On the Map: The Once-Sleepy Danforth Neighbourhood Finds its Place in the 6ix

“There are so many studies that say that once you get a Starbucks in a neighbourhood, you’re A Neighbourhood—with a capital A,” says long-time Danforth resident Jack Howard as we discuss the transformation of the once-sleepy locality into a vibrant and culturally diverse pocket of Toronto.

Howard and his wife chose the Danforth area for their future family home back in 2006 because, at the time, it was one of the more affordable areas of Toronto. Since then, the once-tired, inner-city east side quarter has changed dramatically—for the better.

“I can share with you that our excitement of getting a new shop [in our neighbourhood] ten years ago was very different to our excitement of getting a new shop today,” he tells me. “There used to be an old movie theatre in our area that had been shut down for years, and the neighbourhood got so excited when we heard we were getting an Esso gas station and a Tim Hortons in its place.”

While the Esso appeared a big win for the quaint neighbourhood back in 2006, these days, it is more of an eyesore, albeit a convenient one. Especially now that the neighbourhood has picked up its groove.

“If you fast forward to 2018, you’ve got butchers, great restaurants, cool little watering holes, interesting clothing stores, and even a fish store in our neighbourhood. You’ve got everything you would want. And you’ve got a Starbucks. Most of the neighbourhood realized that our part of the Danforth was being put on the map when we got a Starbucks,” he chuckles.

And the Danforth certainly is on the map. According to Toronto realtor Paul Johnston, the gentrifying Danforth is an increasingly popular habitat for young professionals and families. He also tells me that since about 2016, average home prices around the Danforth have been trending upward more quickly than in the west of the city.

Comparing the Danforth to High Park, an area with similar access to highways, transit, and amenities, Johnston says that despite many interesting parallels—both areas are also very accommodating to families from all backgrounds who seek more affordable urban housing—the Danforth remains the more budget-friendly of the two, something that looks likely to change in the near future.

“The east side has really cometh over the last ten years with the evolution of the Danforth becoming quite prominent and extending farther east, and the rise of Leslieville and Riverdale has really made the east side come onto the map. It’s really changed,” Howard tells me. “It was once almost a little embarrassing to own a house in the Danforth, but now we’re actually proud to own a house here.”

Howard describes the sense of community he and his young family experience: the joy of street hockey with neighbours, and the wonderful outdoor spaces for families. Most of the people that have moved into the area are professionals in their thirties and forties, so the area has witnessed rapid gentrification.

“You can really tell a difference from 2006 where I was the only guy getting on the subway with a suit on, compared to now.  I was once kind of the lone wolf out there coming downtown to work.”

Howard confesses that despite possessing a parking pass in one of the most expensive buildings in the city, he rides the subway to work, because it takes less time to commute downtown by TTC than to drive the seven kilometres to the financial district.

I can’t help thinking that the Danforth may well be one of the city’s best-kept secrets.

“I know there are zoning restrictions on the Danforth, but if I was the mayor, or a city planner, I would love to put up twenty- or thirty-floor condos,” Howard tells me when I ask if there is anything he would like to change about the neigbourhood. “The view from the Danforth down into the core of the city is truly off the charts, and to look at Toronto from that side of the city is truly unique. Why aren’t we helping with the urban sprawl and getting people downtown to feed the core?” Howard asks.

Perhaps urban planning is the shortcoming of the Danforth, or perhaps it’s the reason why the area manages to be both a thriving inner-city hub and a family-oriented pocket. In any case, as realtor Paul Johnston tells me, “the east side is catching up.”

 

Published in On the Danforth, Summer 2019

The Triad: Obsessive Compulsive, Tourette’s Disorder, and ADHD.

It is 10.30pm. I lie in bed. My eyes close but I cannot sleep. I hear my twelve-year-old son from his room. He lies in bed and snorts. The air leaves his nostrils in loud dramatic puffs. I count the repetitive sounds. He snorts about every three seconds. This behaviour continues until he finally sleeps. I doze off. Snorting is just one of his tics.
My son has Tourette’s syndrome. He displays unusual repetitive behaviours. These include both vocal tics and motor, or physical, tics. Tourette’s patients exhibit at least one vocal and one motor tic at any given time for at least one year. Tics wax and wane in their intensity. Tics appear and disappear without warning. One tic may replace another, but a child is rarely tic-free.

The Bigger Picture
My son also displays Attention Deficit Hyperactivity Disorder (ADHD). He blurts out information and fidgets incessantly. He also manifests obsessive-compulsive behaviours. He scrubs his teeth several times before sleep.
According to a 2015 case study published by The Journal of Child and Adolescent Psychopharmacology, my son is not alone in his triple diagnosis. Dr. Rice, the study’s lead researcher, refers to the co-occurrence of Tourette’s syndrome, Obsessive Compulsive Disorder (OCD), and ADHD as the “triad.”
Dr. Rice states that while the disorders often co-occur, symptoms have a unique developmental course in each child. My son displayed the “triad” just shy of his seventh birthday.

The Basal Ganglia
Dr. Rice states that the brain region called the Basal Ganglia connects the three disorders. The Basal Ganglia sits at the bottom of the forebrain. Researchers believe the basal ganglia co-ordinates voluntary motor movements. Voluntary movements include the learned repetitive behaviours witnessed in Tourette’s patients and OCD. The Basal Ganglia connects to the Pre-Frontal Cortex, the centre of higher reasoning. Dr. Rice explains that the two regions work together to improve memory and decision-making functions. Impulsive behaviours may result from deficits in connectivity between the regions.
 Is it Genetic?
Research suggests all three disorders share genetic links, yet to date, no research has identified the culprit. Dr. Rice describes the inherited deficit as “a punitive phenotype,” or an inherited lack of inhibitory control.
The developmental course of the disorder means the most disruptive behaviours associated with ADHD often appear in early childhood. Tics usually manifest in the early school years, while obsessions and compulsions often peak in adolescence.

