Neurodiversity 101- Covid19.... brain fog.... and ADHD

Brain fog .... Covid .... and ADHD

“I did then what I knew how to do. Now that I know better, I do better.”

― Maya Angelou

We learn new things every day.

I really didn't think when people talked about 'Brain Fog' that there was a similarity with some symptoms of ADHD until the other day in a passing conversation we talked about terms like brain freeze, and fog in relation to inattention.. and it made me want to delve more deeply...

What is brain fog?

“Brain fog” isn’t a medical condition as such. It’s a term used for certain symptoms that can affect your ability to think. You may feel confused or disorganized or find it hard to focus or put your thoughts into words. People describe experiences with brain fog as lapses in memory and concentration. Other people say they forget their normal routines like running a meeting at work. Brain fog can impact the way we and others see us personally and professionally.

We also see the term 'brain fog' associated with a number of conditions. Most recently this term has been associated with Covid-19 but with other conditions such as multiple sclerosis, and menopause. It has even been associated with pregnant women having a 'baby brain'. We now know, for example, that general cognitive functioning, memory, and executive functioning are significantly poorer in pregnant than in control women, particularly during the third trimester.

Covid-19 and brain fog

Increasing interest in what happens to cause confusion in Covid-19 cases has led to research including one study from Kings College describing changes to the immune system. NIH in America has also agreed this may be a key area that becomes altered and has looked in mice with Covid-19 ( that's how they are studying this): "Even a ...mild respiratory case of COVID-19, mice had high levels of compounds involved in inflammation. The compounds were found in both the blood and the fluid that surrounds the brain and spinal cord."

The researchers found that after a mild case of COVID-19, a type of human immune cell in the brain called microglia became activated and stayed more reactive even weeks later. One of the crucial functions of the brain’s immune cells, or microglia, is to prune inactive synapses ( cleaning up). When the microglia are more reactive, the brain has trouble keeping up with some of its regular tasks, such as making new neurons in the hippocampus, a region of the brain that plays an important role in learning and memory. What seems to be happening ( noted by another research group from Sweden) is that too many synapses are being cleaned up and so this is what may be causing the 'brain fog'.

Zhou and colleagues also have looked at 'brain fog' and Covid-19. They measured C-Reactive Protein levels. The C-reactive protein (CRP) test is used to find inflammation in your body. Inflammation could be caused by different types of conditions. They found that level of sustained ability to maintain attention was correlated with the inflammatory level as indicated by CRP.

Covid-19 and ADHD

So these different articles made me think about 'brain fog' in relation to ADHD. If brain fog is about maintaining attention and ADHD is too... well????

This then led me to read some of the most recent studies looking at the association between ADHD and Covid-19.

****Yes... I have ADHD and ended up down this rabbit warren of thought processes.....***

One piece of published research from Merzon and colleagues has looked at the risk of Covid-19 in those who have ADHD. They looked at 14,022 people in Israel between February 1st and April 30, 2020, who underwent at least one Covid-19 test and had treated or untreated ADHD. The risk for being Covid-19-Positive was higher in untreated-ADHD subjects compared to non-ADHD subjects while no higher risk was detected in treated ones. Interestingly drug treatment seemed to reduce the risks.

In this same group, another paper interestingly showed that infectious diseases were significantly higher in children with ADHD than those without ADHD and this included acute respiratory infections and urinary tract infections. All antibiotics and other medications were also more often given to children with ADHD.

Heslin and colleagues just published an even more recent paper that also showed a greater risk of Covid-19 among people newly treated for ADHD. The increased risk was higher in females than males and highest among Asian and Black patients. But what was interesting was that they showed better outcomes for hospitalization, mechanical ventilation, and reduced death rates. In contrast to the other study patients who recently received ADHD medication had higher rates of COVID-19. This US study had younger people in it.ADHD with less-severe COVID-19 outcomes was only significant for the older group (≥30). This may indicate something about the people who were being treated recently because they may also have more severe symptoms too or be seen more often by health professionals at the time and have greater access to Covid testing and treatment.

Another study examined the correlation between the prevalence of ADHD and COVID-19 infection and mortality rates at the global level from 156 countries and found inconsistent results (Rajkumar, 2022).

Note: This is early days in our understanding.

Immune functioning and ADHD

We are only just starting to consider immune functioning with ADHD. It has been hypothesized that excessive release of cytokines (small signaling proteins that regulate immune response and inflammation and repair) and keratinocytes (skin cells) under allergic conditions may cause structural and functional changes to the nervous system and brain, which can contribute to conditions like ADHD.

Allergy and ADHD

One big study from the US showed that those with allergies such as hayfever, and asthma were well over 40% more likely to be diagnosed with ADHD than their non-allergic peers. Those with skin allergies were 50% more likely to be diagnosed with ADHD.

The very interesting thing about all this research is that it isn't necessarily always coming with all the answers but it is certainly creating new questions and opening a dialogue about the reasons why we are seeing an intersection between immune functioning and conditions like ADHD.

We need to consider neurodivergent traits and conditions such as ADHD as part of a multi-system process and can no longer see them in a specific silo 'just impacting on the brain'. We never think of Diabetes as being something that is only to do with the pancreas.

We will slowly learn more as the research unfolds but it tells us we need to think more about whole systems and less about the brain and body as if they are disconnected.....

Also.....as Isaac Asimov said:

“Science gathers knowledge faster than society gathers wisdom.”

All I know is that I only know what I have understood today and tomorrow it is likely to be proven that was wrong too!

**HELP**

The fab team at Do-IT Solutions is working in collaboration with the City and Guilds Foundation to create the City & Guilds Foundation Neurodiversity Index and deliver a comprehensive report to share widely. This will be a transformational piece of research if you help us.

Please, please, please can you help us and answer a short survey if you are in HR and/or consider yourself to be neurodivergent/ have neurodivergent traits, OR you are an ally and just interested in being a part of this work to make a real difference.

The bigger the sample we can get the more we will be able to feed this back to you accurate information to inform policy and practice nationally and internationally.

We will collate all the information and provide you with a comprehensive report.

Get started NOW and go to this link:

OR https://tinyurl.com/2v6knsc8

Help us all to understand better about measuring what we need to do to become a more neuro-inclusive workplace.

Author

I am Amanda Kirby, CEO of Do-IT Solutions a tech-for-good company that delivers web-based screening tools and training that help 1000s of people deliver person-centered solutions relating to neurodiversity and wellbeing.

I am a mixed bag of experiences and skills and have 25+ years of working in the field of neurodiversity. I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity; parent and grandparent to neurodivergent wonderful kids and am neurodivergent myself (bits of me I share!).

Theo Smith and I wrote the award-winning book Neurodiversity at Work Drive Innovation, Performance and Productivity with a Neurodiverse Workforce. We have also been shortlisted for an international book award. I have my 10th book coming out called Neurodiversity in Education coming early in 2023. I was also voted one of the top 20 Thinkers by HR magazine for 2022!