Nationally recognized Attention Deficit Hyperactivity Disorder (ADHD) authority Russell Barkley, Ph.D., has embarked on a national speaking tour to discuss the symptoms of ADHD in adults and the potentially serious consequences these symptoms may have on the life of an adult living with this disorder. ADHD is believed to affect an estimated 8.1 percent of adults, or 9.2 million adults across the U.S. based on a retrospective survey of adults aged 18 to 44, projected to the full U.S. adult population. The purpose of this tour is to help raise awareness about the importance of identifying, diagnosing and treating adult ADHD.
In children, ADHD may interfere with paying attention in school, completing homework or making friends. Difficulties experienced in childhood may continue into adulthood. The symptoms of ADHD in adults may lead to potentially serious consequences. Surveys have shown that when compared with their non-ADHD peers, adults with ADHD may be:
* Three times more likely to be currently unemployed
* Two times more likely to have problems keeping friends
* Forty-seven percent more likely to have trouble saving money to pay bills
* Four times more likely to have contracted a sexually transmitted disease
"This educational initiative is meant to provide information about ADHD in adults including the results of recent studies of adults with ADHD concerning their symptoms, impairments and functionality in many domains of life that support the results of previous research in this area," said Dr. Barkley author of a recently published book, ADHD in Adults: What the Science Says.
Two studies, one conducted at the University of Massachusetts (the UMASS study) and one conducted at The Medical College of Wisconsin in Milwaukee (the Milwaukee study), were recently published in a book by Dr. Barkley. They were both designed to observe secondary outcomes of patients living with ADHD. These secondary outcomes included: educational and occupational functioning; drug use and anti-social behaviors; health, lifestyle, money management and driving; sex, dating, marriage, parenting and psychosocial adjustment of offspring; and neurological functioning. Observational outcomes showed that adults with ADHD, when compared to a control group, were more likely to use certain illicit drugs, engage in certain anti-social behavior, have financial problems and engage in risky sexual behavior. Outcomes of both studies were observed and documented through a combination of data gathering techniques, such as self-reporting, patient interviews and observation.
"These results, together with what we already know about ADHD, give the impression that ADHD has a potentially significant impact on the lives of many patients. There is hope for adults with ADHD. Today there are ways to manage this chronic condition, and I hope these findings serve as an impetus for adults with ADHD to seek medical advice from their healthcare providers," said Dr. Barkley.
The UMASS study, conducted from approximately 2003 to 2004, examined lifestyle outcomes among three cohorts of adult patients: 146 clinic-referred adults with ADHD, 97 adults seen at the same clinic who were not diagnosed with ADHD, and also a third general community sample of 109 adults without ADHD. Specifically, the UMASS study found that the adults with ADHD when compared to the non-ADHD control group were approximately three times more likely (21 percent compared to 6 percent) to sell drugs illegally. Additionally, the UMASS study found that 67 percent of adults with ADHD compared to the control group (15 percent) had trouble managing money.
The Milwaukee study, ongoing since 1977 (with the most recent follow-up conducted from 1999 to 2003), is an observational longitudinal study that looked at secondary lifestyle outcomes of 158 children who had been diagnosed with ADHD and, as adults, either continue to experience symptoms or no longer have the disorder at the age of 27, compared to a community control group of 81 children without ADHD who were followed concurrently. The Milwaukee study found that the adults with ADHD were approximately three times as likely when compared with the community control group to initiate physical fights (30 percent compared to 9 percent), destroy others property (31 percent compared to 8 percent) and break and enter (20 percent compared to 7 percent).
"As an organization dedicated to providing information and resources to adults with ADHD, we are excited to see such attention paid to this disorder," said Evelyn Polk-Green, MS, Ed., ADDA President-elect and adult living with ADHD. "The reason why these findings are so important is that they help to inform people that ADHD is not just a childhood disorder, but in fact, a disorder that may affect multiple aspects of adult life and should be properly diagnosed and treated. This research also reinforces the need for formalized and validated criteria for the diagnosis of adult ADHD and may play a significant role in the development of this diagnostic criteria and the addition of it to the Diagnostic and Statistical Manual of Mental Disorders."
Thursday, March 19, 2009
Studies Review Smoking Among College Freshmen And Tobacco Use By Adolescents With ADHD
A supplemental issue of Nicotine and Tobacco Research published yesterday includes a variety of key findings on the smoking habits of college freshmen; nicotine dependence; the use of tobacco by individuals with attention- deficit/ hyperactivity disorder, depression and anxiety; and the challenges of so-called "reduced-exposure" tobacco products.
The papers published in the special supplement represent the work of several universities involved in two major research programs funded by the National Cancer Institute (NCI), National Institute on Drug Abuse (NIDA) and the Robert Wood Johnson Foundation (RWJF) over the last decade.
"The findings in this supplemental issue are of interest to smokers, researchers and policy makers because they focus on practical issues and represent the work of noted scientists from a variety of disciplines," according to Robin Mermelstein, Ph.D., of the University of Illinois at Chicago. Mermelstein wrote the introductory paper in the supplement.
Smoking Habits of College Freshmen
Studies show that smoking initiation typically occurs at age 15 or 16 and over a two- or three-year period gradually increases to daily smoking. Daily smokers continue to escalate their use of cigarettes over the next several years as they develop into chronic, heavily dependent smokers.
This study looked at the daily smoking habits of 912 college students at Purdue University during their freshman year to understand some of the factors that influence trajectories of smoking behavior and tobacco dependence. Students were assessed weekly over the course of the academic year using a web-based survey and provided monthly saliva samples for cotinine analysis. Rates of alcohol and marijuana use were also examined.
Results revealed several patterns of substance use. Heightened use of cigarettes, alcohol, and marijuana were observed during the earliest weeks of school, followed by steady rates of decline over the next several weeks, suggesting that many college freshmen initially experiment with substance use upon arriving on campus, but do not continue to use. Results also found a weekly pattern of smoking, with most cigarettes smoked on Fridays and Saturdays. This pattern was relative consistent across the academic year, with the exception of specific holidays when rates of use increased (i.e., Halloween and New Years Eve), and specific weeks when rates of use decreased (i.e., finals week, winter and spring break). Patterns of smoking and alcohol use were similar, especially for students with higher levels of use.
Among freshmen who had smoked very little prior to beginning college, findings revealed that their initial early-use episodes of smoking during college occurred within a social/party setting and that over 90% occurred when the person was with other people who were smoking. In addition, the majority (65%) of the first recorded early use of cigarettes occurred while the participant was drinking alcohol.
Title of Paper: "Smoking in College Freshmen: University Project of the Tobacco Etiology Research Network (UpTERN)." Lead author: Stephen T. Tiffany, University of Utah.
Attention Deficit Hyperactivity Disorder, Depression and Anxiety
Some studies suggest that individuals with attentional and emotional problems continue to smoke at high rates and are less successful with smoking cessation. With the majority of smokers beginning to smoke by age 18, adolescents with attentional and emotional dysfunctions also have a higher risk for smoking compared to those without such problems. Smoking behavior may reflect adolescents' use of nicotine for self-medicating purposes: to reduce symptoms associated with attention-deficit/ hyperactivity disorder, and to regulate emotions among those who struggle with depression or anxiety.
This paper proposes that adolescents with attentional and emotional disorders may be especially vulnerable to start smoking as a result of their brain functioning. Nicotine may "normalize" certain parts of the brain, thereby increasing the risk of nicotine dependence and increasing difficulty in quitting. Treatment of these attentional and emotional dysfunctions through behavioral and pharmacological interventions that "normalize" the affected parts of the brain may reduce the reinforcing effects of smoking and, thus, may represent tailored smoking cessation strategies. Such tailored smoking cessation strategies may also be useful in prevention programs for at-risk youths.
Title of Paper: "Smoking to self-medicate attentional and emotional dysfunctions." Lead author: Jean-G. Gehricke, Ph.D., Department of Psychiatry and Human Behavior, University of California, Irvine.
Nicotine Dependence/First Cigarette of the Day
Whether or not smokers can quit cigarettes and remain tobacco free is related to their dependence on nicotine. There are many ways to measure nicotine dependence, including number of cigarettes smoked in a day, the withdrawal experienced by smokers, and attitudes toward smoking and quitting. One paper that examined various measures of nicotine dependence, found that the amount of time before lighting the first cigarette of the day was most predictive of a smoker's ability to quit smoking.
The paper finds that the time to the first cigarette in the morning reflected a need for "heavy, uninterrupted and automatic smoking," and it was a valid predictor of a smoker's ability to quit cigarettes and remain tobacco free. The earlier a person smoked the first cigarette, the more difficult it would be for that smoker to quit cigarettes.
Title of Paper: "Time to first cigarette in the morning as an index of ability to quit smoking: Implications for nicotine dependence." Lead author: Timothy B. Baker, Ph.D., University of Wisconsin School of Medicine & Public Health, Center for Tobacco Research and Intervention.
The papers published in the special supplement represent the work of several universities involved in two major research programs funded by the National Cancer Institute (NCI), National Institute on Drug Abuse (NIDA) and the Robert Wood Johnson Foundation (RWJF) over the last decade.
"The findings in this supplemental issue are of interest to smokers, researchers and policy makers because they focus on practical issues and represent the work of noted scientists from a variety of disciplines," according to Robin Mermelstein, Ph.D., of the University of Illinois at Chicago. Mermelstein wrote the introductory paper in the supplement.
Smoking Habits of College Freshmen
Studies show that smoking initiation typically occurs at age 15 or 16 and over a two- or three-year period gradually increases to daily smoking. Daily smokers continue to escalate their use of cigarettes over the next several years as they develop into chronic, heavily dependent smokers.
This study looked at the daily smoking habits of 912 college students at Purdue University during their freshman year to understand some of the factors that influence trajectories of smoking behavior and tobacco dependence. Students were assessed weekly over the course of the academic year using a web-based survey and provided monthly saliva samples for cotinine analysis. Rates of alcohol and marijuana use were also examined.
Results revealed several patterns of substance use. Heightened use of cigarettes, alcohol, and marijuana were observed during the earliest weeks of school, followed by steady rates of decline over the next several weeks, suggesting that many college freshmen initially experiment with substance use upon arriving on campus, but do not continue to use. Results also found a weekly pattern of smoking, with most cigarettes smoked on Fridays and Saturdays. This pattern was relative consistent across the academic year, with the exception of specific holidays when rates of use increased (i.e., Halloween and New Years Eve), and specific weeks when rates of use decreased (i.e., finals week, winter and spring break). Patterns of smoking and alcohol use were similar, especially for students with higher levels of use.
Among freshmen who had smoked very little prior to beginning college, findings revealed that their initial early-use episodes of smoking during college occurred within a social/party setting and that over 90% occurred when the person was with other people who were smoking. In addition, the majority (65%) of the first recorded early use of cigarettes occurred while the participant was drinking alcohol.
Title of Paper: "Smoking in College Freshmen: University Project of the Tobacco Etiology Research Network (UpTERN)." Lead author: Stephen T. Tiffany, University of Utah.
Attention Deficit Hyperactivity Disorder, Depression and Anxiety
Some studies suggest that individuals with attentional and emotional problems continue to smoke at high rates and are less successful with smoking cessation. With the majority of smokers beginning to smoke by age 18, adolescents with attentional and emotional dysfunctions also have a higher risk for smoking compared to those without such problems. Smoking behavior may reflect adolescents' use of nicotine for self-medicating purposes: to reduce symptoms associated with attention-deficit/ hyperactivity disorder, and to regulate emotions among those who struggle with depression or anxiety.
This paper proposes that adolescents with attentional and emotional disorders may be especially vulnerable to start smoking as a result of their brain functioning. Nicotine may "normalize" certain parts of the brain, thereby increasing the risk of nicotine dependence and increasing difficulty in quitting. Treatment of these attentional and emotional dysfunctions through behavioral and pharmacological interventions that "normalize" the affected parts of the brain may reduce the reinforcing effects of smoking and, thus, may represent tailored smoking cessation strategies. Such tailored smoking cessation strategies may also be useful in prevention programs for at-risk youths.
Title of Paper: "Smoking to self-medicate attentional and emotional dysfunctions." Lead author: Jean-G. Gehricke, Ph.D., Department of Psychiatry and Human Behavior, University of California, Irvine.
