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Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder or ADHD is a neurologic disorder characterized by difficulties with attention, distractibility, and/or impulsivity and hyperactivity. There is
a wealth of information on Attention Deficit Hyperactivity Disorder available in books and on the internet.
While many people first think about children when ADHD is mentioned, it also exists in adults and can be just as impairing for adults as
it is for children. Many adults with ADHD are first diagnosed as Adults often at the insistence of a spouse or boss. ADHD can also have a
profound effect on marriages. To read a recent NY Times article on the effect ADHD can have on a marriage
click on this link.
To connect with a research for couples with ADHD click on this link.
InBrief: Executive Function: Skills for Life and Learning
Individuals with ADHD have deficits in executive functions. Individuals with executive function deficts often have difficulties with attention. However individuals with executive functions deficits do not have to have ADHD as these deficits can be caused by a host of other factors and disorders.
This 5-minute video provides an overview of Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function, the joint Working Paper from the National Scientific Council on the Developing Child and the National Forum on Early Childhood Policy and Programs.
Nonadherence to ADHD Medication in Adolescents Transitioning Into College
NASAT reports that "Nonadherence to medical treatment is a major problem, especially in adolescents and young adults whose nonadherence rates can be as high as 75% for chronic illnesses. Majority of nonadherence studies in adolescents have primarily focused on illnesses like asthma, cancer, HIV, and diabetes. However, very little adherence literature exists on conditions that affect mental health, like attention-deficit/hyperactivity disorder (ADHD) characterized by inattention, hyperactivity, and impulsivity. Nonadherence to ADHD medication can have significant consequences for individuals including greater symptom severity, poor academic performance, less productivity, decreased focus, and impaired communication skills. Long-term consequences can include the inability to successfully complete college degrees, little to no progress in career development, poor social life, and low work performance ratings. It is important to better understand the challenges individuals with ADHD face, especially while transitioning to college. Complications at this stage of life can have significant long-term repercussions on social health and career development."
Long-term Use of ADHD Meds: No Benefit, Small negative impact on Adult Growth
Medscape reports that "Children who are treated with stimulant medication for attention-deficit/hyperactivity disorder (ADHD) and who continue that treatment into adulthood may experience a suppression of height as adults without experiencing any ongoing reductions in symptoms, results of a long-term follow-up study indicate. The Multimodal Treatment Study (MTA) showed that although the number of children with ADHD who consistently received treatment into adulthood is relatively small, those who continued to receive these medications showed no differences in symptom severity in comparision those who took treatment holidays or who stopped treatment all together."
Medscape reports that "A history of autoimmune disease, either personal or maternal, is linked to an increased risk for attention-deficit/hyperactivity disorder (ADHD) in children, with type 1 diabetes showing a particularly strong association, new research shows. "In this nationwide study, autoimmune disease in the individual and a maternal history of autoimmune disease were associated with an increased risk of ADHD," the authors, led by Soren Dalsgaard, MD, PhD, with Aarhus University, Denmark, write."
Medscape reports that "The structure of the brain of children with attention-deficit/hyperactivity disorder (ADHD) differs from that of normally developing children ? a difference that is clearly visible on MRI. This suggests that ADHD should be considered a neurologic disorder, researchers say."
Is licorice intake during pregnancy linked to ADHD in offspring?
NASAT reports that "There is an abundance of foods that should be avoided during pregnancy, and a new study suggests that licorice should sit firmly in this category. Researchers have found that children born to mothers who consume large amounts of licorice during pregnancy may be more likely to develop behaviors associated with attention deficit hyperactivity disorder. Study co-author Katri Räikkönen, from the University of Helsinki in Finland, and colleagues hypothesize that glycyrrhizin (the active ingredient in licorice) may interfere with fetal neurodevelopment by increasing levels of "the stress hormone" cortisol. The researchers recently reported their findings in the American Journal of Epidemiology. Though licorice is often hailed for its medicinal benefits - such as the alleviation of peptic ulcers and canker sores - studies have indicated that the plant-derived product has some downsides."
Asthma and ADHD linked to poverty, while Autism is linked to wealth
Medscape reports that "The national prevalence of parent-reported asthma, attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) is on the rise in the United States, as are accompanying comorbid disorders, but poverty influences the prevalence of each of these conditions differently, according to a longitudinal analysis of the National Survey of Children's Health (NSCH). The study was published online February 13 in Pediatrics. "[W]e conducted a data analysis using the 3 waves of the [NSCH] from 2003 through 2012," Christian Pulcini, MD, from the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center in Pennsylvania, and colleagues write. "Within this study's time period, there was a rise in parent-reported lifetime prevalence of all 3 target disorders." Specifically, between 2003 and 2011-2012, the relative increase in lifetime prevalence of asthma was 18%, it was 44% for ADHD, and it was almost 400% for ASD."
