviate iso-
lated dysfunctions and complaints. ADHD first-line treat-
ment involves pharmacological central stimulant therapy
with documented effects on core symptoms but also
negative effects, e.g. headache, nausea and insomnia [8].
Treatment for autistic dysfunctions typically includes
behavioral therapy as well as medication for anxious
tendencies and careful regulation of environmental de-
mands [9]. A common finding is that single core symp-
toms may be effectively treated with medications [10]
but secondary symptoms of both ADHD, autistic and
comorbid disorders also require a more general ap-
proach including sometimes non-traditional therapies for
symptom-relief, healthy life-changes, quality of life and
everyday functioning [8,9]. Alternative treatments are the
subject of a growing number of studies. Iron and magne-
sium supplementation [11], EEG feedback [12] massage,
*Corresponding author.
Copyright © 2013 SciRes. OJMP
relaxation and EMG biofeedback, meditation and vesti-
bular stimulation yield promising pilot study data, essen-
tial fatty acids have not yet demonstrated satisfying re-
sults in clinical controlled trials but interesting case-con-
trol data [13].
In this qualitative single-subject study we investigate
experiences from a therapy known as Flotation-Re-
stricted Environmental Stimulation Technique, i.e., Flo-
tation-REST, or floating, which provides sensory isola-
tion and deep relaxation by means of laying in a tank
with highly salted and body-tempered water. Floating has
shown promising results for e.g. fibromyalgia, muscle
tension pain, whiplash associated disorders as well as on
mental disorders and complaints like stress, burn-out
depression, depression, anxiety and ADHD [14-17]. For
example, a female subject with neuropsychiatric disor-
ders and burn-out depression experienced symptom-
relief, increased well-being, focus, energy, calm and op-
timism after a series of flotation sessions [18].
The aim of this qualitative single-subject study was to
report the experiences from long-term regular flotation
tank therapy made by a 24-year-old female subject with
psychiatric and neuropsychiatric disorders.
2. Methods
2.1. Case Presentation
The respondent was a 24-year-old woman from Sweden.
Her background involved severe social and academic
problems that had started and persisted throughout ele-
mentary school. In high school, she was recommended
for the individual program, i.e., special education meth-
odology, due to bad grades. After two years, she dropped
out of high school in order to live with a man in another
town. He repeatedly abused her and used violence
against her. She managed to leave him and to return to
her hometown. She was depressed and anxious, and suf-
fered from social phobia and easily became anxious in
social situations. She had a strong fear of talking and was
often afraid of saying something wrong and of being
clumsy. After two years of sick-leave she was thoroughly
assessed and diagnosed with Attention Deficit Hyperac-
tivity Disorder predominantly inattentive subtype (DSM-
IV; 314.00) and with atypical autism (DSM-IV; 299:80)
by a neuropsychiatric specialist-team according to the
criterions of the DSM-IV [19]. When she initiated float-
ing, she suffered from PTSD (due to the earlier episode
of assault), high stress load, fatigue, social phobia, anxi-
ety, recurring episodes of depression, muscle tension
pain and general stiffness.
Psychopharmacological treatment included central
stimulants (Concerta, 54 mg), and anxiolytic medication
(Sobril, as needed). She was introduced to pharmacol-
ogical stimulant treatment fourteen weeks before flota-
tion, starting at 18 mg for five weeks, 36 mg for two
weeks and 54 mg for eight weeks. Floating was self-ini-
tiated at the end of the 54 mg period as an attempt to ease
the headache she felt was a side effect from the medicine.
After a few flotation sessions, a self-initiated decrease of
stimulants took place through consultation with her phy-
sician, starting with 36 mg for the first three days, 18 mg
for three more days and then stimulants was completely
put out. She terminated all prescribed drugs at close to
one month after starting with flotation.
At week one, flotation was performed for 3 × 45 min-
utes, at week two and three for 2 × 45 minutes, at week
four to six for 1 × 45 minutes, and week seven and for-
ward included one or two sessions per month. At the time
of the first interview she had performed flotation for one
and half year including approximately 50 sessions in
total. At the one-year follow-up, she had floated ap-
proximately 75 sessions.