Nicotine Dependence/First Cigarette of the Day
Whether or not smokers can quit cigarettes and remain tobacco free is related to their dependence on nicotine. There are many ways to measure nicotine dependence, including number of cigarettes smoked in a day, the withdrawal experienced by smokers, and attitudes toward smoking and quitting. One paper that examined various measures of nicotine dependence, found that the amount of time before lighting the first cigarette of the day was most predictive of a smoker's ability to quit smoking.
The paper finds that the time to the first cigarette in the morning reflected a need for "heavy, uninterrupted and automatic smoking," and it was a valid predictor of a smoker's ability to quit cigarettes and remain tobacco free. The earlier a person smoked the first cigarette, the more difficult it would be for that smoker to quit cigarettes.
Title of Paper: "Time to first cigarette in the morning as an index of ability to quit smoking: Implications for nicotine dependence." Lead author: Timothy B. Baker, Ph.D., University of Wisconsin School of Medicine & Public Health, Center for Tobacco Research and Intervention.
Shock Treatment May Continue At Special Education School
A special education school which has been in the news for inappropriate use of electric shock treatment has been allowed to continue using shock treatment for the most dangerous and self-destructive behaviors. In such cases the shock treatment must lead to a diminution in the undesirable actions. The Judge Rotenberg Educational Center (JRC) has to prove that these treatments really work.
The one-year reauthorization contrasts with previous ones which lasted two years each time.
Electric shock treatment at the center must never be used for petty infractions, such as leaving one's seat without getting permission or using offensive language. The school has been ordered to show that it is committed to phasing out this type of aversion therapy. This phasing out must be especially so for students who are on the verge of leaving and about to enter the community.
In August 2007 three adolescents were given several electric shocks after a former resident called pretending to be a supervisor. The residents in question were asleep at the time, the caller told staff to wake them up and give them dozens of shocks with restraints in response to behavior that had allegedly taken place over five ours beforehand. A series of phone calls with instructions were made by the former resident between 2am and 4.45am. Although the JRC claims the victims were evaluated by JRC nursing staff, JRC's doctor, as well as the victim's treating clinical Doctor, and found to be in good health, one victim was further examined at a hospital and was reported to have two areas of first degree burns related to the presence of the GED.
The center pledges not to utilize delayed punishments. It also says it will not punish children who are asleep with electric shocks.
Many are surprised the school was not ordered to end shock treatment straight away.
The one-year reauthorization contrasts with previous ones which lasted two years each time.
Electric shock treatment at the center must never be used for petty infractions, such as leaving one's seat without getting permission or using offensive language. The school has been ordered to show that it is committed to phasing out this type of aversion therapy. This phasing out must be especially so for students who are on the verge of leaving and about to enter the community.
In August 2007 three adolescents were given several electric shocks after a former resident called pretending to be a supervisor. The residents in question were asleep at the time, the caller told staff to wake them up and give them dozens of shocks with restraints in response to behavior that had allegedly taken place over five ours beforehand. A series of phone calls with instructions were made by the former resident between 2am and 4.45am. Although the JRC claims the victims were evaluated by JRC nursing staff, JRC's doctor, as well as the victim's treating clinical Doctor, and found to be in good health, one victim was further examined at a hospital and was reported to have two areas of first degree burns related to the presence of the GED.
The center pledges not to utilize delayed punishments. It also says it will not punish children who are asleep with electric shocks.
Many are surprised the school was not ordered to end shock treatment straight away.
Additional Dosage Strengths Of Vyvanse Approved By FDA
Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ), the global specialty biopharmaceutical company, has announced that it has received approval from the U.S. Food and Drug Administration (FDA) for three additional dosage strengths for the attention deficit hyperactivity disorder (ADHD) treatment, VYVANSE™ (lisdexamfetamine dimesylate). Shire expects the three additional dosage strengths of 20 mg, 40 mg and 60 mg will be available in retail pharmacies in the second quarter of 2008 to supplement the existing 30 mg, 50 mg and 70 mg dosage strengths currently available in pharmacies throughout the country.
"Shire is pleased that physicians will soon have the benefit of a wider range of VYVANSE dosage strengths which they can prescribe to help manage the ADHD symptoms of their patients," said Matt Emmens, Chief Executive Officer of Shire Pharmaceuticals. "In its first six months of availability, more than 500,000 VYVANSE prescriptions have been dispensed, indicating that physicians see VYVANSE as an effective treatment option for their patients."
Dose titration, the process of incrementally increasing or decreasing the dose of a medication, is a widely used method in clinical practice to help achieve optimal efficacy and tolerability for each patient. The option of having dosage strengths with smaller increments allows for a more gradual titration of medication and may help the physician tailor the treatment for each individual patient.
"Shire has also experienced early success with managed care coverage for VYVANSE, which is now preferred on three of the five largest national plans. According to available national data, more than 85 percent of lives in the United States are covered for VYVANSE in Tier 3 or better," added Emmens. "We are optimistic that the formulary coverage for VYVANSE will continue to improve as we move into 2008."
VYVANSE is currently approved in the United States for the treatment of ADHD in children aged 6 to 12 years. A Supplemental New Drug Application (sNDA) for VYVANSE for the treatment of ADHD in adults is currently under review by the FDA.
VYVANSE is a therapeutically inactive prodrug, in which d-amphetamine is covalently bonded to l-lysine, and after oral ingestion it is converted to pharmacologically active d-amphetamine. The conversion of VYVANSE to d-amphetamine is not affected by gastrointestinal pH and is unlikely to be affected by alterations in normal GI transit times.
"Shire is pleased that physicians will soon have the benefit of a wider range of VYVANSE dosage strengths which they can prescribe to help manage the ADHD symptoms of their patients," said Matt Emmens, Chief Executive Officer of Shire Pharmaceuticals. "In its first six months of availability, more than 500,000 VYVANSE prescriptions have been dispensed, indicating that physicians see VYVANSE as an effective treatment option for their patients."
Dose titration, the process of incrementally increasing or decreasing the dose of a medication, is a widely used method in clinical practice to help achieve optimal efficacy and tolerability for each patient. The option of having dosage strengths with smaller increments allows for a more gradual titration of medication and may help the physician tailor the treatment for each individual patient.
"Shire has also experienced early success with managed care coverage for VYVANSE, which is now preferred on three of the five largest national plans. According to available national data, more than 85 percent of lives in the United States are covered for VYVANSE in Tier 3 or better," added Emmens. "We are optimistic that the formulary coverage for VYVANSE will continue to improve as we move into 2008."
VYVANSE is currently approved in the United States for the treatment of ADHD in children aged 6 to 12 years. A Supplemental New Drug Application (sNDA) for VYVANSE for the treatment of ADHD in adults is currently under review by the FDA.
VYVANSE is a therapeutically inactive prodrug, in which d-amphetamine is covalently bonded to l-lysine, and after oral ingestion it is converted to pharmacologically active d-amphetamine. The conversion of VYVANSE to d-amphetamine is not affected by gastrointestinal pH and is unlikely to be affected by alterations in normal GI transit times.
Attention Seeking Confused With ADHD
Teachers and parents need to beware of confusing children who are attention seeking with those who suffer from attention-deficit hyperactivity disorder (ADHD).
This is the finding of Dr Nigel Mellor an independent Educational Psychologist who presented his research on Thursday 10 January 2008, at the British Psychological Society's Division of Child and Educational Psychology Annual Conference in Bournemouth.
ADHD is an issue of growing concern which has attracted a great deal of research, and interest due to the number of children currently claiming to have the disorder. Unfortunately, attention seeking has been largely neglected by researchers and the two problems can appear very similar making identifying ADHD and treating it effectively very difficult.
The researcher said there are many behaviours which can be observed during attention seeking interactions. Behaviours commonly associated with ADHD (over activity, poor concentration and impulsivity) can appear within attention seeking behaviour. "It is possible that some ADHD is attention seeking in disguise," said Dr Mellor.
The research partly focussed on 15 schools over a period of three years and established that it was possible to distinguish between the two and enable treatment to be used appropriately. It found that children who were attention seeking generally "acted-up" to gain the attention of nearby adults and were able to relate well to older or younger people, just not their peers, displayed good language skills. None of this behaviour could be characterised with ADHD.
Dr Mellor said: "If you consider that the typical support for parents of an ADHD child might require eight to twelve sessions, or even more, whereas attention seeking behaviour can be addressed in as little as two to five sessions. Being able to correctly identify those children with ADHD from those who attention seek will enable us to ensure that we can focus the right kind of support to the right people."
This is the finding of Dr Nigel Mellor an independent Educational Psychologist who presented his research on Thursday 10 January 2008, at the British Psychological Society's Division of Child and Educational Psychology Annual Conference in Bournemouth.
ADHD is an issue of growing concern which has attracted a great deal of research, and interest due to the number of children currently claiming to have the disorder. Unfortunately, attention seeking has been largely neglected by researchers and the two problems can appear very similar making identifying ADHD and treating it effectively very difficult.
The researcher said there are many behaviours which can be observed during attention seeking interactions. Behaviours commonly associated with ADHD (over activity, poor concentration and impulsivity) can appear within attention seeking behaviour. "It is possible that some ADHD is attention seeking in disguise," said Dr Mellor.
The research partly focussed on 15 schools over a period of three years and established that it was possible to distinguish between the two and enable treatment to be used appropriately. It found that children who were attention seeking generally "acted-up" to gain the attention of nearby adults and were able to relate well to older or younger people, just not their peers, displayed good language skills. None of this behaviour could be characterised with ADHD.
Dr Mellor said: "If you consider that the typical support for parents of an ADHD child might require eight to twelve sessions, or even more, whereas attention seeking behaviour can be addressed in as little as two to five sessions. Being able to correctly identify those children with ADHD from those who attention seek will enable us to ensure that we can focus the right kind of support to the right people."
Finding The Causes Of ADHD - New Study Launched By Norwegian Institute Of Public Health
An unprecedented ADHD study was launched on Wednesday 16th January to find causes and early warning signs of ADHD among pre-school age children.
ADHD is frequently diagnosed but little is known about the causes, despite all the published research. Today there are no diagnostic criteria for ADHD in children under 6 years of age. The ADHD study intends to address many unanswered questions around the causes of this condition. The study will also contribute to identifying early signs of ADHD, allowing for earlier identification and therefore develop better prevention and support for this group.
"The study is unique because we have access to biological material and information about foetal conditions and early infancy via the ongoing Norwegian Mother and Child Cohort Study" says project leader Heidi Aase at the Norwegian Institute of Public Health (NIPH) in Oslo. The ADHD study is a collaboration project with nearby Ullevaal University Hospital.
Children taking part in the ADHD study are recruited through the Norwegian Mother and Child Cohort Study run by the NIPH. This unique resource gives pre-birth information about the children, plus blood samples from both parents and from the child's umbilical cord. Thus genetic and environmental links can also be investigated.
The ADHD study will include thorough clinical and neuropsychological examinations of approximately 1500 children at an early age (from 3 - 3.5 years) to build a picture of their difficulties and how they develop.
The ADHD study is a major focus for both the NIPH and Ullevaal University Hospital. The study is financed by the Department of Health and Social Care, the Directorate for Health and Social Affairs and the Research Council of Norway.
About the Norwegian Institute of Public Health
Our goal is to improve public health through promotion of good health and prevention of disease. The Norwegian Institute of Public Health is a national centre of excellence in the areas of epidemiology, mental health, infectious disease control, environmental medicine, forensic toxicology and drug abuse. Our vision: A healthier society. Our motto: Knowledge for better public health.
ADHD is frequently diagnosed but little is known about the causes, despite all the published research. Today there are no diagnostic criteria for ADHD in children under 6 years of age. The ADHD study intends to address many unanswered questions around the causes of this condition. The study will also contribute to identifying early signs of ADHD, allowing for earlier identification and therefore develop better prevention and support for this group.
"The study is unique because we have access to biological material and information about foetal conditions and early infancy via the ongoing Norwegian Mother and Child Cohort Study" says project leader Heidi Aase at the Norwegian Institute of Public Health (NIPH) in Oslo. The ADHD study is a collaboration project with nearby Ullevaal University Hospital.
Children taking part in the ADHD study are recruited through the Norwegian Mother and Child Cohort Study run by the NIPH. This unique resource gives pre-birth information about the children, plus blood samples from both parents and from the child's umbilical cord. Thus genetic and environmental links can also be investigated.