Medscape reports that "Children and adolescents receiving stimulant medications suffer sleep impairment and should be monitored for sleep issues, and perhaps switched to different dosing schedules, according to a small meta-analysis published online November 23 and in the December issue of Pediatrics. Objective measurements of sleep in randomized controlled trials published up to March 2015 found that these medications, used in an estimated 7% of US children and youth for attention-deficit hyperactivity disorder (ADHD), resulted in poor sleep patterns. These included longer latency, worse efficiency, and shorter duration, report researchers led by Katherine M. Kidwell, MA, a pediatric psychologist at the University of Nebraska in Lincoln"
Insurance and socioeconomic status as well as race/ethnicity seem to influence whether a child is diagnosed with attention-deficit/hyperactivity disorder (ADHD), according to a new data brief from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS).
Medscape reports that "Individuals with attention-deficit/hyperactivity disorder (ADHD) are more than twice as likely to die prematurely compared with their counterparts without the disorder, new research shows. The study, which is the first to demonstrate a direct association between ADHD and increased mortality, included nearly 2 million people and had a 32-year follow-up period. Mortality rates were highest among people diagnosed with ADHD in adulthood, at the age of 18 years or older (MRR, 4.25; 3.05 - 5.78). The risk was lower among children diagnosed at ages younger than 6 years (MRR, 1.86), and it was lowest among those diagnosed from the ages 6 to 17 years (MRR, 1.58).
Sex-Based Brain differences visible in Kids with ADHD
Medscape reports that "Boys and girls with attention-deficit/hyperactivity disorder (ADHD) show differences in brain structure that are consistent with observed differences in clinical presentation between the sexes, a new imaging study shows. "Our findings suggest that boys, at least in this age range, demonstrate more problems with motor control, whereas the girls show more abnormalities in circuits responsible for a higher level of organization and planning."
Another Medication fails to treat ADHD kids' sleep problems
Many children with ADHD struggle with sleep. There have been attempts to find medications that can help with that issue. This latest research investigated whether Lunestra could help with sleep. Medscape reports that "A large, randomized, controlled 12-week trial of eszopiclone (Lunesta, Sunovion Pharmaceuticals Inc) in children and adolescents with ADHD and insomnia was no better than placebo in treating the sleep disorder. This study comes on the heels of an earlier trial of zolpidem (multiple brands) that showed similar results."
New Research further confirms the fact that exercise can reduce the severity of ADHD symptoms. In this recent study researcers found that moderate to vigorous aerobic
exercise in the morning may reduce symptoms of ADHD in young children at risk for the illness. In a randomized study involving Kindergarten through 2nd grade students,
those students that completed a 12 weeks of before-school physical activity had significantly higher rates of reduction in their ADHD symptoms of inattention and moodiness,
when compared to a control group who completed a sedentary classroom-based intervention.
New Study shows stimulant use does not effect height in ADHD
Medscape reports that "Previous research has produced a foggy picture of the relationships among ADHD, stimulants, and growth. Whereas some
studies suggest that young adolescents with ADHD are shorter than their peers without ADHD, regardless of treatment, others suggest that
patients with ADHD who are not treated with stimulants are taller than their peers. Still other studies suggest that children referred for
ADHD are taller at baseline than those not referred." A new study finds that neither ADHD nor stimulant medication appear to be linked to
children's growthor their height in adulthood.
ADHD proposed to be a disorder based on poor decision making
Medscape reports that "A novel approach to evaluating the neural processes of children with attention-deficit/hyperactivity disorder
(ADHD) reveals that, contrary to convention, the condition does not necessarily represent a learning impairment as much as it does a decision-making
impairment.'Individuals with ADHD cannot be characterized by an impaired learning rate per se, in contrast to what has been suggested by theoretical
models,' the authors, led by Tobias U. Hauser, PhD, University College London's Wellcome Trust Centre for Neuroimaging, write. 'Rather, they show
a less fine-grained decision process and explore more frequently.'"
Eye Test May Diagnose ADHD, Predict Medication Response
Medscape reports that "A simple test examining involuntary eye movements may provide an objective way to tell whether individuals have
ADHD and whether stimulant medication will be an effective treatment." It reports that "Investigators from Tel Aviv University in Tel Hashomer,
Israel, observed increased microsaccades and blink rates in adults with ADHD, which normalized with methylphenidate treatment. 'We had 2
objectives going into this research,' lead investigator Moshe Fried, PhD, from the Goldschleger Eye Institute, said in a statement. 'The first
was to provide a new diagnostic tool for ADHD, and the second was to test whether ADHD medication really works — and we found that it does.
