John J. Ratey

The positive impact of physical activity on cognition during adulthood: a review of underlying mechanisms, evidence, and recommendations

Abstract A growing body of literature suggests that physical activity beneficially influences brain function during adulthood, particularly frontal lobe-mediated cognitive processes, such as planning, scheduling, inhibition, and working memory. For our hunter-gatherer ancestors, times of famine interspersed with times of feast necessitated bouts of intense physical activity balanced by periods of rest. However, the sedentary lifestyle that pervades modern society has overridden the necessity for a physically active lifestyle. The impact of inactivity on disease processes has been the focus of much attention; the growing understanding that physical activity also has the benefit of enhancing cognitive performance strengthens the imperative for interventions that are successful in increasing physical activity, with the outcomes of promoting health and productivity. Population health and performance programs that promote physical activity provide benefits for employees and employers through improvements in worker health and performance and financial returns for the company. In this review, we examine the mechanisms by which physical activity improves cognition. We also review studies that evaluate the effects of physical activity on cognitive executive performance in adulthood, including longitudinal studies that address the impact of physical activity during early adulthood and midlife on preservation of cognition later in life. This is of particular importance given that adulthood represents prime working years and that physical activity promotion is a key component of population health and performance programs. Finally, we provide recommendations for maximizing the lasting benefits of movement and physical activity on cognition in adulthood.

Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy.

ABSTRACT Adult patients with significant childhood and current symptoms of attention-deficit hyperactivity disorder (ADHD), but whose ADHD had not been previously recognized, were evaluated by three clinical consultants working with diverse referral populations. These 60 adults shared common characteristics of physical and mental restlessness, impulsivity, disabling distractibility, low self-esteem, self-loathing, and a gnawing sense of underachievement. Specific learning or behavior problems were often present. These patients were chronically disaffected. The diagnosis of ADHD appeared to be missed because these individuals presented with atypical symptoms or had found ways to compensate for their deficits. Descriptive generalizations are offered concerning their coping strategies. These adults had sought previous psychiatric care for non-ADHD symptoms but had numerous unsuccessful treatment attempts. Most patients had been treated for mood or anxiety disorders. Traditional defense analysis had little beneficial effect and aggravated problems of self-esteem; modifications of the psychotherapeutic process are recommended. In open clinical trials without formal measures, the majority of such patients appeared to respond to low doses of antidepressants (i.e., desipramine 10-30 mg daily) and seemed to lose the therapeutic effect at higher antidepressant doses.

Brief report: Open trial effects of beta-blockers on speech and social behaviors in 8 autistic adults

We began open trials of beta-blockers, as adjunctive medication, in eight consecutive autistic adults. The immediate result across all patients was a rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug increased, subtler changes in speech and socialization emerged. While results of open trials must be interpreted with caution, these changes were significant and lasting. We speculate that these effects may be the result of a lessening of the autistic individuals state of hyperarousal. As the individual becomes less anxious, defensive and dearousing behaviors are relinquished and more social and adaptive behaviors appear. There is a concomitant improvement in language, though it is unclear whether lost skills are recouped or new ones developed. Further research is indicated.

Autism: the treatment of aggressive behaviors

Eight consecutive cases of adults with the diagnosis of early infantile autism and who were treated with a betablocker are presented. Each had been on various and multiple drug, educational, and behavioral regimens to help control aggressive and self-abusive behavior. Most had been institutionalized from an early age, and a broad range of IQs and speech capacities are represented. Results show the betablockers to have a remarkable effect potentiating measurable diminution in previously intractable aggressive behavior and in many cases the decrease or withdrawal of their neuroleptic.

Combination of treatments for attention deficit hyperactivity disorder in adults.

Three adults with DSM-III-R diagnoses of attention deficit hyperactivity disorder were treated with a combination of a psychostimulant and nadolol. Previous treatment with only a psychostimulant had not been effective or had not been tolerated. The combination treatment resulted in an increase in attention and focusing capacities, along with a decrease in anxiety, impulsiveness, and somatic discomfort. These improvements suggest an effective regimen for treatment-resistant adults with attention deficit hyperactivity disorder.

Hysteria, anorexia and the culture of self-denial

Anorexia and hysteria seem to be expressions of age-specific conflicts intensified by constrictive cultural ideas and certain kinds of familial constellations. The disorder that ensues appears to represent the individuals desperate attempt to escape the conflicts of adult life according to models offered by the prevailing cultural values.

Defense behavior and coping in an autistic savant: the story of Temple Grandin, PhD

The causal factors in the behaviorally defined syndrome of autism remain unclear, although the past decade has brought to bear two significant developments that shape our view of the disorder. The first of these developments is a growing body of biomedical research that indicates there are multiple etiologies associated with the disorder. This research has allowed for the formation of subgroups based upon neuroanatomical, neurobiological, and neurophysiological abnormalities (Damasio 1984; Piggot 1979; Ritvo et al. 1990). The second is neuropsychological research indicating that the socioemotional deficits are primary to the disorder and may underlie much of the behavioral symptomatology (Fein et al. 1986). These areas of concern undoubtedly have enhanced our understanding of the disorder, yet in their achievements they may too easily absorb what we know about autistics who experience a chronic state of physiological hyperarousal, evidence of which has been found in neurophysiological studies (Delius 1967; Hutt et al. 1965), neurochemical studies (Lake et al. 1977), psychopharmacologic studies (Ratey et al. 1987a), and behavioral studies (Kinsbourne 1980; Kootz et al. 1982; Tinbergen and Tinbergen 1972; Zentall and Zentall 1983). These individuals, perhaps constituting a subgroup of their own, experience an inner state of disorganization that markedly impairs their functioning (Sands and Ratey 1986).

Paramenstrual aggression in mentally retarded adult ameliorated by buspirone

Objective: This case examined the efficacy of buspirone therapy as a reductive technique for severe treatment resistant paramenstrual aggression. Method: Aggressive outbursts of an institutionalized mentally retarded adult were analyzed and correlated with menstrual cycling. Behavior was closely monitored, and after ineffective trials of antipsychotics, benzodiazepines and beta blockers, a trial of buspirone was initiated. Results: Buspirone therapy resulted in a marked decrease in aggressive incidences, and substantial increases in desirable behaviors. As a result of the subjects improvement, doses of concurrent psychotropic medications were reduced or discontinued altogether. Conclusions: The authors conclude that buspirone is an effective pharmacotherapy for paramenstrual aggression in the developmentally disabled, and encourage similar experimentation when behavior seems to be otherwise unbeatable.

Autism and emotion: an ethological theory.

Autistic symptomatology is described as resulting from three processes which have become integrated in clinical presentation. The basic deficit is hypothesized as an inability to participate in information exchange through systems of emotional communication. These systems have been extensively studied in lower animals and a direct phylogenetic line, from posture display to facial expression to human empathy, can be traced in evolutionary advance.

Neurocognitive disorders in psychiatry : a case example of diagnostic and treatment dilemmas

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.