The ADHD study will include thorough clinical and neuropsychological examinations of approximately 1500 children at an early age (from 3 - 3.5 years) to build a picture of their difficulties and how they develop.
The ADHD study is a major focus for both the NIPH and Ullevaal University Hospital. The study is financed by the Department of Health and Social Care, the Directorate for Health and Social Affairs and the Research Council of Norway.
About the Norwegian Institute of Public Health
Our goal is to improve public health through promotion of good health and prevention of disease. The Norwegian Institute of Public Health is a national centre of excellence in the areas of epidemiology, mental health, infectious disease control, environmental medicine, forensic toxicology and drug abuse. Our vision: A healthier society. Our motto: Knowledge for better public health.
Study Raises Questions About Diagnosis, Medical Treatment Of ADHD
A new UCLA study shows that only about half of children diagnosed with attention-deficit hyperactivity disorder, or ADHD, exhibit the cognitive defects commonly associated with the condition.
The study also found that in populations where medication is rarely prescribed to treat ADHD, the prevalence and symptoms of the disorder are roughly equivalent to populations in which medication is widely used.
The results of the first large, longitudinal study of adolescents and ADHD, conducted among the population of northern Finland, appeared in several papers in a special section of the Journal of the American Academy of Child and Adolescent Psychiatry published in December and are currently online.
ADHD is a common, chronic behavioral disorder characterized by inattention, hyperactivity and impulsivity that is thought to affect some 5 to 10 percent of school-age children worldwide.
In adolescence, ADHD is generally associated with cognitive deficits, particularly with working memory and inhibition, which have been linked to overall intelligence and academic achievement, according to UCLA psychiatry professor Susan Smalley, who headed the research. Interestingly, the study showed that these deficits are only present in about half of adolescents diagnosed with ADHD.
Part of the explanation may lie in the common method for diagnosing the disorder. The researchers found that ADHD is an extreme on a normal continuum of behavior that varies in the population, much like height, weight or IQ. Its diagnosis, and thus its prevalence, is defined by where health professionals "draw the line" on this continuum, based on the severity of the symptoms and overall impairment.
However, children with cognitive deficits do not show increased levels of inattention or hyperactivity when compared with other children diagnosed with ADHD, the study found, suggesting that behavior-rating scales alone are not sensitive enough to differentiate between the two groups. Additional psychological testing is recommended to confirm the presence of cognitive impairments.
Researchers also found surprising results regarding the effectiveness of medicine in treating ADHD. In contrast to children in United States, youth in northern Finland are rarely treated with medicine for ADHD, yet the 'look' of the disorder its prevalence, symptoms, psychiatric comorbidity and cognition is relatively the same as in the U.S., where stimulant medication is widely used. The researchers point out that this raises important issues about the efficacy of the current treatments of ADHD in dealing with the disorder's long-term problems.
"We know medication is very effective in the short-term," said Smalley, who authored or co-authored each of the papers. "But the study raises important questions concerning the long-term efficacy of ADHD treatment. Here we have two different cultures and two different approaches to treatment, yet at the time of adolescence, there are few differences in the presentation and problems associated with ADHD."
Other findings from the wide-ranging study include:
-- Further confirmation that ADHD symptoms do change with age: Hyperactivity and impulsivity decrease with age, while inattention increasingly predominates. In fact, about two-thirds of children with ADHD continue to exhibit significant levels of inattentiveness and impairment into adolescence.
-- ADHD is associated with increased rates of other psychiatric problems. Most prominent in adolescence are depression; anxiety; oppositional behaviors, such as arguing, losing one's temper and being easily annoyed; and conduct disorders like vandalism and truancy. Surprisingly, post-traumatic stress disorder is significantly elevated among adolescents with ADHD, compared with non-ADHD youth. The prevalence of these co-occurring disorders is comparable to that found in other ADHD populations worldwide.
-- Two genes, labeled DBH and DRD2, involved in the regulation of dopamine a neurotransmitter involved in attention, motivation and emotion have also been associated with ADHD in the population of northern Finland. Although the researchers involved say they likely account for very little of the genetic variation underlying ADHD, the findings further support the involvement of the dopamine pathway in the etiology of the disorder.
"This set of articles brings to light the necessity of engaging in new ways of thinking about ADHD," said Smalley, who is also a member of the Center for Neurobehavioral Genetics at UCLA. "Certainly it is a valid disorder in terms of its diagnosis; there are relatively similar prevalences around the world. But the predisposition to ADHD is a normal distribution in attention and activity level, much like diabetes and glucose tolerance, or dyslexia and reading disability.
"The continuous nature of liability to ADHD requires that we examine more carefully what environmental pressures may be leading to impairment, instead of broadening our diagnostic classifications even further," she said.
The study started in 1986, when researchers from Imperial College, London, and Finland's University of Oulu began studying 9,432 children in northern Finland. They tracked the children from the early fetal period to adolescence (age 16 to 18). UCLA researchers then joined in the effort to examine the adolescents for ADHD behaviors, using a standard screening survey and diagnostic criteria. Among the 6,622 respondents to the survey, a subset of 457 likely cases and controls were evaluated for ADHD and other psychiatric disorders. The estimated prevalence of ADHD among these adolescents was 8.5 percent, with a male-female ratio of 5.7 to 1.
In addition to Smalley, UCLA researchers involved in the study included Lorie A. Humphrey, Sandra K. Loo, James T. McCracken, James J. McGough and Stanley F. Nelson.
Funding was provided by the National Institute of Mental Health, the Juselius Foundation in Finland and the Academy of Finland.
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The study also found that in populations where medication is rarely prescribed to treat ADHD, the prevalence and symptoms of the disorder are roughly equivalent to populations in which medication is widely used.
The results of the first large, longitudinal study of adolescents and ADHD, conducted among the population of northern Finland, appeared in several papers in a special section of the Journal of the American Academy of Child and Adolescent Psychiatry published in December and are currently online.
ADHD is a common, chronic behavioral disorder characterized by inattention, hyperactivity and impulsivity that is thought to affect some 5 to 10 percent of school-age children worldwide.
In adolescence, ADHD is generally associated with cognitive deficits, particularly with working memory and inhibition, which have been linked to overall intelligence and academic achievement, according to UCLA psychiatry professor Susan Smalley, who headed the research. Interestingly, the study showed that these deficits are only present in about half of adolescents diagnosed with ADHD.
Part of the explanation may lie in the common method for diagnosing the disorder. The researchers found that ADHD is an extreme on a normal continuum of behavior that varies in the population, much like height, weight or IQ. Its diagnosis, and thus its prevalence, is defined by where health professionals "draw the line" on this continuum, based on the severity of the symptoms and overall impairment.
However, children with cognitive deficits do not show increased levels of inattention or hyperactivity when compared with other children diagnosed with ADHD, the study found, suggesting that behavior-rating scales alone are not sensitive enough to differentiate between the two groups. Additional psychological testing is recommended to confirm the presence of cognitive impairments.
Researchers also found surprising results regarding the effectiveness of medicine in treating ADHD. In contrast to children in United States, youth in northern Finland are rarely treated with medicine for ADHD, yet the 'look' of the disorder its prevalence, symptoms, psychiatric comorbidity and cognition is relatively the same as in the U.S., where stimulant medication is widely used. The researchers point out that this raises important issues about the efficacy of the current treatments of ADHD in dealing with the disorder's long-term problems.
"We know medication is very effective in the short-term," said Smalley, who authored or co-authored each of the papers. "But the study raises important questions concerning the long-term efficacy of ADHD treatment. Here we have two different cultures and two different approaches to treatment, yet at the time of adolescence, there are few differences in the presentation and problems associated with ADHD."
Other findings from the wide-ranging study include:
-- Further confirmation that ADHD symptoms do change with age: Hyperactivity and impulsivity decrease with age, while inattention increasingly predominates. In fact, about two-thirds of children with ADHD continue to exhibit significant levels of inattentiveness and impairment into adolescence.
-- ADHD is associated with increased rates of other psychiatric problems. Most prominent in adolescence are depression; anxiety; oppositional behaviors, such as arguing, losing one's temper and being easily annoyed; and conduct disorders like vandalism and truancy. Surprisingly, post-traumatic stress disorder is significantly elevated among adolescents with ADHD, compared with non-ADHD youth. The prevalence of these co-occurring disorders is comparable to that found in other ADHD populations worldwide.
-- Two genes, labeled DBH and DRD2, involved in the regulation of dopamine a neurotransmitter involved in attention, motivation and emotion have also been associated with ADHD in the population of northern Finland. Although the researchers involved say they likely account for very little of the genetic variation underlying ADHD, the findings further support the involvement of the dopamine pathway in the etiology of the disorder.
"This set of articles brings to light the necessity of engaging in new ways of thinking about ADHD," said Smalley, who is also a member of the Center for Neurobehavioral Genetics at UCLA. "Certainly it is a valid disorder in terms of its diagnosis; there are relatively similar prevalences around the world. But the predisposition to ADHD is a normal distribution in attention and activity level, much like diabetes and glucose tolerance, or dyslexia and reading disability.
"The continuous nature of liability to ADHD requires that we examine more carefully what environmental pressures may be leading to impairment, instead of broadening our diagnostic classifications even further," she said.
The study started in 1986, when researchers from Imperial College, London, and Finland's University of Oulu began studying 9,432 children in northern Finland. They tracked the children from the early fetal period to adolescence (age 16 to 18). UCLA researchers then joined in the effort to examine the adolescents for ADHD behaviors, using a standard screening survey and diagnostic criteria. Among the 6,622 respondents to the survey, a subset of 457 likely cases and controls were evaluated for ADHD and other psychiatric disorders. The estimated prevalence of ADHD among these adolescents was 8.5 percent, with a male-female ratio of 5.7 to 1.
In addition to Smalley, UCLA researchers involved in the study included Lorie A. Humphrey, Sandra K. Loo, James T. McCracken, James J. McGough and Stanley F. Nelson.
Funding was provided by the National Institute of Mental Health, the Juselius Foundation in Finland and the Academy of Finland.
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SpeechWorks Debuts New Autism/ADHD Therapy In Columbia
SpeechWorks is one of 30 providers internationally that offer the Sensory Learning Program, an innovative 30-day program geared towards correcting sensory issues in the brain. The program combines three conventional therapies into one, and it's showing progress not just for Autism, but for kids with learning disabilities, attention deficit disorder and developmental delays.
"We could not believe our ears in the days, weeks and months following our son's completion of the Sensory Learning Program. My husband and I were constantly turning to each other and saying, 'Did he just say what I think he said?' Friends would comment on his increased eye contact and social interaction. After longing to hear our son talk to us, it is such a joy to have him carry on a conversation with us!" - L.B., Pickens, SC
Many children with Autism display self-stimming behaviors such as hand-flapping and toe walking. "The overload of sensory input is too confusing for them to handle, so they'll actually be able to flap in order to concentrate on the flapping and calm themselves down," says Dr. Brad Habermehl of Flint Sensory Learning Center in Michigan. "They cannot multitask, so when they're looking at something it's almost as if they're deaf and can't hear because they suppress or turn off their auditory system. We're stimulating the brain stem in 3 different areas, all at the same time. All three systems being stimulated at the same time so the patient has to develop coordination and put them in sync with one another."
The program consists of two 30-minute sessions per day for 12 straight days in office, followed by an 18-day home program. SpeechWorks has offices in both the Midlands and the Upstate. Our new Columbia office will be hosting an open house Thursday, January 31st, from 4pm to 8pm.
"We could not believe our ears in the days, weeks and months following our son's completion of the Sensory Learning Program. My husband and I were constantly turning to each other and saying, 'Did he just say what I think he said?' Friends would comment on his increased eye contact and social interaction. After longing to hear our son talk to us, it is such a joy to have him carry on a conversation with us!" - L.B., Pickens, SC
Many children with Autism display self-stimming behaviors such as hand-flapping and toe walking. "The overload of sensory input is too confusing for them to handle, so they'll actually be able to flap in order to concentrate on the flapping and calm themselves down," says Dr. Brad Habermehl of Flint Sensory Learning Center in Michigan. "They cannot multitask, so when they're looking at something it's almost as if they're deaf and can't hear because they suppress or turn off their auditory system. We're stimulating the brain stem in 3 different areas, all at the same time. All three systems being stimulated at the same time so the patient has to develop coordination and put them in sync with one another."