It is certainly not a placebo, as some have suggested.'
ADHD stimulant Medications may double Cardivascular Event Risk in Children
The use of psychostimulants in children and adolescents was associated with nearly twice the risk for a cardiovascular event compared with
nonuse of the drugs, and the risk is even higher when the drugs are used for the treatment of ADHD, new research suggests. However, some
experts are questioning whether these findings are clinically meaningful. The study included 700,000 Danish children born between 1990 and
1999. Overall, the use of stimulants in the population of 714,258 was associated with a nearly 2-fold risk for a cardiovascular event.
Anxiety and Quality of Life in Children with ADHD and Anxiety Disorders
New Research from Australia reports that the presence of 2 or more comorbid anxiety disorders in children with ADHD impairs functioning, increases problematic behavior, and is associated with a poorer quality of life when compared with children with ADHD who have only 1 anxiety disorder or no anxiety disorders. The study included 392 children with diagnostically confirmed ADHD. Anxiety comorbidities included separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). The research found that 36 percent of the participants had no comorbid anxiety; 26 percent had 1 anxiety disorder; and 39 percent had 2 or more anxiety disorders. Social phobia was the most common anxiety comorbidity, occurring in 48 percent of children with 2 or more anxiety disorders. This was followed by generalized anxiety disorder (34 percent); separation anxiety (32 percent); OCD (8 percent); PTSD (6 percent); and panic disorders (2 percent).
New Research shows a connection between ADHD, Stimulant Use, and Teen obesity. The research shows that children with ADHD who were not on stimulant medication had a faster rate of increase in their BMI than children without ADHD. Children with ADHD treated with stimulants demonstrated slower BMI growth early in childhood, but then rebounded later in adolescence with higher BMIs. Their BMIs were higher than in children without a history of ADHD or stimulant use.
Neurofeedback for ADHD: New research shows significant, lasting improvement at 6 months post study
A new study conducted in the School setting showed significant and lasting improvement at 6 months for students with ADHD who were provided training with Neurofeedback. The study involved two experimental groups and a control group. Both experimental groups were provided training for 3x 45-minute intervention sessions per week in the classroom for a total of 40 sessions under the supervision of a research assistant. The first group received training with in neurofeedback the second with Cognitive Training software. Neurofeedback has been a hotly debated and controversial treatment for ADHD. The children wore a bicycle helmet with electroencephalographic sensors embedded it to increase their beta waves (an attentive state) and to suppress theta waves (a drowsy state) when viewing their brain waves on a computer screen. The Cognitive Training involved cognitive exercises that focused on attention and working memory with computer feedback to reinforce correct responses. The neurofeedback program as Play Attention, Unique Logic and Technology Inc. The Cognitive Training was program as Captain's Log, BrainTrain. Observations before and immediately after the interventions, reported previously by the investigators, showed significantly greater improvements in ADHD symptoms, including attention and executive functioning, in the neurofeedback group relative to the CT or control condition groups. At 6 months the same findings were revealed. One additional finding was that children who were already on medication who were in the in the neurofeedback group maintained their stimulant medication dose while presumably experiencing the same physical growth and increased school demands as children in the Cognitive Training and control groups, whose medication dosage increased by 9 to 13 mg methylphenidate-equivalent units.
Prenatal Acetaminophen Linked to Behavioral Problems in Children
Prenatal exposure to acetaminophen -- a drug considered safe in pregnancy -- may raise the risk for behavioral problems in children, including attention-deficit/hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD), a severe form of ADHD, new research suggests. The study found that for all outcomes, stronger effects were seen among children exposed to acetaminophen during more than 1 trimester and among those exposed for a greater number of weeks.
Sluggish Cognitive Tempo proposed as Distinct type of ADHD
Sluggish Cognitive Tempo has been proposed by Dr. Russell Barkley and others to be a distinct type of Attention Deficit Hyperactivity Disorder. Individuals with SCT like individuals with ADHD have symptoms that typically presents in childhood. Characteristic features described in the literature include being daydreamy, mentally foggy, easily confused, and staring frequently. Affected individuals may also have symptoms of hypoactivity, lethargy, slow movement, and even sleepiness. Children with SCT also appear to have slow processing speed and reaction times. There is not current official diagnosis of SCT, but some researchers believe that there maybe one in the future. The current issue of the Journal of Abnormal Child Psychology includes a special section on SCT.