2.2. The Interviews
The first interview was conducted at the respondents
flotation centre, it prolonged for 74 minutes and was re-
corded on a mini-disc. The interview was semi-structured
with questions like: how come you started floating, how
do you experience floating, has your life somehow been
affected by floating, has your experience of floating
changed over time? A one-year follow-up was performed
to understand more about the experiences from long-
lasting flotation and handwritten notes were taken. The
respondent was informed that all of the material would
be treated confidentially, that some of the quotations
would be included in the presentation of the study later
on, and that she had the right to terminate the interview
and participating in the study at any time. The study fol-
lowed the ethical standards for research involving Hu-
man subjects according to the Helsinki declaration [20].
Also, a short follow-up interview was performed again
after two additional years.
2.3. The Analysis
The Empirical Psychological Phenomenological (EPP)
method according to Karlsson [21] was used to analyse
the interviews. The EPP-method includes five steps of
processing the material; thoroughly reading the tran-
scribed text in order to get a comprehensive understand-
ing; the text is divided into Meaning Units (MU) based
upon the underlying psychological meaning of the text;
every meaning unit is transformed from spoken language
into abstract language in order to fully recognize the un-
derlying psychological phenomenon of the material; the
transformed MUs are arranged into categories; these
categories are then arranged into clusters of typological
structures (themes). In order to control for reliability of
Copyright © 2013 SciRes. OJMP
the analyses, two of the authors independently sorted
MUs into typological structures according to Norlander
Credibility Test, NCT (e.g. [21]) and the level of match-
ing was found to be very high. Twenty typological struc-
tures, based on a total of 264 MUs, were found during
the analyses and they have been arranged into five gen-
eral themes. Below, these themes are described together
with highlighting quotations (in italics) from the respon-
dent and discussed with regard to its suggested theoreti-
cal and practical implications.
3. Results and Discussion
The first theme involves The time before floating (in-
cluding 52 MU) and contains descriptions of her personal
history, setbacks in life (including a case of assault), be-
ing on sick-leave and how she was assessed for mental
health problems. In social settings, she remained silent
most of the time in fear of saying something wrong or
behaving clumsy. She described how she used to analyse
and reflect upon her thoughts, but could not verbalize
what she perceived as frightening. She also described her
physical pain including stiffness and tension and how she
believed this was the result of the difficult things she had
been through. Furthermore, she felt tired and without
energy, and everything she did was very slow. She was
troubled by frequently recurring depressions and had
been prescribed several medicines and had many side
The second theme Turning point in her life (including
57 MU) summarizes her first encounter with the flota-
tion-REST technique. At that time, she got a long-term-
internship at a company with flotation tanks and since
she had heard that it might alleviate headache, which had
become a problem since the stimulant therapy, she de-
cided to try flotation. Her first floating sessions were not
trouble-free since she had problems with finding a good
position and was able to relax in the new environment.
Her level of stress before entering the tank affected her
experiences of floating but she eventually learned that
the tensions disappeared when she became relaxed. After
three to four times, she began to notice positive effects.
She experienced more energy, positive thoughts, deep
relaxation and became less tense “I became more posi-
tive, had more energy and was no longer as tense”. All
this became a big turning point in her life and about ten
times she experienced even deeper relaxation.
The third theme Experiences in the flotation tank (27
MU) involves experiences during the stay in the tank. A
total and profound relaxation was induced in the tank and
bodily tensions disappeared. This state of relaxation was
appreciated, extended into her everyday life and often
accompanied with joy. It felt as if something “bad” was
lifted away from her body during the profound relaxation
and sometimes she became so relaxed that she fell asleep.
She felt completely safe in the tank and had never felt
like that before, the feeling of safeness helped her to re-
lax I felt so safe, so I could relax”. Relaxation in the
tank induced a “here-and-now” state and the normal
thoughts were stopped or changed. Instead she needed
not to bother about being evaluated or criticized and she
was able to analyse her social phobia and to be herself.