The program consists of two 30-minute sessions per day for 12 straight days in office, followed by an 18-day home program. SpeechWorks has offices in both the Midlands and the Upstate. Our new Columbia office will be hosting an open house Thursday, January 31st, from 4pm to 8pm.
Probable Cause Identified Of Age Differences In Stimulant Response
In young children, psychostimulants relieve symptoms of Attention Deficit Disorder, yet in adolescents and adults, those same medications can cause euphoria and are often abused.
What is behind these differing drug responses?
Temple University scientists have identified a potential molecular mechanism, the neurotrophin system comprised of brain-derived neurotrophic factor (BDNF) and its receptor TrkB, as the cause of age differences in stimulant response. Their findings appear in the current issue of the Journal of Neuroscience.
"Our findings suggest that the rapidly developing young brain is able to adapt and protect itself against the rewarding effects of stimulants due to the input of the TrkB system," said Ellen Unterwald, PhD, lead investigator and professor of pharmacology at Temple University's School of Medicine and Center for Substance Abuse Research.
Most preclinical studies have found that susceptibility to the addictive properties of stimulants is age-dependent. This is the first study to link the TrkB neurotrophin system to those age-specific responses. The hope is that BDNF/TrkB might someday be used as a target for the development of new treatments for childhood neuropsychiatric disorders or addiction.
What is behind these differing drug responses?
Temple University scientists have identified a potential molecular mechanism, the neurotrophin system comprised of brain-derived neurotrophic factor (BDNF) and its receptor TrkB, as the cause of age differences in stimulant response. Their findings appear in the current issue of the Journal of Neuroscience.
"Our findings suggest that the rapidly developing young brain is able to adapt and protect itself against the rewarding effects of stimulants due to the input of the TrkB system," said Ellen Unterwald, PhD, lead investigator and professor of pharmacology at Temple University's School of Medicine and Center for Substance Abuse Research.
Most preclinical studies have found that susceptibility to the addictive properties of stimulants is age-dependent. This is the first study to link the TrkB neurotrophin system to those age-specific responses. The hope is that BDNF/TrkB might someday be used as a target for the development of new treatments for childhood neuropsychiatric disorders or addiction.
Cocaine's Effects On Brain Metabolism May Contribute To Abuse
Many studies on cocaine addiction - and attempts to block its addictiveness - have focused on dopamine transporters, proteins that reabsorb the brain's "reward" chemical once its signal is sent. Since cocaine blocks dopamine transporters from doing their recycling job, it leaves the feel-good chemical around to keep sending the pleasure signal. Now a new study conducted at the U.S. Department of Energy's Brookhaven National Laboratory suggests that cocaine's effects go beyond the dopamine system. In the study, cocaine had significant effects on brain metabolism, even in mice that lack the gene for dopamine transporters.
"In dopamine-transporter-deficient mice, these effects on metabolism are clearly independent of cocaine's effects on dopamine," said Brookhaven neuroscientist Panayotis (Peter) Thanos, who led the research. "These metabolic factors may be a strong regulator of cocaine use and abuse, and may also suggest new avenues for addiction treatments." The study will appear in the May 2008 issue of the journal Synapse, and will be available online on Monday, February 18, 2008.
The scientists used positron emission tomography, or PET scanning, to measure brain metabolism in dopamine-transporter deficient mice (known as DAT knockouts) and in littermates that had normal dopamine transporter levels. In this technique, the scientists administer a radioactively labeled form of sugar (glucose) - the brain's main "fuel" - and use the PET scanner to track its site-specific concentrations in various brain regions. They tested the mice before and after cocaine administration, and compared the results to mice treated with saline instead of the drug.
Before any treatment, mice lacking dopamine transporters had significantly higher metabolism in the thalamus and cerebellum compared with normal mice. This elevated metabolism may be linked to chronically high levels of dopamine in the DAT knockout mice. It also suggests that dopamine levels may play an important role in modulating glucose levels in these brain areas, which play important roles integrating sensory information, learning, and motor function.
Interestingly, DAT knockout mice have been suggested as an animal model for attention-deficit hyperactivity disorder (ADHD). Elevated metabolism due to persistent elevated dopamine levels may be a factor contributing to the symptoms of ADHD, Thanos said.
After the scientists administered cocaine, whole brain metabolism decreased in both groups of mice, but more significantly in normal mice than in DAT knockouts. The scientists were able to detect this reduction in metabolism in a wide range of brain regions in the normal mice, suggesting that these decreases in metabolism are somehow associated with the blockade of dopamine transporters by cocaine.
The scientists also observed a reduction in metabolism in the thalamus region in the DAT knockout mice. This effect may likely be due to the effect of cocaine on other neurotransmitter systems, for example, norepinepherine or serotonin.
In summary, cocaine exposure has an effect on regional brain activity, which is mostly driven by dopamine action and to a secondary degree norepinephrine or serotonin. These results also support the idea that the thalamus and the cerebellum play key roles in cocaine's mechanism of effect on sensory input, learning, and motor function. This is particularly of interest in better understanding the mechanism of cocaine addiction as well as the neurobiology of ADHD.
"In dopamine-transporter-deficient mice, these effects on metabolism are clearly independent of cocaine's effects on dopamine," said Brookhaven neuroscientist Panayotis (Peter) Thanos, who led the research. "These metabolic factors may be a strong regulator of cocaine use and abuse, and may also suggest new avenues for addiction treatments." The study will appear in the May 2008 issue of the journal Synapse, and will be available online on Monday, February 18, 2008.
The scientists used positron emission tomography, or PET scanning, to measure brain metabolism in dopamine-transporter deficient mice (known as DAT knockouts) and in littermates that had normal dopamine transporter levels. In this technique, the scientists administer a radioactively labeled form of sugar (glucose) - the brain's main "fuel" - and use the PET scanner to track its site-specific concentrations in various brain regions. They tested the mice before and after cocaine administration, and compared the results to mice treated with saline instead of the drug.
Before any treatment, mice lacking dopamine transporters had significantly higher metabolism in the thalamus and cerebellum compared with normal mice. This elevated metabolism may be linked to chronically high levels of dopamine in the DAT knockout mice. It also suggests that dopamine levels may play an important role in modulating glucose levels in these brain areas, which play important roles integrating sensory information, learning, and motor function.
Interestingly, DAT knockout mice have been suggested as an animal model for attention-deficit hyperactivity disorder (ADHD). Elevated metabolism due to persistent elevated dopamine levels may be a factor contributing to the symptoms of ADHD, Thanos said.
After the scientists administered cocaine, whole brain metabolism decreased in both groups of mice, but more significantly in normal mice than in DAT knockouts. The scientists were able to detect this reduction in metabolism in a wide range of brain regions in the normal mice, suggesting that these decreases in metabolism are somehow associated with the blockade of dopamine transporters by cocaine.
The scientists also observed a reduction in metabolism in the thalamus region in the DAT knockout mice. This effect may likely be due to the effect of cocaine on other neurotransmitter systems, for example, norepinepherine or serotonin.
In summary, cocaine exposure has an effect on regional brain activity, which is mostly driven by dopamine action and to a secondary degree norepinephrine or serotonin. These results also support the idea that the thalamus and the cerebellum play key roles in cocaine's mechanism of effect on sensory input, learning, and motor function. This is particularly of interest in better understanding the mechanism of cocaine addiction as well as the neurobiology of ADHD.
Nonstimulant Medication Is A Safe And Effective Alternative For ADHD Treatment In Children With Fragile X Syndrome
Fragile X syndrome (FXS) is the most common hereditary form of mental retardation. Many children with FXS also suffer from attention deficit and/or hyperactivity disorder (ADHD), which complicates social relationships at home and at school. Although stimulant medication such as Ritalin® is often successfully used to treat children with ADHD, studies have shown that while it is effective in children with mental retardation, it also causes side effects such as increased irritability, decreased verbalization and social withdrawal.
A previous study showed that L-acetyl carnitine (LAC), a form of the amino acid carnitine, significantly reduced hyperactive behavior in FXS boys with ADHD who were treated with it for one year without causing adverse side effects. The same authors have now conducted a randomized, double-blind, placebo-controlled multicenter study to determine the effectiveness of LAC in a larger group. The study is published in the April 1st, 2008 issue of the American Journal of Medical Genetics Part A, available online via Wiley InterScience.
Led by M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome, the study involved 51 boys between 6 and 12 years old with FXS and ADHD who were treated in one of eight centers in Italy, France and Spain. Each patient followed the treatment for 12 months, which involved 500 milligrams of LAC or a placebo given twice daily. Patients were evaluated by an interdisciplinary team of child neuropsychiatrists and psychologists at the start of the study, after one month, six months and 12 months. The effects of the drug and placebo were evaluated using a set of neuropsychological tests to assess behavior.
Those treated with LAC demonstrated reduced hyperactive behavior and increased attention. No side effects were exhibited, confirming that LAC is a safe alternative to stimulants. The patients treated with the placebo also showed reduced hyperactive behavior, although not nearly to the extent as the LAC-treated patients. The patients treated with LAC also had significantly improved social ability compared to the placebo-treated group. Both groups took intelligence tests, but LAC did not improve overall intellectual functioning.
"We propose that LAC be recommended as a treatment of ADHD in FXS children," conclude the authors, "since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects." They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants.
A previous study showed that L-acetyl carnitine (LAC), a form of the amino acid carnitine, significantly reduced hyperactive behavior in FXS boys with ADHD who were treated with it for one year without causing adverse side effects. The same authors have now conducted a randomized, double-blind, placebo-controlled multicenter study to determine the effectiveness of LAC in a larger group. The study is published in the April 1st, 2008 issue of the American Journal of Medical Genetics Part A, available online via Wiley InterScience.
Led by M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome, the study involved 51 boys between 6 and 12 years old with FXS and ADHD who were treated in one of eight centers in Italy, France and Spain. Each patient followed the treatment for 12 months, which involved 500 milligrams of LAC or a placebo given twice daily. Patients were evaluated by an interdisciplinary team of child neuropsychiatrists and psychologists at the start of the study, after one month, six months and 12 months. The effects of the drug and placebo were evaluated using a set of neuropsychological tests to assess behavior.
Those treated with LAC demonstrated reduced hyperactive behavior and increased attention. No side effects were exhibited, confirming that LAC is a safe alternative to stimulants. The patients treated with the placebo also showed reduced hyperactive behavior, although not nearly to the extent as the LAC-treated patients. The patients treated with LAC also had significantly improved social ability compared to the placebo-treated group. Both groups took intelligence tests, but LAC did not improve overall intellectual functioning.
"We propose that LAC be recommended as a treatment of ADHD in FXS children," conclude the authors, "since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects." They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants.
CME LLC Offers Education To Help Medical Professionals Better Recognize Adult ADHD
CME LLC, a leading provider of fully accredited continuing medical education programs since 1978, today announced a new interactive educational program designed to increase recognition of the complexities and complications often encountered when diagnosing and treating patients with adult ADHD.
The presentation of adult ADHD is often complicated by the presence of comorbid conditions such as depression, anxiety, bipolar disorder and substance abuse. A patient's symptoms often mask either the comorbid condition or the adult ADHD, making a diagnosis more challenging.
"Of the estimated four-to-five percent of adults with ADHD, only 20 percent are ever diagnosed, and this presents us with a tremendous opportunity to raise awareness and make a positive impact for patients and physician learners alike," said Niki Oquist, M.D., FAAP and senior vice president of medical affairs for CME LLC. "ADHD is most commonly associated with children and adolescents, and it morphs to take on a completely different form in adults. Sixty percent of children and adolescents with ADHD continue to have impairment into adulthood."
Children with ADHD have symptoms of hyperactivity and impulsiveness which progress to inattentiveness and restlessness in adults. This educational initiative is just the start of a year-long program to educate and assist physicians with diagnosing and treating patients with ADHD.
"It's easy to understand why there's so much confusion about classifying ADHD," said Oquist. "A shortage of physician training and variable symptoms may lead to the underdiagnosis of adult ADHD."