Methylphenidate Linked to Priapism, Prompts FDA Warning, Label Change
Methylphenidate has been linked to a rare risk for priapism in males taking the stimulant for the treatment of ADHD, the US Food and Drug Administration (FDA) warns. In a release, the agency reports that the stimulant may in rare instances cause prolonged and sometimes painful erections, and as a result, it has updated drug labels to alert the public to this rare but serious side effect.
Number of children in US with ADHD continues to rise
The number of children diagnosed with ADHD has increased and more US children are on medication to treat their ADHD. The new study from investigator's from the Centers for Disease Control and Prevention showed that from 2003 to 2011, 6.4 million children in the United States, a total of 11% of 4- to 17-year-olds, were reported by their parents to have received a diagnosis of ADHD. This constituted a 42% increase from the period 2003-2004 to 2011-2012. In addition, the researchers found that more than 3.5 million children in the United States (6% of 4- to 17-year-olds) were reported by their parents to be taking medication for ADHD. This was a 28% increase from 2007-2008 to 2011-2012. The report also showed that children are commonly being diagnosed at a young age, with half diagnosed by age 6 years. However, among children with more severe ADHD, 50% receive a diagnosis by age 4 years.
Prenatal risk factors for ADHD are the same for boys and girls
A very large study from Australia looked at prenatal risk factors for ADHD. The study included 12,991 children and adolescents with ADHD and 30,071 children without the disorder who acted as controls. The study found that there was an elevated risk for ADHD in both boys and girls when mothers had a urinary tract infection during pregnancy, or preeclampsia . Mothers of children with ADHD were also significantly more likely to be younger, single, to have smoked during pregnancy, to have had labor induced, and to have experienced threatened preterm labor.
Almost one-third of children with autism also have attention deficit hyperactivity disorder and symptoms appear to be more severe in kids affected by both conditions, new research suggests. The findings come from a long-term study of 162 children who were tracked starting when they were still infants or toddlers. By the time the kids reached ages 4 through 8, researchers found that 63 had autism. Of those with the developmental disorder, parent reports indicated that 18 of the children — or about 29 percent — also had clinically significant symptoms of ADHD.
Teenage boys with ADHD on stimulants are shorter and thinner
New Research suggests that the use of stimulants in teenage boys with ADHD can slow their growth. The study found that teenage boys with ADHD start puberty at the same time as other teenage boys, but have delayed growth spurts. The authors suggest making sure teenage boys are on the lowest therapeutic dose possible to help prevent any problems with growth.
The NY Times reports that "Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.
Girls with ADHD more prone to Self-Harm, Suicide in later years
Research says that as girls with ADHD become adults, they are especially prone toward internalizing their problems and feelings of inadequacy - that in turn can lead to self-injury and even attempted suicide.
Students with ADHD helped by the use of a daily report card
A new small study found a statistically significant improvement in student with ADHD when their teachers used a daily report card that was sent home (daily) and when parents then provided home reinforcement or consequences for the child's report card.
NY Times article on the misuse of stimulant medications
A New York Times article on the use of stimulant medication in high school students who do not have ADHD for the purpose of getting better grades and into better colleges. The article points to the fact that children are feeling pressure to do well in School and on their PSATs and SATs and lying to their doctors to get prescriptions or buying from friends so that they can do better on the tests.
While a child's impulsivity may be obvious their struggles with executive function can often be hidden. In this helpful blog Dr. Bertin explains what executive function disorders are. I like his analogy of the iceberg, where the hyperactivity is the part of the iceberg everyone sees above the water, but the executive function issues, like time management and organization, and the larger areas no one sees under the water.
ADHD Behavioral Therapy may be more effective then medicine in the long run
An article reviewing recent research indicating that cognitive and behavioral therapies that help young people reduce impulsivity and cultivate good study habits are costlier and take longer to administer, but may be more efficacious over time.
My patients know that I strongly encourage regular exercise and Vitamin D (from sunlight). Many of my patients are what we call "summer kids", meaning that over the summer, they are happier, less anxious, and more up in their moods. The combination of exercise, sunlight (vitamin D), and fresh air does wonders. This study from last year shows a similar effect for children with ADHD.
Stimulant medicine not linked to high blood pressure
Chronic use of stimulant medication to treat attention deficit hyperactivity disorder (ADHD) in children does not appear to increase risk for high blood pressure over the long term, but it may have modest effects on heart rate, according to follow-up data from the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA).
The prescribed use of stimulant medications to treat ADHD rose slowly but steadily from 1996 to 2008, according to a study conducted by the National Institutes of Health (NIH) and the Agency for Health care Research and Quality (AHRQ).
New Research from the MTA - Chronic use of stimulant medications to treat ADHD does not appear to cause high blood pressure, but may affect heart rate
Chronic use of stimulant medication to treat attention deficit hyperactivity disorder (ADHD) in children does not appear to increase risk for high blood pressure over the long term, but it may have modest effects on heart rate, according to follow-up data from the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA).