She had a feeling of “being” and described altered time
perception, “[…]but wow, it has already passed 45 min-
utes, I want to be here a little longer because it feels so
The fourth theme Effects due to the flotation tank
treatment (89 MU) comprises the experienced effects of
flotation. Her life became better from floating and it
made her feel healthy “I feel good and it does not get
worse and it just gets better and better… it is hard to
explain… but it has helped me so much”. The relaxation
extends into her everyday life and includes psychological
relaxation as well as relief from earlier painful muscle
tensions. Her quality of sleep is good; she has energy and
no longer problems with fatigue. She describes being
alive, alert and positive, and she no longer feels depres-
sive or bothered with negative feelings “I can do more
and I am more positive”. The problems with lethargy and
dullness are gone and she has the capacity to carry out
many things and to be active. Floating has provided feel-
ings of security, self-confidence, and the ability to handle
setbacksI have a little more confidence and floating is
like an energy boost. I feel like more when I feel better”.
Her social abilities have increased, and she is not silent
or shy anymore. She is no longer afraid of making mis-
takes and about how her behavior might be evaluated.
The respondent no longer needs medications and she is
happy to avoid the side effects that she previously ex-
The last theme Perspectives on the method of flota-
tion-REST (39 MU) summarizes what flotation means
for the respondent personally and her reflections on the
method at large. She was surprised by the effect since she
did not believe floating would affect her in any signifi-
cant way. Her friends and co-workers were also surprised
about the positive effects that they saw and they asked
her what she had done. She describes floating as a non-
demanding process, nothing special is needed in order to
float, and it is just a matter of relaxing and let things
happen. The effects were gradually reduced and she
needed to float regularly for about two times a month,
otherwise the lethargy, negative thoughts and social shy-
ness would return. Floating made her feel like “a new
person” and she came back to life and felt good. She says
there are no side effects and prefer floating in front of the
drugs she used to take. She believes floating has positive
effects for different problems like pain and depression
and therefore hopes it gets more attention as a treatment
Copyright © 2013 SciRes. OJMP
At the follow-up interview 2 additional years later, she
is still free from all medications. She still uses the flota-
tion-tank about once a month as a stress-reducing tech-
nique. As an additional bonus she also had stopped
smoking; she had smoked about 15 cigarettes a day for
the previous last 9 years, and she attributed the stress
reducing effects of the flotation tank as helpful for
smoking cessation. Her last sentence during this fol-
low-up interview was: “floating is the best thing I have
ever tried, no side effects, and it Works!”
From this qualitative single-subject study we learn that
floating was associated with beneficial therapeutic ef-
fects in terms of quality of life, subjective wellbeing and
healthy behavior. The respondent: feel good well like a
new person and so it has made a great difference… it
really has and I really want to continue with this because
I really need it.”
4. Acknowledgements
This project was supported by unrestricted grants from
the County Council (Landstinget) of Värmland, LiV,
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... In the different investigations it was evidenced that the tank is reliable, safe, and that it decreases the frequency, duration and intensity of the symptoms of the different pathologies. [15][16][17][18][19][20][21][22] Thus, studies such as those by Bood; 15 Bood, Sundequist, Kjellgren, Nordström and Norlandejem (2005) and Kjellgren 22 cited by Kjellgren and collaborators,17 indicate that treatments in a flotation ion tank (Flotation-Rest) with relaxation, can generate a multitude of positive effects such as stress reduction, significant reduction in stress-related pain, the increase in optimism and decrease in the degree of depression and anxiety, which are mainly mediated by deep relaxation. 17 This relaxation response is evaluated using neurobiofeedback methods where an electrical device measures intracorporeal variation, allowing precise evaluation of different physiological variables such as brain waves, muscle tone, galvanic response of the skin, temperature, heart rate and respiratory rate, to verify whether this state of relaxation has been triggered. ...