"Understanding the Complexities in the Differential Diagnosis of Adult ADHD" offers clinicians access to a Web site (http://www.adultadhd-ddx.com) with online anecdotal patient case studies, as well as live 4-hour meetings in Chicago; Dearborn, Mich.; Los Angeles; Washington, D.C.; and New York beginning March 1 and running through April 12. Each meeting includes two sessions: "Understanding the Challenges in the Differential Diagnosis of Adult ADHD," with Joel L. Young, M.D., medical director and founder at the Rochester Center for Behavioral Medicine and "Evaluating Treatment Strategies for Adult ADHD," with David Goodman, M.D., assistant professor for the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University, the director of Suburban Psychiatric Associates, LLS and the director for the Adult Attention Deficit Disorder Center of Maryland. All course materials are peer-developed and peer-reviewed. Information and other educational opportunities will be added to the Web site throughout 2008. Meeting pre-registration is requested at http://www.adultadhd-ddx.com.
About CME LLC
CME LLC, a division of CMPMedica, is a leading provider of fully accredited continuing medical education programs and offers a wide range of informational and educational resources for healthcare professionals. Based in Irvine, Calif., CME produces a variety of live events and conferences, print supplements, multimedia home study products, and Web sites and is the sponsor of the U.S. Psychiatric and Mental Health Congress and Regional Extensions and the Advances series of medical education sessions, which includes Advances in Primary Care Medicine, Neurology and Pediatric Medicine.
The presentation of adult ADHD is often complicated by the presence of comorbid conditions such as depression, anxiety, bipolar disorder and substance abuse. A patient's symptoms often mask either the comorbid condition or the adult ADHD, making a diagnosis more challenging.
"Of the estimated four-to-five percent of adults with ADHD, only 20 percent are ever diagnosed, and this presents us with a tremendous opportunity to raise awareness and make a positive impact for patients and physician learners alike," said Niki Oquist, M.D., FAAP and senior vice president of medical affairs for CME LLC. "ADHD is most commonly associated with children and adolescents, and it morphs to take on a completely different form in adults. Sixty percent of children and adolescents with ADHD continue to have impairment into adulthood."
Children with ADHD have symptoms of hyperactivity and impulsiveness which progress to inattentiveness and restlessness in adults. This educational initiative is just the start of a year-long program to educate and assist physicians with diagnosing and treating patients with ADHD.
"It's easy to understand why there's so much confusion about classifying ADHD," said Oquist. "A shortage of physician training and variable symptoms may lead to the underdiagnosis of adult ADHD."
"Understanding the Complexities in the Differential Diagnosis of Adult ADHD" offers clinicians access to a Web site (http://www.adultadhd-ddx.com) with online anecdotal patient case studies, as well as live 4-hour meetings in Chicago; Dearborn, Mich.; Los Angeles; Washington, D.C.; and New York beginning March 1 and running through April 12. Each meeting includes two sessions: "Understanding the Challenges in the Differential Diagnosis of Adult ADHD," with Joel L. Young, M.D., medical director and founder at the Rochester Center for Behavioral Medicine and "Evaluating Treatment Strategies for Adult ADHD," with David Goodman, M.D., assistant professor for the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University, the director of Suburban Psychiatric Associates, LLS and the director for the Adult Attention Deficit Disorder Center of Maryland. All course materials are peer-developed and peer-reviewed. Information and other educational opportunities will be added to the Web site throughout 2008. Meeting pre-registration is requested at http://www.adultadhd-ddx.com.
About CME LLC
CME LLC, a division of CMPMedica, is a leading provider of fully accredited continuing medical education programs and offers a wide range of informational and educational resources for healthcare professionals. Based in Irvine, Calif., CME produces a variety of live events and conferences, print supplements, multimedia home study products, and Web sites and is the sponsor of the U.S. Psychiatric and Mental Health Congress and Regional Extensions and the Advances series of medical education sessions, which includes Advances in Primary Care Medicine, Neurology and Pediatric Medicine.
For Boys With Fragile X Sydrome And ADHD, New Hope Found In Non-Stimulant Medication
The most common hereditary form of hereditary mental retardation is known as Fragile X syndrome (FXS), so dubbed for its characteristic mutation on the X chromosome, or Escalante's syndrome. Manifestations of this disease in patients usually include a characteristic long facial pattern, tooth and jaw misalignment, musculoskeletal abnormalities, or autism.
Additionally, many FXS patients also suffer from attention deficit and/or hyperactivity disorder (ADHD), a disorder that can make functioning socially or professionally difficult. Stimulant medications, such as Ritalin®, are often effective for ADHD patients with mental retardation, but there are counterproductive side effects such as irritability, diminished speech, and social withdrawal.
L-acetyle carnitine (LAC,) a variant of the amino acid carnitine, showed promise in a previous study of reducing hyperactive behavior in FXS boys with AHDH. They were treated with it for one year, with no adverse side effects reported. The same authors have subsequently performed a andomized, double-blind, placebo-controlled study over multiple centers to determine how effective LAC can be in a larger group. This study will be published in the April 1, 2008 issue of American Journal of Medical Genetics Part A, which is available online via Wiley InterScience at the following address: http://www3.interscience.wiley.com/cgi-bin/jhome/33129.
M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome led the study, which brought together 51 boys between the ages of 6 and 12 who had been diagnosed with FXS and ADHD. They were treated in one of eight facilities in Italy, France, and Spain. The treatment, 500 milligrams of LAC or a placebo twice a day, was continued for 12 months. A team of child neuropsychiatrists and psychologists evaluated each patient at the start of the study, after one month, 6 months, and 12 months. Neuropsychologicial tests were used to evaluate the effects of the drug and the placebo.
Subjects in the LAC group showed reduced hyperactive behavior and better attention. In this group there were also no side effects, indicating that LAC provides a safe alternative to stimulant therapies. The placebo group showed less hyperactive behavior as well, but not at the magnitude of the LAC group. Additionally, LAC patients showed improved social ability. While both groups took intelligence tests, LAC did not appear to improve intellectual function.
"We propose that LAC be recommended as a treatment of ADHD in FXS children," the authors state, "since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects." They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants.
About Wiley InterScience
Introduced in 1997 and launched commercially in January 1999, Wiley InterScience (www.interscience.wiley.com) is a leading international resource for quality content promoting discovery across the spectrum of scientific, technical, medical and professional endeavors. In nearly a decade, Wiley InterScience has built its reputation by regularly adding new content and functionality; offering sophisticated search and navigation capabilities; and providing robust online manuscript submission and management tools.
Today, Wiley InterScience features must-have content from more than 2,500 journals, books, reference works, databases, laboratory manuals and the Cochrane Library, which is the world's best-known resource for evidence-based medicine. More than half of Wiley's journals on Wiley InterScience are digitized back to Volume 1, Issue 1 as part of the development of the journal backfile initiative.
About Wiley
Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Our core businesses include scientific, technical, medical, and scholarly journals, encyclopedias, books, and online products and services; professional/trade books, subscription products, training materials, and online products and services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at www.wiley.com. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.
A Double-Blind, Parallel, Multicenter Comparison of L-acetylcarnitine with Placebo on the Attention Deficit Hyperactivity Disorder in Fragile X Syndrome Boys
M. Giulia Torrioli, Silvia Vernacotola, Laura Peruzzi, Elisabetta Tabolacci, Montserrat Mila, Roberto Militerni, Sebastiano Musumeci, Feliciano J. Ramos, Marìa Frontera, Giovanni Sorge, Elisabetta Marzullo, Giusi Romeo, Louis Vallee, Edvige Veneselli, Elena Cocchi, Eleonora Garbarino, Umberto Moscato, Pietro Chiurazzi, Stefania D'Iddio, Menotti Calvani, Giovanni Neri
American Journal of Medical Genetics Part A, April 1st, 2008
DOI: 10.1002/ajmg.a.32268
Additionally, many FXS patients also suffer from attention deficit and/or hyperactivity disorder (ADHD), a disorder that can make functioning socially or professionally difficult. Stimulant medications, such as Ritalin®, are often effective for ADHD patients with mental retardation, but there are counterproductive side effects such as irritability, diminished speech, and social withdrawal.
L-acetyle carnitine (LAC,) a variant of the amino acid carnitine, showed promise in a previous study of reducing hyperactive behavior in FXS boys with AHDH. They were treated with it for one year, with no adverse side effects reported. The same authors have subsequently performed a andomized, double-blind, placebo-controlled study over multiple centers to determine how effective LAC can be in a larger group. This study will be published in the April 1, 2008 issue of American Journal of Medical Genetics Part A, which is available online via Wiley InterScience at the following address: http://www3.interscience.wiley.com/cgi-bin/jhome/33129.
M. Giulia Torrioli and Giovanni Neri of the Università Cattolica in Rome led the study, which brought together 51 boys between the ages of 6 and 12 who had been diagnosed with FXS and ADHD. They were treated in one of eight facilities in Italy, France, and Spain. The treatment, 500 milligrams of LAC or a placebo twice a day, was continued for 12 months. A team of child neuropsychiatrists and psychologists evaluated each patient at the start of the study, after one month, 6 months, and 12 months. Neuropsychologicial tests were used to evaluate the effects of the drug and the placebo.
Subjects in the LAC group showed reduced hyperactive behavior and better attention. In this group there were also no side effects, indicating that LAC provides a safe alternative to stimulant therapies. The placebo group showed less hyperactive behavior as well, but not at the magnitude of the LAC group. Additionally, LAC patients showed improved social ability. While both groups took intelligence tests, LAC did not appear to improve intellectual function.
"We propose that LAC be recommended as a treatment of ADHD in FXS children," the authors state, "since it effectively reduces hyperactive behavior and improves social abilities without adverse side effects." They also suggest that these results may be applicable to children with autism, who also do not easily tolerate stimulants.
About Wiley InterScience
Introduced in 1997 and launched commercially in January 1999, Wiley InterScience (www.interscience.wiley.com) is a leading international resource for quality content promoting discovery across the spectrum of scientific, technical, medical and professional endeavors. In nearly a decade, Wiley InterScience has built its reputation by regularly adding new content and functionality; offering sophisticated search and navigation capabilities; and providing robust online manuscript submission and management tools.
Today, Wiley InterScience features must-have content from more than 2,500 journals, books, reference works, databases, laboratory manuals and the Cochrane Library, which is the world's best-known resource for evidence-based medicine. More than half of Wiley's journals on Wiley InterScience are digitized back to Volume 1, Issue 1 as part of the development of the journal backfile initiative.
About Wiley
Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Our core businesses include scientific, technical, medical, and scholarly journals, encyclopedias, books, and online products and services; professional/trade books, subscription products, training materials, and online products and services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at www.wiley.com. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.
A Double-Blind, Parallel, Multicenter Comparison of L-acetylcarnitine with Placebo on the Attention Deficit Hyperactivity Disorder in Fragile X Syndrome Boys
M. Giulia Torrioli, Silvia Vernacotola, Laura Peruzzi, Elisabetta Tabolacci, Montserrat Mila, Roberto Militerni, Sebastiano Musumeci, Feliciano J. Ramos, Marìa Frontera, Giovanni Sorge, Elisabetta Marzullo, Giusi Romeo, Louis Vallee, Edvige Veneselli, Elena Cocchi, Eleonora Garbarino, Umberto Moscato, Pietro Chiurazzi, Stefania D'Iddio, Menotti Calvani, Giovanni Neri
American Journal of Medical Genetics Part A, April 1st, 2008
DOI: 10.1002/ajmg.a.32268
State-To-State Differences In Quality Of Care Revealed By New Child Health Data
The Data Resource Center, keeper of this data, is a project of the Child and Adolescent Health Measurement Initiative housed in the Oregon Health & Science University Department of Pediatrics
A new government survey reveals children with special health care needs, such as autism, attention deficit hyperactivity disorder and asthma, don't consistently get the care that is federally recommended and that there are vast state-to-state differences. This is the first time standardized data at the national and state level has been available to the media and families in an easily accessible way.
"Parents of children with special health care needs often have obstacles in getting the information they need," said Christina Bethell, Ph.D., director of the Data Resource Center and associate professor of pediatrics in the Oregon Health & Science University School of Medicine. "The Maternal and Child Health Bureau, which designed and sponsored this survey, is committed to making this data available to the public, parents and media through the Data Resource Center, where you can find specific information about how your state fares in an easy-to-use Web site."
The survey is especially significant because it finds that more than 10 million American children have a special health care need -- that amounts to one in five households with children younger than 18. While states perform well in specific areas, no state is providing all of the recommended care to the majority of their children with special health care needs.