70% of children with ADHD have a co-occurring condition.
The study based in Los Angeles found that about 8% of children in the study had been diagnosed with ADHD. The authors then estimated from that population that there are about 4 million cases of ADHD in children aged 6 to 17 in the U.S.. the authors then found that around 70% of their study participants were reported to have at least one of ten (they only asked about 10) related cormorbid conditions, such as Learning Disabilities, Oppositional Defiant Disorder, and Tourette Syndrome.
New research has once again suggested a connection between diet and ADHD. We know what we eat contributes to our mental and emotional states, but can it cause someone to develop ADHD or does it simply make someone's ADHD worse or better.
FDA panel votes not to label food dyes as a cause of ADHD
An FDA panel has voted not to label specific food dyes as being a cause of ADHD. The question of whether food dyes, which are a petroleum based product, cause ADHD first arose in the 1960's and has gone in and out of favor since that time. The recent question has been whether 8 (yellow 5 and 7 other synthetic food dyes) of the 9 color additives that are currently approved for use in food in the United States lead to higher levels of ADHD. The FDA panel voted 8 to 6 not to ban these food dyes.
Changing diet reduces ADHD and Behavioral Problems in subset of children with ADHD
New Research shows that in one study that when children between the ages of 4 and 8 were placed on a diet containing no processed foods for five weeks, 77% of the children showed a reduction in their ADHD symptoms diminished. When the researchers then had them children start eating the offending foods again the two-thirds of the children experienced a relapse of their symptoms.
One Million More U.S. Kids Are Diagnosed With Attention Deficit
The number of U.S. children diagnosed with attention-deficit/hyperactivity disorder rose by about 1 million, reflecting more premature births and increased awareness among parents and doctors, researchers said.
New Research finds a strong correlation between ADHD and Reading Disabilities. The study, which looked at more than 5,000 Minnesota youth, found that children with ADHD have dramatically higher rates of reading disabilities than youth without the disorder. The incidence of reading disabilities among boys with ADHD was 51 percent, and among girls it was 46.7 percent. For boys without ADHD, the reading disability rate among the study participants was 14.5 percent; among girls it was 7.7 percent. This news is particularly noteworthy for girls, because those who don't have ADHD have relatively low rate of reading disabilities, according to the study. The authors conclude: "Although the American Academy of Pediatrics clinical practice guideline on the diagnosis and evaluation of children with ADHD does not specifically recommend psychoeducational testing for every child with ADHD, our findings clearly demonstrate that it is essential for clinicians to assess all children with ADHD for the presence of comorbid [reading disabilities.]"
New evidence that ADHD is a genetic disorder. There has long been a debate about whether ADHD is a behavioral disorder or neurodevelopmental disorder. My patients know that I have long considered ADHD a neurodevelopmental disorder that leads to challenges with behavior and learning. A new study from England provides further proof that ADHD is a genetically based disorder.
CBT significantly reduced ADHD symptoms in Adults with ADHD
New Research finds that adults with ADHD, who previously took medication alone, showed significant improvements in their ADHD symptoms when they received three months of counseling using Cognitive Behavioral Therapy (CBT).
One third of Children and Teens with ADHD drop out of high school
New research shows that teens with ADHD are significantly more likely to drop out of high school or delay high school graduation rates. While ADHD is often not viewed in more media as a not serious condition, it is very serious. This new study finds that children and adolescents with ADHD have a significantly higher occurrence of school dropping out than children with any other mental health disorder, including Bipolar Disorder.
New Research finds that in a small study the practice of tai chi chuan for 6 weeks during a summer camp improved behavior control in adolescents with mental illness. The authors "found beneficial effects in controlling hyperactivity in the group as a whole, and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD)also showed improvements in cognitive skills, "said Peng Pang, MD, a resident in psychiatry at Maimonides Medical Center, Brooklyn, New York.
A new study, with a new major finding finds that pesticides used on food, maybe a leading cause of ADHD,...or not. The study found that in a representative sample of US children, those with higher levels of organophosphate pesticide metabolites in their urine were more likely to have ADHD than children with lower levels. The researchers found that each 10-fold increase in urinary concentration of organophosphate metabolites was associated with a 55% to 72% increase in the odds of ADHD. The reason for the ..or not, is that any research needs to be replicated, and their is always a question of correlation versus causation. Do pesticides exposure cause ADHD, or are children with ADHD for some reason more likely to be exposed to higher levels of pesticides.