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This study aimed to investigate the cerebral volumetric changes measurable by brain magnetic resonance imaging, as well as the different physiological variables documented through neurobiofeedback equipment, before and after 30 serial sessions of guided meditations in a sensory isolation tank. A pilot test was carried out, with a single subject, and it was concluded that serial sessions of meditations in flotation tanks changed the brain structure, triggered the relaxation response, generating greater physical, psychological and mental well-being for the research participant.
... The second study [26], a pilot trial in 50 participants randomized to either a waitlist control group or 12 sessions of Floatation-REST, observed a significant reduction in symptoms of generalized anxiety in the float group that was maintained at 6-month follow-up. No studies to date have examined the effects of Floatation-REST in posttraumatic stress disorder (PTSD), panic disorder, agoraphobia, social anxiety disorder, or major depressive disorder, and with the exception of a few individual case studies [27,28], there has been no other research investigating the impact of Floatation-REST in patients with clinically diagnosed anxiety, depression, or any other mental health disorder. Anxiety and depression are the two most common mental health disorders, with the proportion of people who will develop a disorder at some point in life (i.e., lifetime morbid risk) estimated to be 42% for anxiety disorders and 30% for major depression [29]. ...
Background: Burnout is a hidden productivity killer in organizations. Finding a solution to efficiently measure and proactively prevent or rehabilitate employees with burnout is a challenge. To meet this unabated demand, companies and caregivers can focus on proactive measures to prevent "Burnout as an Occupational Phenomenon." Objective: We aimed to address effectiveness, reliability, and validity of the empowerment for participation (EFP) batch of assessments to measure burnout risk in relation to the efficacy of web-based interventions using cognitive behavioral therapy (CBT) and floating to improve mental health and well-being. We introduced three risk assessments: risk for burnout, risk of anxiety, and risk for depression. Methods: We used an interventional, empirical, and parallel design using raw EFP psychometric data to measure the effectiveness of web-based therapy to reduce the risk of burnout between a control group and web-based therapy group. A total of 50 participants were selected. The rehabilitation and control groups consisted of 25 normally distributed employees each. The rehabilitation group received therapy, whereas the control group had not yet received any form of therapy. IBM SPSS was used to analyze the data collected, and a repeated measures ANOVA, an analysis of covariance, a discriminant analysis, and a construct validity analysis were used to test for reliability and validity. The group was selected from a list of employees within the My-E-Health ecosystem who showed a moderate or high risk for burnout. All assessments and mixed-method CBT were web-based, and floating was conducted at designated locations. The complete EFP assessment was integrated into a digital ecosystem designed for this purpose and therapy, offering a secure and encrypted ecosystem. Results: There was a statistically significant difference between pre- and postassessment scores for burnout. The reliability of the burnout measure was good (Cronbach α=.858; mean 1.826, SD 3.008; Cohen d=0.607; P<.001) with a high validity of 0.9420. A paired samples 2-tailed test showed a good t score of 4.292 and P<.001, with a good effect size, Cohen d=0.607. Web-based therapy reduced the risk for burnout in participants compared with the control group. Tests of between-subject effects show F=16.964, a significant difference between the control group and the web-based therapy group: P<.001, with movement between the group variables of 0.261 or 26.1% for the dependent variable. Conclusions: This study suggests good reliability and validity of using web-based interventional mixed methods CBT to reduce the risk of burnout. The EFP batch of web-based assessments could reliably identify morbidity risk levels and successfully measure clinical interventions and rehabilitation with consistently reliable results to serve as both a diagnostic and therapeutic tool worthy of major research in the future. Trial registration: NCT05343208;
It is very often reported that 85–90% of driving clues come from vision (Senders et al., 1967; though see also Sivak, 1996). Despite this claim, and many others suggesting the importance and even ‘dominance’ of vision on our daily activities, research in the field of psychology and neurosciences has clearly shown that the large majority of our interactions with the world are actually ‘multisensory’ in nature (e.g., Calvert et al., 2004; see also Ghazanfar & Schroeder, 2006, for a discussion on the multisensory architecture of our brain cortex). Our brain continuously processes information from several sensory sources and integrates them into neural representations that are used to direct our movements and organize more or less complex forms of behaviors. This should not come to a surprise to the average sailor who often experiences the importance of all the senses in their beloved activity. That does not come as a surprise either to those who tried sailing for the very first time, and certainly not to the many visually disabled people who have, at least once, enjoyed sailing activities. Actually, as a sailor and neuroscientist, I would be in trouble to try and choose what ‘the most important sense’ for sailing is.