These differences found between states are cause for concern. For instance, in Kansas, just 28 percent of children younger than 12 with special health needs receive care that meets all five of the performance measures recommended by the federal government. By contrast, in Montana, only 13 percent of children with special health care needs meet all five of these measures. For adolescents, the best-performing state was New Hampshire and the worst was Mississippi.
In addition to state-by-state comparisons, the Data Resource Center Web site housed at OHSU allows media and families to search by other factors such as income or race/ethnicity. The public and others are encouraged to take advantage of the federally funded Data Resource Center for Child and Adolescent Health Web site at http://www.childhealthdata.org/.
Additional findings of the survey include:
* While nearly all children with special health care needs have some type of health insurance, 3.3 million are underinsured. The health benefits packages for one-third of currently insured children with special health care needs do not adequately cover needed services or have reasonable co-pays.
* Only one-third of children with special needs who are Hispanic or who are living below the federal poverty level get coordinated and family-centered care from their health care providers.
* Out-of-pocket medical costs exceeded $1,000 for 1 in 5 children with special health care needs during 2005-06.
* Family members of nearly 2.5 million children with special health care needs had to cut back or stopped working because of their child's health conditions.
In the National Survey of Children with Special Health Care Needs, 40,465 families were interviewed, covering an average of 800 or more children with special health care needs younger than 18 in each of the 50 states and the District of Columbia.
A new government survey reveals children with special health care needs, such as autism, attention deficit hyperactivity disorder and asthma, don't consistently get the care that is federally recommended and that there are vast state-to-state differences. This is the first time standardized data at the national and state level has been available to the media and families in an easily accessible way.
"Parents of children with special health care needs often have obstacles in getting the information they need," said Christina Bethell, Ph.D., director of the Data Resource Center and associate professor of pediatrics in the Oregon Health & Science University School of Medicine. "The Maternal and Child Health Bureau, which designed and sponsored this survey, is committed to making this data available to the public, parents and media through the Data Resource Center, where you can find specific information about how your state fares in an easy-to-use Web site."
The survey is especially significant because it finds that more than 10 million American children have a special health care need -- that amounts to one in five households with children younger than 18. While states perform well in specific areas, no state is providing all of the recommended care to the majority of their children with special health care needs.
These differences found between states are cause for concern. For instance, in Kansas, just 28 percent of children younger than 12 with special health needs receive care that meets all five of the performance measures recommended by the federal government. By contrast, in Montana, only 13 percent of children with special health care needs meet all five of these measures. For adolescents, the best-performing state was New Hampshire and the worst was Mississippi.
In addition to state-by-state comparisons, the Data Resource Center Web site housed at OHSU allows media and families to search by other factors such as income or race/ethnicity. The public and others are encouraged to take advantage of the federally funded Data Resource Center for Child and Adolescent Health Web site at http://www.childhealthdata.org/.
Additional findings of the survey include:
* While nearly all children with special health care needs have some type of health insurance, 3.3 million are underinsured. The health benefits packages for one-third of currently insured children with special health care needs do not adequately cover needed services or have reasonable co-pays.
* Only one-third of children with special needs who are Hispanic or who are living below the federal poverty level get coordinated and family-centered care from their health care providers.
* Out-of-pocket medical costs exceeded $1,000 for 1 in 5 children with special health care needs during 2005-06.
* Family members of nearly 2.5 million children with special health care needs had to cut back or stopped working because of their child's health conditions.
In the National Survey of Children with Special Health Care Needs, 40,465 families were interviewed, covering an average of 800 or more children with special health care needs younger than 18 in each of the 50 states and the District of Columbia.
ADHD Stimulant Treatment Has No Effect On Risk Of Future Substance Abuse
A new study finds that the use of stimulant drugs to treat children with ADHD has no effect on their future risk of substance abuse. The report, which will appear in the American Journal of Psychiatry and has been issued online, assessed more than 100 young men 10 years after they had been diagnosed with ADHD and is the most methologically rigorous analysis of any potential relationship between stimulant treatment and drug abuse.
"Because stimulants are controlled drugs, there has been a concern that using them to treat children would promote future drug-seeking behavior," says Joseph Biederman, MD, director of Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital (MGH), the study's lead author. "But our study found no evidence that prior treatment with stimulants was associated with either increased or decreased risk for subsequent drug or alcohol abuse."
Earlier studies examining whether stimulant treatment could increase substance abuse risk have had conflicting results, but they had several limitations, the authors note. Some only looked at adolescents, although young adults are at the highest risk of substance abuse. Others did not control for conditions such as conduct disorder that are know to be associated with substance abuse or may have looked at the impact on use of only a particular substance. The current study, designed to address those shortcomings, analyzed patterns of substance use in a group of young men 10 years after their original diagnosis with ADHD.
Of the 112 study participants, who ranged in age from 16 to 27 at the time of their reassessment, 73 percent had been treated with stimulants at some time, and 22 percent were currently receiving stimulant treatment. Study participants were interviewed using standard tools for assessment of psychiatric disorders and additional questions about their use of alcohol, tobacco products and a wide variety of psychoactive drugs. Study results, controlled for the presence of conduct diagnosis in the original diagnosis, showed no relationship between whether a participant ever received stimulant treatment and the risk of future tobacco use or alcohol or other substance abuse. The age at which stimulant treatment began and how long it continued also had no effect on substance use.
Earlier studies from the MGH Psychopharmacology group had suggested that stimulant treatment might actually reduce the risk of substance abuse in ADHD patients, who are at elevated risk to begin with, but that result did not hold up in the current analysis, which included some of the same participants. The researchers note that those shorter-term studies only followed participants into adolescence and that treatment may delay rather than totally prevent future substance use, something that should be investigated in the future.
"Our current results, combined with other investigations, should help reduce the concerns that clinicians and parents may have about the use of stimulants to treat ADHD in children," says Biederman, a professor of Psychiatry at Harvard Medical School. The current study was supported in part by grants from the National Institutes of Health, including the National Institute for Drug Abuse. Co-authors of the article are Michael Monuteaux, ScD, Thomas Spencer, MD, Timothy Wilens, MD, Heather MacPherson and Stephen Faraone, PhD, of the Research Program in Pediatric Psychopharmacology and Adult ADHD at MGH.
"Because stimulants are controlled drugs, there has been a concern that using them to treat children would promote future drug-seeking behavior," says Joseph Biederman, MD, director of Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital (MGH), the study's lead author. "But our study found no evidence that prior treatment with stimulants was associated with either increased or decreased risk for subsequent drug or alcohol abuse."
Earlier studies examining whether stimulant treatment could increase substance abuse risk have had conflicting results, but they had several limitations, the authors note. Some only looked at adolescents, although young adults are at the highest risk of substance abuse. Others did not control for conditions such as conduct disorder that are know to be associated with substance abuse or may have looked at the impact on use of only a particular substance. The current study, designed to address those shortcomings, analyzed patterns of substance use in a group of young men 10 years after their original diagnosis with ADHD.
Of the 112 study participants, who ranged in age from 16 to 27 at the time of their reassessment, 73 percent had been treated with stimulants at some time, and 22 percent were currently receiving stimulant treatment. Study participants were interviewed using standard tools for assessment of psychiatric disorders and additional questions about their use of alcohol, tobacco products and a wide variety of psychoactive drugs. Study results, controlled for the presence of conduct diagnosis in the original diagnosis, showed no relationship between whether a participant ever received stimulant treatment and the risk of future tobacco use or alcohol or other substance abuse. The age at which stimulant treatment began and how long it continued also had no effect on substance use.
Earlier studies from the MGH Psychopharmacology group had suggested that stimulant treatment might actually reduce the risk of substance abuse in ADHD patients, who are at elevated risk to begin with, but that result did not hold up in the current analysis, which included some of the same participants. The researchers note that those shorter-term studies only followed participants into adolescence and that treatment may delay rather than totally prevent future substance use, something that should be investigated in the future.
"Our current results, combined with other investigations, should help reduce the concerns that clinicians and parents may have about the use of stimulants to treat ADHD in children," says Biederman, a professor of Psychiatry at Harvard Medical School. The current study was supported in part by grants from the National Institutes of Health, including the National Institute for Drug Abuse. Co-authors of the article are Michael Monuteaux, ScD, Thomas Spencer, MD, Timothy Wilens, MD, Heather MacPherson and Stephen Faraone, PhD, of the Research Program in Pediatric Psychopharmacology and Adult ADHD at MGH.
Methylphenidate Can Have Sleep Benefits In Adults With ADHD
Treatment with methylphenidate (MPH) appears to have beneficial effects on sleep parameters in adults with ADHD, including increased sleep efficiency and a feeling of improved restorative value of sleep, according to a study published in the March 1 issue of the journal SLEEP.
The study, authored by Esther Sobanski, MD, of the Central Institute of Mental Health in Mannheim, Germany, focused on 34 non-medicated patients with ADHD, of whom 24 were without current psychiatric disorders, and 34 control subjects without current psychiatric disorders or psychotropic medication. Compared to the control group, all subjects in the ADHD sample displayed reduced sleep efficiency, with longer sleep onset latency and more nocturnal awakenings. They had altered sleep architecture, with a higher percentage of stage 1 and reduced percentage of REM sleep. Patients also showed a trend toward the reduced total REM density and elevated percentage of wakefulness after sleep onset.
According to Dr. Sobanski, this study showed that objective and subjective sleep problems in adults with ADHD are identical with sleep problems in children with ADHD, including longer sleep latencies, more nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and slightly decreased REM activity during sleep, although the clinical significance of the last findings remains to be clarified.
Dr. Sobanski added that the effects of MPH on sleep in adults with ADHD have never been shown before, and that this study demonstrated that it has beneficial effects on several sleep parameters in addition to the positive effects on daytime functioning.
"Under treatment with MPH, patients reported improved evening mood, less psychosomatic symptoms while falling asleep, reduced sleep latency, and fewer nocturnal awakenings during the night spent in our sleep laboratory," said Dr. Sobanski. "For the two weeks at home preceding their polysomnographic investigation, patients reported significantly better restorative value of sleep and a trend for less nocturnal awakenings compared to baseline."
MPH is a prescription stimulant commonly used to treat ADHD. It is also one of the primary drugs used to treat the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome.
A medication can provide much needed relief for someone with a severe sleep problem. This can promote good health and an overall sense of well being. But there is also a level of risk involved with the use of any medication. Many people will have some side effects.
Keep in mind that the same drug can affect people in different ways. A medication that helps someone else may not work for you. Your doctor can determine if a medication is the best treatment for your sleep problem. Never take a medication without the approval of your doctor.
It is recommended that adults get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:
* Follow a consistent bedtime routine.
* Establish a relaxing setting at bedtime.
* Get a full night's sleep every night.
* Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
* Do not bring your worries to bed with you.
* Do not go to bed hungry, but don't eat a big meal before bedtime either.
* Avoid any rigorous exercise within six hours of your bedtime.
* Make your bedroom quiet, dark and a little bit cool.
* Get up at the same time every morning.
The study, authored by Esther Sobanski, MD, of the Central Institute of Mental Health in Mannheim, Germany, focused on 34 non-medicated patients with ADHD, of whom 24 were without current psychiatric disorders, and 34 control subjects without current psychiatric disorders or psychotropic medication. Compared to the control group, all subjects in the ADHD sample displayed reduced sleep efficiency, with longer sleep onset latency and more nocturnal awakenings. They had altered sleep architecture, with a higher percentage of stage 1 and reduced percentage of REM sleep. Patients also showed a trend toward the reduced total REM density and elevated percentage of wakefulness after sleep onset.
According to Dr. Sobanski, this study showed that objective and subjective sleep problems in adults with ADHD are identical with sleep problems in children with ADHD, including longer sleep latencies, more nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and slightly decreased REM activity during sleep, although the clinical significance of the last findings remains to be clarified.
Dr. Sobanski added that the effects of MPH on sleep in adults with ADHD have never been shown before, and that this study demonstrated that it has beneficial effects on several sleep parameters in addition to the positive effects on daytime functioning.
"Under treatment with MPH, patients reported improved evening mood, less psychosomatic symptoms while falling asleep, reduced sleep latency, and fewer nocturnal awakenings during the night spent in our sleep laboratory," said Dr. Sobanski. "For the two weeks at home preceding their polysomnographic investigation, patients reported significantly better restorative value of sleep and a trend for less nocturnal awakenings compared to baseline."