The use of melatonin for treating insomnia in children with ADHD
A new literature review and meta-analysis assessed the efficacy and safety of melatonin for treating insomnia in children with ADHD. The review found that when given at doses ranging from 3 to 6 mg within a few hours of a scheduled bedtime, melatonin was associated with improvement in sleep onset and sleep latency in 4 studies in children aged 6-14 years with ADHD and insomnia. Adverse events were transient and mild in all studies.
Teen girls with ADHD at higher risk of mental illness
A new study focusing on girls with ADHD finds that girls with ADHD are at higher risk for a variety of psychiatric disorders. This longitudinal study reexamined a group of girls with ADHD 11 years after their initial diagnosis. The study found that girls with ADHD had significantly higher rates of Mood disorder, Anxiety Disorder, Antisocial Disorders, Substance Dependence Disorders, and Eating Disorders that the nonADHD girls in the control group.
A new study finds that phthalates may play a role in ADHD symptoms. Phthalate chemicals create the softer, more flexible plastics used in many consumer products. Recent research suggests that children exposed to phthalates have a greater difficulty performing well in school, as evidenced by increased inattentive and hyperactive behavior. Any new study if of interest, but findings from any one study need to be replicated in additional studies before the results can be finalized.
Children With ADHD at Risk for Zinc and Copper Deficiency
A new study presented at the annual conference of the American Academy of Child and Adolescent Psychiatry finds that children with ADHD are at risk for being deficient in their zinc and copper levels, 2 micronutrients needed for the production of key neurotransmitters.
Evaluating Prescriptions Drugs used to treat ADHD: Comparing Effectiveness, Safety and Cost
Many parents struggle with the decision to try medication and often feel lost in the decision making process. The National Institutes of Health recommend the following guide from Consumers Report: Evaluating Prescriptions Drugs used to treat ADHD: Comparing Effectiveness, Safety and Cost. As the author's note in the report the guide is written to provide parents with information to review and the discuss with their child's Pediatrician, Doctor, or psychiatrist.
New research using a study wwith 209 children (aged 10 - 16 years) with dyslexia only, 124 children with ADHD and dyslexia (ADHD+D) and 27 children with only ADHD, that the use of Strattera (Atomexetine) improved reading in the children with dyslexia and ADHD and dyslexia.
Lower Adherence to a mediterranean Diet Linked to ADHD
Medscape reports that "A new cross-sectional study shows a higher risk for attention-deficit/hyperactivity disorder (ADHD) among children and adolescents who are less adherent to a Mediterranean diet than those who are more adherent to the diet. "Previous studies done in other countries showed that low-quality diets are persistently associated with a higher risk of ADHD [but] no studies had been done regarding the Mediterranean diet and ADHD," senior author Maria Izquierdo-Pulido, PharmD, PhD, University of Barcelona, Spain, told Medscape Medical News."
Exercise can help adults better cope with ADHD symptoms
Exercise, even a small amount, can help alleviate symptoms of ADHD in adults, according to a recent study by University of Georgia researchers. The study, released in the journal Medicine and Science in Sports and Exercise, found a single bout of exercise has psychological benefits for adults with these elevated ADHD symptoms. About 6 percent of American adults report symptoms consistent with attention deficit hyperactivity disorder, or ADHD, which lead to anxiety, depression, low energy and motivation, poor performance at work or school and also increased traffic accidents.
FDA approves chewable Methylphenidate (QuilliChew) for ADHD
Medscape reports that "The US Food and Drug Administration (FDA) has approved a chewable tablet form of extended-release methylphenidate (QuilliChew ER, Pfizer Inc) for attention-deficit/hyperactivity disorder (ADHD) in children aged 6 years and older, the company announced today. The chewable product will be available in tablet form in strengths of 20, 30, and 40 mg. The tablets will be scored to allow prescribers to individualize the dose to meet the specific needs of individual patients with ADHD. It is to be taken once daily in the morning with or without food. The product is expected to be available in pharmacies in the first quarter of 2016, the company said. The recommended starting dose is 20 mg daily, with the dosage increased or decreased weekly in increments of 10, 15, or 20 mg per day, the company said. Daily doses higher than 60 mg are not recommended.".
Medscape reports FDA concerned over bioequivalence of two generic ADHD Medicines
An internal US Food and Drug Administration (FDA) re-examination of previously submitted data has raised concerns that two generic medications used to treat attention-deficit/hyperactivity disorder (ADHD) may not have the same therapeutic benefits as the reference brand-name product (Concerta).