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This study aimed to investigate long-term effects of the flotation-REST (restricted environmental stimulation technique) 4 months after treatment. Seventy patients, 54 women and 16 men, participated, diagnosed as having stress-related pain. Twenty-six participants had also the diagnosis of burnout depression. Participants were randomly assigned in equal numbers to either a control group or a flotation-REST group and participated in a total of 12 flotation-REST or control sessions. Results indicated that pain areas, stress, anxiety, and depression decreased, whereas sleep quality, optimism, and prolactin increased. Positive effects generally maintained 4 months after treatment, but prolactin returned to initial levels. It was concluded that flotation tank therapy is an effective method for the treatment of stress-related pain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8–15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n = 8) or placebo feedback (n = 6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study. Electronic supplementary material The online version of this article (doi:10.1007/s00702-010-0524-2) contains supplementary material, which is available to authorized users.
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The objective of this qualitative case report was to describe experiences of flotation-Restricted Environmental Stimulation Technique from the perspective of a woman with Attention Deficit Hyperactivity Disorder, Aspergers syndrome and experiences of depression and distress. The respondent is a 36-year-old woman from Sweden, assessed and diagnosed by a neuropsychological multi-professional team in 2006. The 19-session flotation series prolonged during almost one year. The positive development of arousal control, activity regulation, sensory integration and interpretation, cognitive functioning and emotional maturity created experiences of personal independence and quality of life. Flotation-restrictive environmental stimulation technique was experienced as a meaningful treatment. Additional studies of treatment for Attention Deficit Hyperactivity Disorder and comorbid disorders in adults using the flotation-restrictive environmental stimulation technique are strongly encouraged.
This edited text comprehensively describes the multiple ways in which other psychiatric and learning disorders complicate ADHD in both children and adults. More than 30 leading clinician-researchers provide information on ADHD and its full range of comorbidities including anxiety disorders, mood disorders, learning disorders, substance use disorders, sleep disorders, OCD, autism spectrum disorders, oppositionality and aggression, Tourette syndrome and developmental coordination disorder.
Our aim was to gain increased understanding of the effects of sensorimotor therapy on the physical and psychological development of children and young people when using the method Retraining for Balance. The records of 8 children who had completed the program were randomly selected from a cohort of 232 with sensorimotor difficulties and concentration problems. The participants, 7 boys and 1 girl, averaged 9 years of age. The Empirical Phenomenological Psychological method (the EPP-method, Gunmar Karlsson, 1995) was used for this analysis, which resulted in 29 categories which yielded 3 overarching themes: a) the introduction of sensorimotor exercises, b) regression to earlier sensorimotor and psychological behaviors, and c) transformations in which the sensorimotor and psychological skills of the children matured and developed. The themes formed the kinesthetic-vestibular developmental model illustrating how sensorimotor exercises push the therapy process forward while recurrent regressions are followed by positive developmental phases. The results of the study were generalized to the remaining 224 children in the cohort by comparing each individual's records to the kinesthetic-vestibular model.