MPH is a prescription stimulant commonly used to treat ADHD. It is also one of the primary drugs used to treat the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome.
A medication can provide much needed relief for someone with a severe sleep problem. This can promote good health and an overall sense of well being. But there is also a level of risk involved with the use of any medication. Many people will have some side effects.
Keep in mind that the same drug can affect people in different ways. A medication that helps someone else may not work for you. Your doctor can determine if a medication is the best treatment for your sleep problem. Never take a medication without the approval of your doctor.
It is recommended that adults get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:
* Follow a consistent bedtime routine.
* Establish a relaxing setting at bedtime.
* Get a full night's sleep every night.
* Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
* Do not bring your worries to bed with you.
* Do not go to bed hungry, but don't eat a big meal before bedtime either.
* Avoid any rigorous exercise within six hours of your bedtime.
* Make your bedroom quiet, dark and a little bit cool.
* Get up at the same time every morning.
Auriga Laboratories Announces FDA Approval Of Liquadd (TM) Oral Solution For The Treatment Of ADHD And Upcoming Product Launch
Auriga Laboratories, Inc. (OTCBB: ARGA), a specialty pharmaceutical company, announced today the FDA approval of Liquadd™ (dextroamphetamine sulfate) Oral Solution 5 mg/5 mL indicated for the treatment of Attention Deficit Disorder with Hyperactivity (ADHD).
The ADHD market is valued at over $3.5 billion dollars, with approximately 35 million prescriptions written annually. Dextroamphetamine is one of the most frequently prescribed molecules for the treatment of ADHD. "Liquadd™ will now provide physicians the proven efficacy of dextroamphetamine in a unique new oral solution form, with our key target consisting of the estimated 5% to 10% of patients that have difficulty swallowing pills. We are excited about expanding the treatment options available to physicians by providing a dextroamphetamine treatment regimen in an easy to swallow form previously not available in the market," said Rick Coulon, Executive Vice President of Sales and Marketing of Auriga.
Liquadd™ will be launched during the 2nd Quarter of 2008. "This new product further solidifies Auriga's commitment to enhance our product portfolio. Currently, we promote several of our products to psychiatrists and pediatricians, and Liquadd™ will be a highly synergistic addition to Auriga's current promotional efforts in these specialties," said Frank Greico, Chief Executive Officer of Auriga.
Amphetamines Have A High Potential For Abuse. Administration Of Amphetamines For Prolonged Periods Of Time May Lead To Drug Dependence And Must Be Avoided. Particular Attention Should Be Paid To The Possibility Of Subjects Obtaining Amphetamines For Non-Therapueitc Use Or Distribution To Others, And The Drugs Should Be Prescribed Or Dispensed Sparingly. Misuse Of Amphetamines May Cause Sudden Death And Serious Cardiovascular Adverse Events.
Do not use Liquad™ in patients with a history of drug abuse. Do not use during or within 14 days following administration of MAO inhibitors; hypertensive crisis may result. Liquadd™ is contraindicated in patients with advance arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma and agitated states.
About Auriga Laboratories™
Auriga Laboratories is a specialty pharmaceutical company building an extensive product portfolio of prescription brands targeting high growth therapeutic categories in the respiratory, dermatology, and psychiatry markets, which have combined annual revenues of more than fifteen billion dollars in the United States. The company's high-growth business model combines driving revenues through a primarily variable cost commission-based sales structure, acquisition of proven brand names, introduction of new brands, and a strategic development pipeline, all of which designed to enhance its growing direct relationships with physicians nationwide. Auriga's exclusive prescription and over-the-counter product portfolio includes Aquoral™ for the treatment of Xerostomia, Akurza™, Xyralid™, Zytopic™, and Coraz™ dermatology products, and the Zinx™ Extendryl®, and Levall® Families of products for relief of symptoms associated with a range of acute respiratory diseases.
The ADHD market is valued at over $3.5 billion dollars, with approximately 35 million prescriptions written annually. Dextroamphetamine is one of the most frequently prescribed molecules for the treatment of ADHD. "Liquadd™ will now provide physicians the proven efficacy of dextroamphetamine in a unique new oral solution form, with our key target consisting of the estimated 5% to 10% of patients that have difficulty swallowing pills. We are excited about expanding the treatment options available to physicians by providing a dextroamphetamine treatment regimen in an easy to swallow form previously not available in the market," said Rick Coulon, Executive Vice President of Sales and Marketing of Auriga.
Liquadd™ will be launched during the 2nd Quarter of 2008. "This new product further solidifies Auriga's commitment to enhance our product portfolio. Currently, we promote several of our products to psychiatrists and pediatricians, and Liquadd™ will be a highly synergistic addition to Auriga's current promotional efforts in these specialties," said Frank Greico, Chief Executive Officer of Auriga.
Amphetamines Have A High Potential For Abuse. Administration Of Amphetamines For Prolonged Periods Of Time May Lead To Drug Dependence And Must Be Avoided. Particular Attention Should Be Paid To The Possibility Of Subjects Obtaining Amphetamines For Non-Therapueitc Use Or Distribution To Others, And The Drugs Should Be Prescribed Or Dispensed Sparingly. Misuse Of Amphetamines May Cause Sudden Death And Serious Cardiovascular Adverse Events.
Do not use Liquad™ in patients with a history of drug abuse. Do not use during or within 14 days following administration of MAO inhibitors; hypertensive crisis may result. Liquadd™ is contraindicated in patients with advance arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma and agitated states.
About Auriga Laboratories™
Auriga Laboratories is a specialty pharmaceutical company building an extensive product portfolio of prescription brands targeting high growth therapeutic categories in the respiratory, dermatology, and psychiatry markets, which have combined annual revenues of more than fifteen billion dollars in the United States. The company's high-growth business model combines driving revenues through a primarily variable cost commission-based sales structure, acquisition of proven brand names, introduction of new brands, and a strategic development pipeline, all of which designed to enhance its growing direct relationships with physicians nationwide. Auriga's exclusive prescription and over-the-counter product portfolio includes Aquoral™ for the treatment of Xerostomia, Akurza™, Xyralid™, Zytopic™, and Coraz™ dermatology products, and the Zinx™ Extendryl®, and Levall® Families of products for relief of symptoms associated with a range of acute respiratory diseases.
ADHD Treatment For Children Different Between Specialties, Australia
Standardisation of diagnosis and treatment of ADHD is needed to ensure consistency between treatment by psychiatrists and paediatricians, according to a study in the latest Medical Journal of Australia.
Dr David Preen, Director of the Centre for Health Services Research at The University of Western Australia's School of Population Health, and his co-authors found that treatment of children with stimulant medicines for ADHD differed significantly between the two clinical specialties.
"Paediatricians treated more patients per prescriber, a greater proportion of boys, and a younger age demographic," Dr Preen says.
"Paediatricians relied less on combined psychotropic pharmacotherapy and prescribed lower stimulant doses than psychiatrists."
The authors suggest one reason the majority of children were seen by paediatricians was because referral pathways are more likely to direct child patients to paediatricians first.
Similarly, paediatricians may have treated more male patients because boys often exhibit disruptive behaviour that is more readily identified resulting in greater referral for treatment.
Differences in medication prescription between the two specialties may be because psychiatrists are more often referred children with psychiatric or behavioural disorders requiring multifaceted medication regimens.
"It is possible that the differences in prescribing medication are due to fundamental variations surrounding ADHD diagnosis and treatment as a result of differing levels of mental health training," Dr Preen says.
"A case could be made for the standardisation of diagnosis and treatment of ADHD within and between specialities."
"A state or national ADHD plan with consistency across clinical disciplines appears to have merit."
The Medical Journal of Australia is a publication of the Australian Medical Association.
Dr David Preen, Director of the Centre for Health Services Research at The University of Western Australia's School of Population Health, and his co-authors found that treatment of children with stimulant medicines for ADHD differed significantly between the two clinical specialties.
"Paediatricians treated more patients per prescriber, a greater proportion of boys, and a younger age demographic," Dr Preen says.
"Paediatricians relied less on combined psychotropic pharmacotherapy and prescribed lower stimulant doses than psychiatrists."
The authors suggest one reason the majority of children were seen by paediatricians was because referral pathways are more likely to direct child patients to paediatricians first.
Similarly, paediatricians may have treated more male patients because boys often exhibit disruptive behaviour that is more readily identified resulting in greater referral for treatment.
Differences in medication prescription between the two specialties may be because psychiatrists are more often referred children with psychiatric or behavioural disorders requiring multifaceted medication regimens.
"It is possible that the differences in prescribing medication are due to fundamental variations surrounding ADHD diagnosis and treatment as a result of differing levels of mental health training," Dr Preen says.
"A case could be made for the standardisation of diagnosis and treatment of ADHD within and between specialities."
"A state or national ADHD plan with consistency across clinical disciplines appears to have merit."
The Medical Journal of Australia is a publication of the Australian Medical Association.
Increased Risk For Eating Disorders Found In Adolescent Girls With ADHD
Girls with attention deficit hyperactivity disorder stand a substantially greater risk of developing eating disorders in adolescence than girls without ADHD, a new study has found.
"Adolescent girls with ADHD frequently develop body-image dissatisfaction and may go through repeating cycles of binge eating and purging behaviors that are common in bulimia nervosa," said University of Virginia psychologist Amori Yee Mikami, who led the study.
The findings appear in the current issue of the Journal of Abnormal Psychology.
ADHD is a disorder that affects about 5 percent of school-age children, and three times more boys than girls. Symptoms include a short attention span, poor organization, excessive talking, disruptive and aggressive behavior, restlessness and irritability. Many children with ADHD suffer through a range of problems, from poor grades to poor relations with parents and teachers, and more than half have serious problems making friends.
Because the disorder is far more common in boys, researchers are still learning its long-term effects on girls.
"Our finding suggests that girls may develop a broader range of problems in adolescence than their male counterparts," Mikami said. "They may be at risk for eating problems, which are a female-relevant domain of impairment. We know that eating disorders occur 10 times more often in girls than boys."
Additionally, Mikami noted that because ADHD is more common in boys, many girls with the disorder may go undiagnosed and untreated.
"Girls with ADHD may be more at risk of developing eating problems as adolescents because they already have impulsive behaviors that can set them apart from their peers," Mikami said. "As they get older, their impulsivity may make it difficult for them to maintain healthy eating and a healthy weight, resulting in self-consciousness about their body image and the binging and purging symptoms."
The study was conducted with an ethnically diverse sample of 228 girls in the San Francisco Bay area; 140 who had been diagnosed with ADHD and 88 matched comparison girls without ADHD. They were first assessed between the ages of 6 and 12 and again five years later.
"Adolescent girls with ADHD frequently develop body-image dissatisfaction and may go through repeating cycles of binge eating and purging behaviors that are common in bulimia nervosa," said University of Virginia psychologist Amori Yee Mikami, who led the study.
The findings appear in the current issue of the Journal of Abnormal Psychology.
ADHD is a disorder that affects about 5 percent of school-age children, and three times more boys than girls. Symptoms include a short attention span, poor organization, excessive talking, disruptive and aggressive behavior, restlessness and irritability. Many children with ADHD suffer through a range of problems, from poor grades to poor relations with parents and teachers, and more than half have serious problems making friends.
Because the disorder is far more common in boys, researchers are still learning its long-term effects on girls.
"Our finding suggests that girls may develop a broader range of problems in adolescence than their male counterparts," Mikami said. "They may be at risk for eating problems, which are a female-relevant domain of impairment. We know that eating disorders occur 10 times more often in girls than boys."
Additionally, Mikami noted that because ADHD is more common in boys, many girls with the disorder may go undiagnosed and untreated.
"Girls with ADHD may be more at risk of developing eating problems as adolescents because they already have impulsive behaviors that can set them apart from their peers," Mikami said. "As they get older, their impulsivity may make it difficult for them to maintain healthy eating and a healthy weight, resulting in self-consciousness about their body image and the binging and purging symptoms."
The study was conducted with an ethnically diverse sample of 228 girls in the San Francisco Bay area; 140 who had been diagnosed with ADHD and 88 matched comparison girls without ADHD. They were first assessed between the ages of 6 and 12 and again five years later.