Children with ADHD and Aggression benefit from dual drug therapy
New research suggests that Children with ADHD and Agression benefit from the use of a dual medication therapy through the use of both a
stimulant medication and an antipsychotic medication, such as risperidone (Risperdal). Medscape reports that "Children with attention-deficit/hyperactive disorder (ADHD)
and severe aggression may benefit from having an antipsychotic added to a psychostimulant medication as well as behavioral parent
training, new research suggests. New data from the Treatment of Severe Childhood Aggression (TOSCA) study confirms that such combination therapy is efficacious."
Adding in Gaunafacine for the treatment of hard to treat ADHD
Medscape reports that "Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who do not respond well to psychostimulant
monotherapy may benefit from adding guanfacine extended-release (Intuniv, Shire), a post hoc analysis of a randomized controlled trial shows.
Among a group of children and adolescents who had a suboptimal but at least partial response to a psychostimulant, adding guanfacine extended-release
produced greater response and symptomatic remission rates than continued psychostimulant monotherapy, the researchers, led by Andrew J. Cutler, MD,
of the Florida Clinical Research Center in Bradenton, note."
Omega 3s are effective in treating the symptoms of ADHD and in increasing word reading
A new study in Nutrition suggests that high intake of omega-3 fatty acids, particularly DHA helps improve the condition of ADHD. More specifically the researchers found increased intake of docosahexaenoic acid (DHA) was associated with improved word reading and better behaviors.
FDA approves a once a day liquid ADHD medication. The new medicine Quillivant XR (methylphenidate hydrochloride) while a once day medicine, has a duration of effect of 12 hours. This is a boon for children who have difficulty taking pills.
5 Questions to ask before starting your child on medication for ADHD
A helpful guide to read when confronted with the question of should you put your child (or start medication yourself if you are an adult). Remember medications can make a significant difference in the lives of people with ADHD, but they are hardly ever the only treatment option and many individuals can do well with out needing to take medication. Pills don't teach skills. As my patients know effective treatment of ADHD involves some or all of the following areas:
Building and focusing on Strengths
Considering the use of medication or using the appropriate medication
Counseling to deal with the emotional impact for the person and family members of the disorder
Life style interventions: diet, exercise, sleep, etc...
For children who need them receiving appropriate services (504 plans, IEPS) or reasonable accommodations if an adult or college student.
New Treatment Guidelines: Kids as young as 4 can have ADHD.
In October of 2011 the American Academy of Pediatrics issues new treatment guidelines. These guidelines have expanded the age range for diagnosis and treatment to ages 4 through 18. The previous guidelines, from 2000 and 2001, targeted children ages 6 to 12, the new report covers children from preschool to the end of high school. This is based on recent evidence that supports including preschool children and adolescents in ADHD diagnosis and treatment management.
AAP releases new ADHD guidelines broadening the age range to diagnosis ADHD
The American Academy of Pediatrics has issued new guidelines on the diagnosis and treatment of ADHD and has expanded the age range for the diagnosis and treatment of ADHD. The guidelines calls for the diagnosis and treatment of children as young as 4 and as old as 18.
Meta-analysis shows Omega 3s effective in treatment of ADHD
Medscape reports that "Supplementation with omega-3 fatty acid may decrease symptoms of attention-deficit/hyperactivity disorder (ADHD) in children, a new meta-analysis suggests.
In an evaluation of 10 trials with 699 total children with ADHD, investigators found that those who received omega-3 supplements had a "small but significant" improvement in symptom severity compared with those who were given placebo. This effect was also significant in the children who received supplements that specifically contained higher doses of eicosapentaenoic acid.
"I was actually expecting this treatment to not be effective at all, that we shouldn't expect much from a nutritional supplement that often takes a while to work. So the results were a surprise to me," lead author Michael H. Bloch, MD, assistant professor at the Yale Child Study Center at Yale University School of Medicine in New Haven, Connecticut, told Medscape Medical News.
"However, I would hope that nobody thinks the take-home message is that omega-3s are the answer for everyone in lieu of traditional medications," said Dr. Bloch.
In fact, the investigators note that the relative efficacy of this treatment "was modest compared with currently available pharmacotherapies for ADHD, such as psychostimulants, atomoxetine, or a2 agonists."
Still, because of its "relatively benign side-effect profile," they write, omega-3 supplements may be a reasonable add-on to traditional interventions or an option for families who do not want other psychopharmacologic treatments.
"I think the medication treatments we currently have for ADHD work best. But omega-3 represents a potentially safer alternative, especially in mild cases," said Dr. Bloch.
The study was published online August 16 in the Journal of the Academy of Child and Adolescent Psychiatry.
Past Research Results "Mixed"
According to the investigators, past research has shown that individuals with ADHD have omega-3 differences in both plasma and erythrocyte membranes compared with their healthy peers.