Previous work has shown that adolescent hyperactivity patients are significantly more likely to smoke than controls. To determine whether this pattern persists in adults, we studied a series of 71 patients (55 males, 16 females; mean age +/- SD: 33.9 +/- 11.4 years) diagnosed with ADHD. Of the males, 23 (42%) were current smokers, 7 (13%) were ex-smokers, and 25 (45%) were never smokers. Comparable figures for males in the general population in 1991, unselected for ADHD, were 28.1%, 29.1%, and 42.1%, respectively. Of the females, 6 (38%) were current smokers, 5 (31%) were ex-smokers, and 5 (31%) had never smoked, as compared with 23.5%, 19.0%, and 57.6%, respectively, in the general population. Quit ratio (percentage of ever-smokers who were ex-smokers) was 29% for ADHD patients, compared with 48.5% in the general population. The discrepancy was accounted for by the males, whose quit ratio was 23%, compared with 51.6% in the general population; the figure for ADHD females (45%) was similar to that in the general population (44.7%). Smokers recalled experiencing a significantly higher number of ADHD symptoms (11.5 +/- 1.7) as children than never smokers (9.9 +/- 2.3; p < .01) and scored significantly higher on several indices of childhood and adult comorbidity. Our findings suggest that ADHD patients overinclude smokers, and that these smokers find it extremely difficult to quit. For ADHD smokers, smoking may have begun as an attempt to manage deficits in attention and concentration, as suggested by greater childhood symptomatology in these patients.
The purpose of this study was to examine the psychiatric comorbidity between children presenting with Post Traumatic Stress Disorder (PTSD) and traumatized children not developing this disorder. One-hundred and seventeen severely maltreated children were examined for evidence of PTSD. Analyses probed for diagnostic relationship, between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised Version (DICA-CR). All children presented before a juvenile/family court due to severe child maltreatment and psychological trauma. These children had been ordered removed from parental custody due to the trauma suffered by the child. For the purposes of analyses, this entire group of maltreated and traumatized children were dichotomized into a PTSD group and a non-PTSD group. Thirty-five percent (41 of 117) of the children met strict DICA criteria for PTSD. The children were examined by means of a structured clinical interview. The Diagnostic Interview for Children and Adolescents, revised version (DICA-Child-R), along with a more general psychiatric interview. The DICA-Child-R responses provided the only determination of whether the children met formal PTSD criteria. Data gathering on the sample also included a comprehensive review of risk factors for the development of PTSD, including demographics, and type(s) of trauma suffered. Findings revealed that the PTSD diagnosis was significantly correlated with: 1. Attention Deficit Hyperactivity Disorder (ADHD) 2. Other anxiety disorders 3. Brief Psychotic Disorder or Psychotic Disorder NOS 4. The presence of suicidal ideation 5. A trend toward mood disorders. There were no differences between the two samples on measures of age, race, and family income. Pediatric PTSD is a severe psychiatric disorder. In this study, PTSD was statistically related to other formal psychiatric diagnoses. The investigators attended to the issues relating to true comorbidity versus inaccurate diagnosis secondary to symptom overlap between different conditions. Applying strict criteria, the results suggest that the presence of PTSD in children confers a substantial likelihood of other formal diagnosis. Moreover, the symptom of suicidal ideation was overrepresented among PTSD subjects. Given these additional conditions, more extensive evaluation and specialized, multi-modal treatment should be considered in children presenting with PTSD.
The authors examined the effects of attention-deficit hyperactivity disorder (ADHD) and psychiatric comorbidity on recovery from psychoactive substance use disorder (PSUD) with 130 referred adults with ADHD and 71 non-ADHD adults, all of whom had a lifetime history of PSUD. Although PSUD remitted in 80% of both groups, the rate of remission and duration of PSUD was quite different in the ADHD vs. non-ADHD subjects. The duration of PSUD was 37.2 months longer in the ADHD than in non-ADHD subjects. The median time to PSUD remission was more than twice as long in ADHD than in control subjects (144 vs. 60 months, respectively). ADHD is associated with a longer, duration of PSUD and a significantly slower remission rate. If confirmed, such findings extend previous work showing that ADHD is a risk factor for early initiation and specific pathways of PSUD, providing further evidence of the relevance of this association.
A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some cases, they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few have failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, although not safer than standard Tx, may be preferable for an etiologic subgroup.