Medication and Tics
Many children with ADHD take medication to aid concentration and curb hyperactivity. Previous research failed to prove whether these medications aggravate tic behaviours. But current research by the American Academy of Child and Adolescent Psychiatry reports that medications used to treat symptoms of ADHD do not exacerbate tics in children.
The findings of the study are particularly pertinent because most prior research suggests that psycho-stimulant medications trigger tics. As a result, the Food and Drug Administration Agency of the United States (FDA) issues warnings on all psycho-stimulant medications listing tics as an adverse effect. The warnings deter doctors from prescribing psycho-stimulants to any child with a family history of tics. Psycho-stimulants remain the best-known solution for ADHD symptoms.

What are Psycho-stimulant Medications?
Psycho-stimulants, or amphetamines, activate the central nervous system to increase dopamine in the brain. Dopamine is an important neurotransmitter. Neurotransmitters help connectivity between brain regions. For ADHD patients, increasing connectivity between brain regions improves concentration and reduces the behavioural issues associated with impulsivity.

The Study
Researchers performed a meta-analysis to examine whether medications increased tics. A meta-analysis looks at previous studies and compares results. Researchers compared twenty-two previous studies from a total of 2385 children with ADHD. The twenty-two studies together included data sets collected between 1974 and 2011.
All studies reported some increased tic behaviour after either trials with a psycho-stimulant medication, or a non-active placebo medication. All trials lasted at least seven days. The Yale Global Tic Severity Scale considers a seven-day trial the minimum sufficient for successful clinical testing.

Results of the Study
Tic behaviours increased the most after placebo treatments. Psycho-stimulant medications designed for ADHD did not increase tics. Researchers examined all FDA approved ADHD medications.

What Causes the Tics?
This new study shows ADHD medications do not exacerbate tics. Aligning with Dr. Rice’s claims, the new study suggests that tics probably result from an underlying predisposition to a tic disorder. Twenty percent of children diagnosed with ADHD posses an underlying tic disorder. Psycho-stimulant treatments generally commence before tics appear. Increases in subsequent tic behaviour may be coincidental.

Should We Medicate?
Although the new study indicates that ADHD medications do not intensify tics in children, other known side effects exist. Common side effects include appetite loss and insomnia. It is important to remember, however, that poor social skills and low academic performance often affect young ADHD patients more than any known side effect.
For my son, treating his ADHD with medication improves his social and educative success.
As for his tics, we hope they will wane naturally with age.

 

References

Berman, S. M., Kuczenski, R., McCracken, J. T., & London, E. D. (2009). Potential adverse effects of amphetamine treatment on brain and behavior: A review. Molecular Psychiatry, 14(2), 123–142. http://doi.org/10.1038/mp.2008.90

Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., Coughlin, C. G., Leckman, J. F., & Bloch, M. H. (2015). Meta-analysis: Risk of tics associated with psychostimulant use in randomized, placebo-controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54(9), 728-736. doi:10.1016/j.jaac.2015.06.011

Himle, M. B., Chang, S., Woods, D. W., Bunaciu, L., Pearlman, A., Buzzella, B., & Piacentini, J. C. (2007). Evaluating the contributions of ADHD, OCD, and tic symptoms in predicting functional competence in children with tic disorders. Journal of Developmental and Physical Disabilities, 19(5), 503-512. doi:10.1007/s10882-007-9066-4

Hirschtritt, M.E., Lee, P.C., Pauls, D.L., Dion, Y., Grados, M.A., Illmann, C., King, R.A., Sandor, P., McMahon, W.M., Lyon, G.J., Cath, D.C., Kurlan, R., Robertson, M.M., Osiecki, L., Scharf, J.M. &, Mathews, C.A. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry.72(4), 325–333. doi:10.1001/jamapsychiatry.2014.2650

Khajehpiri, Z., Mahmoudi-Gharaei, J., Faghihi, T., Karimzadeh, I., Khalili, H., & Mohammadi, M. (2014). Adverse reactions of methylphenidate in children with attention deficit-hyperactivity disorder: Report from a referral center. Journal of Research in Pharmacy Practice, 3(4), 130–136. http://doi.org/10.4103/2279-042X.145389

Lebowitz, E., Motlagh, M., Katsovich, L., King, R., Lombroso, P., Grantz, H., Lin, H., Belntley, J., Gilbert, D., Singer, H., Coffey, B., Kurlan, R., & Leckman, J. (2012). Tourette syndrome in youth with and without obsessive-compulsive disorder and attention deficit hyperactivity disorder. European Child & Adolescent Psychiatry, 21(8), 451-457. doi:10.1007/s00787-012-0278-5

Rice, T., & Coffey, B. (2015). Pharmacotherapeutic challenges in treatment of a child with “the triad” of obsessive compulsive disorder, attention- deficit/hyperactivity disorder and tourette’s disorder. Journal of Child and Adolescent Psychopharmacology, 25(2), 176-179. doi: 10.1089/cap.2015.2522

 

Published in Communicating Science. A text for the University of Toronto, 2019