"Omega-3 fatty acids have anti-inflammatory properties and can alter central nervous system cell membrane fluidity and phospholipid composition," they explain.
Although several studies have looked at how effective omega-3 is in treating ADHD, the results have been mixed, prompting the need for the current meta-analysis.
The researchers examined 10 randomized control trials that compared omega-3 supplements with placebo in children with ADHD. All studies were conducted between 2001 and 2009 and lasted between 7 weeks and 4 months.
ADHD severity improvement, as measured by mean differences in rating scales, was the primary outcome. In secondary analysis, the investigators assessed dosing effects of the following omega-3 fatty acids found within the supplements used: eicosapentaenoic acid, docosahexaenoic acid, and a-linolenic acid.
Efficacy When Studies Combined
Results showed significant efficacy of omega-3 supplementation compared with placebo in only 2 of the trials. Of the remaining studies, 6 showed no benefit at all, and 2 showed benefit only on some of the ADHD rating scales.
Still, the overall analysis did show a significant improvement in ADHD symptoms for the participants receiving omega-3 compared with those receiving placebo (standard mean difference [SMD], 0.31; P less than .0001).
"Looking at these studies individually, most did not find that omega-3 was effective. It was only when you combined them that the effect became significant to a small degree," said Dr. Bloch.
Results were similar when parental ratings of ADHD severity were assessed (SMD, 0.29; P = .0002), and when separate evaluations of inattentive (SMD, 0.29; P = .009) and hyperactivity (SMD, 0.23; P = .005) symptoms were conducted.
Omega-3 supplements that included higher doses of eicosapentaenoic acid were also significantly associated with lowering ADHD symptoms (P = .04).
There were no significant differences found for any dose of docosahexaenoic acid or a-linolenic acid, or between omega-3 monotherapy vs augmenting traditional ADHD medications with omega-3.
"No evidence of publication bias or heterogeneity between trials was found," write the researchers.
However, "because of poor quality and potential issues of blinding in many of the included trials," further studies are needed to replicate the results, they write.
"I think this is something that's potentially useful for families who either don't respond to treatment with traditional medications or are hesitant to take them because of side effects," said Dr. Bloch.
He added that he hopes a future multisite trial with at least 400 children will be conducted to finally give "a definitive answer on how much omega-3 might really work."
Missing Side Effects Profile
"This is a well-done meta-analysis with attention to several aspects," Jaswinder Kaur Ghuman, MD, associate professor of psychiatry and pediatrics at the University of Arizona, Tucson, told Medscape Medical News.
However, she added that one of her concerns is the investigators' statement that omega-3 treatments have a benign side effects profile.
"They did not include analysis of side effects from the included studies, neither do they discuss what are the side effects of omega-3 supplements. Anecdotally, I have seen some people be unable to tolerate [these] supplements due to gastrointestinal upset."
Dr. Ghuman said that if parents are interested in letting their children try omega-3 supplements for their ADHD symptoms, "they should be advised to use adequate doses for effectiveness and tolerability should be carefully monitored."
The study was supported by grants from the National Institutes of Health and from the National Center for Research Resources, and by the National Institute of Mental Health, the American Psychiatric Institute for Research and Education/Eli Lilly and Co Psychiatric Research Fellowship, the American Academy of Child and Adolescent Psychiatry/Eli Lilly and Co Pilot Research Award, the Trichotillomania Learning Center, and the National Alliance for Research on Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships."
FDA approves Intuniv as stimulant adjunct for ADHD
The FDA has approved the use of guanfacine extended-release tablets (Intuniv) made by Shire Plc, for the adjunct use with another stimulant for the treatment of children and adolescents with ADHD. The approval was based on a 9-week placebo-controlled study of Intuniv. In the study, Intuniv was given in combination with a stimulant medication. The control group only received the stimulant medication. The children receiving the stimulant and Intuniv together showed greater reduction of ADHD symptoms than the children only taking a stimulant.
There are a number of different medications that can be used to treat ADHD. There are also a number of other ways to treat ADHD besides medication. This helpful page details the different types of medications available.
Consumer Report finds most parents try medication to treat ADHD
Consumer reports recently conducted a survey of parents with children with ADHD. The study found a number of factors one of those being that most parents of children with ADHD had tried medication and that most found the medication to be very helpful. Many parents had also tried alternative techniques to help their children ranging from trying Omega 3s to changing schools.
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Roughly a third of Adults with ADHD were physically abused in Childhood
New Research finds that roughly 30% of adults with ADD or ADHD were physically abused as children. The researchers from the University of Toronto in Canada found that only 7.2% of those without ADD/ADHD reported childhood physical abuse, in sharp contrast to the 29.6% of those with ADD/ADHD who reported this abuse.