Studying ADHD In Youth Of Different Races
The research in the article looked at childhood ADHD in underrepresented minorities, reviewing controversy around evaluation, diagnosis, and obstacles faced by families, ending with recommendations for assessment and treatment. Studying causes and consequences of untreated ADHD in minority children, the article considers:
* evaluating the child's physical and neurological responses
* assessing family history, including health issues
* building rapport between the family, the school and the health care provider
* recommendations, including psychotherapy, medication and behavioral interventions
* removing barriers such as lack of finances, health care providers and insurance
* maintaining cultural awareness and providing community educational campaigns
"A child of any race can be deeply affected by attention difficulties not only during school years but for a lifetime," writes coauthor Heather Hervey-Jumper. "It is tragic that many minority children are not provided with culturally sensitive assessments when we have effective treatments that can start these children on a track of progress. Untreated attention disorders can cause devastating results and we believe there are solutions for children of all ethnic backgrounds."
* evaluating the child's physical and neurological responses
* assessing family history, including health issues
* building rapport between the family, the school and the health care provider
* recommendations, including psychotherapy, medication and behavioral interventions
* removing barriers such as lack of finances, health care providers and insurance
* maintaining cultural awareness and providing community educational campaigns
"A child of any race can be deeply affected by attention difficulties not only during school years but for a lifetime," writes coauthor Heather Hervey-Jumper. "It is tragic that many minority children are not provided with culturally sensitive assessments when we have effective treatments that can start these children on a track of progress. Untreated attention disorders can cause devastating results and we believe there are solutions for children of all ethnic backgrounds."
Young Hyperactive Girls More Likely To Have Serious Problems As Adults
Young girls who are hyperactive are more likely to get hooked on smoking, under-perform in school or jobs and gravitate towards mentally abusive relationships as adults, according to a joint study by researchers from the Université de Montréal and the University College London (UCL).
The study, published in the latest issue of the Archives of General Psychiatry, followed 881 Canadian girls from the ages of six to 21 years to see how hyperactive or aggressive behaviour in childhood could affect early adulthood. The research team found that one in 10 girls monitored showed high levels of hyperactive behaviour. Another one in ten girls showed both high levels of hyperactive and physically aggressive behaviour.
"Few studies have looked at the consequences of aggressive and hyperactive behaviour in girls," said UCL lead researcher, Nathalie Fontaine. "This study shows that hyperactivity combined with aggressive behaviour in girls as young as six years old may lead to greater problems with abusive relationships, lack of job prospects and teenage pregnancies."
Girls with hyperactive behaviour (restlessness, jumping up and down, a difficulty keeping still or fidgety), while girls exhibiting physical aggression (fighting, bullying, kicking, biting or hitting) were found to have a high risk of developing adjustment problems in adulthood.
The study also found that hyperactive or aggressive girls were more vulnerable to grow into smoking, psychologically abusive partners and poor performance in school. What's more, females with both hyperactivity and physical aggression reported physical and psychological aggression towards their partner, along with early pregnancy and dependency on welfare.
"Our study suggests that girls with chronic hyperactivity and physical aggression in childhood should be targeted by intensive prevention programmes in elementary school, because they are more likely to have serious adjustment problems later in life," cautioned Dr. Fontaine. "Programmes targeting only physical aggression may be missing a significant proportion of at-risk girls. In fact, our results suggest that targeting hyperactive behaviour will include the vast majority of aggressive girls."
Not all hyperactive and physically aggressive girls, however, grow up with serious adjustment problems, according to co-author Richard Tremblay, a professor of psychology, pediatrics and psychiatry and director of the Research Unit on Children's Psycho-Social Maladjustment at the Université de Montréal and Sainte-Justine Hospital.
"We found that about 25 per cent of the girls with behavioural problems in childhood did not have adjustment problems in adulthood, although more than a quarter developed at least three adjustment problems," Dr. Tremblay said, noting additional research is needed into related social aggression such as rumour spreading, peer group exclusion. "We need to find what triggers aggression and how to prevent such behavioural problems."
"Girls' Hyperactivity and Physical Aggression During Childhood and Adjustment Problems in Early Adulthood - A 15-Year Longitudinal Study"
Nathalie Fontaine, PhD; René Carbonneau, PhD; Edward D. Barker, PhD; Frank Vitaro, PhD; Martine Hébert, PhD; Sylvana M. Côté, PhD; Daniel S. Nagin, PhD; Mark Zoccolillo, MD; Richard E. Tremblay, PhD
Arch Gen Psychiatry. 2008;65(3):320-328.
Click here to see Abstract online
Partners in research:
This study was funded by the CQRS, SSHRC, FCAR, NHRDP/CIHR, US NSF, US NIMH and NCOVR. The study was carried out by the Université de Montréal UCL, King's College London, Laval University, University of Quebec, McGill University, Carnegie Mellon University and Inserm in France.
About UCL:
Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. UCL is in the top 10 world universities in the 2007 THES-QS World University Rankings, and the fourth-ranked UK university in the 2007 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay.
About the Université de Montréal:
Deeply rooted in Montreal and dedicated to its international mission, the Université de Montréal is one of the top universities in the French-speaking world. Founded in 1878, the Université de Montréal today has 13 faculties and together with its two affiliated schools, HEC Montréal and École Polytechnique, constitutes the largest centre of higher education and research in Québec, the second largest in Canada, and one of the major centres in North America. It brings together 2,400 professors and researchers, accommodates more than 55,000 students, offers some 650 programs at all academic levels, and awards about 3,000 masters and doctorate diplomas each year. On the Web:
The study, published in the latest issue of the Archives of General Psychiatry, followed 881 Canadian girls from the ages of six to 21 years to see how hyperactive or aggressive behaviour in childhood could affect early adulthood. The research team found that one in 10 girls monitored showed high levels of hyperactive behaviour. Another one in ten girls showed both high levels of hyperactive and physically aggressive behaviour.
"Few studies have looked at the consequences of aggressive and hyperactive behaviour in girls," said UCL lead researcher, Nathalie Fontaine. "This study shows that hyperactivity combined with aggressive behaviour in girls as young as six years old may lead to greater problems with abusive relationships, lack of job prospects and teenage pregnancies."
Girls with hyperactive behaviour (restlessness, jumping up and down, a difficulty keeping still or fidgety), while girls exhibiting physical aggression (fighting, bullying, kicking, biting or hitting) were found to have a high risk of developing adjustment problems in adulthood.
The study also found that hyperactive or aggressive girls were more vulnerable to grow into smoking, psychologically abusive partners and poor performance in school. What's more, females with both hyperactivity and physical aggression reported physical and psychological aggression towards their partner, along with early pregnancy and dependency on welfare.
"Our study suggests that girls with chronic hyperactivity and physical aggression in childhood should be targeted by intensive prevention programmes in elementary school, because they are more likely to have serious adjustment problems later in life," cautioned Dr. Fontaine. "Programmes targeting only physical aggression may be missing a significant proportion of at-risk girls. In fact, our results suggest that targeting hyperactive behaviour will include the vast majority of aggressive girls."
Not all hyperactive and physically aggressive girls, however, grow up with serious adjustment problems, according to co-author Richard Tremblay, a professor of psychology, pediatrics and psychiatry and director of the Research Unit on Children's Psycho-Social Maladjustment at the Université de Montréal and Sainte-Justine Hospital.
"We found that about 25 per cent of the girls with behavioural problems in childhood did not have adjustment problems in adulthood, although more than a quarter developed at least three adjustment problems," Dr. Tremblay said, noting additional research is needed into related social aggression such as rumour spreading, peer group exclusion. "We need to find what triggers aggression and how to prevent such behavioural problems."
"Girls' Hyperactivity and Physical Aggression During Childhood and Adjustment Problems in Early Adulthood - A 15-Year Longitudinal Study"
Nathalie Fontaine, PhD; René Carbonneau, PhD; Edward D. Barker, PhD; Frank Vitaro, PhD; Martine Hébert, PhD; Sylvana M. Côté, PhD; Daniel S. Nagin, PhD; Mark Zoccolillo, MD; Richard E. Tremblay, PhD
Arch Gen Psychiatry. 2008;65(3):320-328.
Click here to see Abstract online
Partners in research:
This study was funded by the CQRS, SSHRC, FCAR, NHRDP/CIHR, US NSF, US NIMH and NCOVR. The study was carried out by the Université de Montréal UCL, King's College London, Laval University, University of Quebec, McGill University, Carnegie Mellon University and Inserm in France.
About UCL:
Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. UCL is in the top 10 world universities in the 2007 THES-QS World University Rankings, and the fourth-ranked UK university in the 2007 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay.
About the Université de Montréal:
Deeply rooted in Montreal and dedicated to its international mission, the Université de Montréal is one of the top universities in the French-speaking world. Founded in 1878, the Université de Montréal today has 13 faculties and together with its two affiliated schools, HEC Montréal and École Polytechnique, constitutes the largest centre of higher education and research in Québec, the second largest in Canada, and one of the major centres in North America. It brings together 2,400 professors and researchers, accommodates more than 55,000 students, offers some 650 programs at all academic levels, and awards about 3,000 masters and doctorate diplomas each year. On the Web:
Encouraging Preschool Kids To Talk To Themselves
Parents should not worry when their pre-schoolers talk to themselves; in fact, they should encourage it, says Adam Winsler, an associate professor of psychology at George Mason University. His recent study published in Early Childhood Research Quarterly showed that 5-year-olds do better on motor tasks when they talk to themselves out loud (either spontaneously or when told to do so by an adult) than when they are silent.
"Young children often talk to themselves as they go about their daily activities, and parents and teachers shouldn't think of this as weird or bad," says Winsler. "On the contrary, they should listen to the private speech of kids. It's a fantastic window into the minds of children."
In the study, "'Should I let them talk?': Private speech and task performance among preschool children with and without behavior problems," 78 percent of the children performed either the same or better on the performance task when speaking to themselves than when they were silent.
The study also showed that children with behavioral problems (such as those diagnosed with Attention Deficit Hyperactivity Disorder, or ADHD) tend to talk to themselves more often than children without signs of behavior problems.
"Given that kids with behavior concerns need more direction and control from adults, teachers may unnecessarily ask children to be quiet in classrooms out of fear that such speech coming from difficult-to-manage kids will lead to problem behavior," says Winsler. "Yet non-disruptive private speech would actually help these children as they develop. Therefore, teacher training and professional development efforts should suggest that teachers increase their tolerance level for this kind of private speech."
Winsler says that private speech is very common and perfectly normal among children between the ages of 2 and 5. As children begin talking to themselves, their communication skills with the outside world improve.
"This is when language comes inside," says Winsler. "As these two communication processes merge, children use private speech in the transition period. It's a critical period for children, and defines us as human beings."
Winsler also conducted the first-ever study looking at private speech in children with autism. He found that high-functioning autistic children talk to themselves often and in the same ways that non-autistic children do. Talking aloud also improved their performance on tasks.
"Children with autism have problems with their external social speech, so psychologists assumed that their private speech would also be impaired," says Winsler. "But this study shows that it is not the case - that autistic children use their private speech very effectively as a tool to help them with tasks.
"Young children often talk to themselves as they go about their daily activities, and parents and teachers shouldn't think of this as weird or bad," says Winsler. "On the contrary, they should listen to the private speech of kids. It's a fantastic window into the minds of children."
In the study, "'Should I let them talk?': Private speech and task performance among preschool children with and without behavior problems," 78 percent of the children performed either the same or better on the performance task when speaking to themselves than when they were silent.
The study also showed that children with behavioral problems (such as those diagnosed with Attention Deficit Hyperactivity Disorder, or ADHD) tend to talk to themselves more often than children without signs of behavior problems.
"Given that kids with behavior concerns need more direction and control from adults, teachers may unnecessarily ask children to be quiet in classrooms out of fear that such speech coming from difficult-to-manage kids will lead to problem behavior," says Winsler. "Yet non-disruptive private speech would actually help these children as they develop. Therefore, teacher training and professional development efforts should suggest that teachers increase their tolerance level for this kind of private speech."
Winsler says that private speech is very common and perfectly normal among children between the ages of 2 and 5. As children begin talking to themselves, their communication skills with the outside world improve.
"This is when language comes inside," says Winsler. "As these two communication processes merge, children use private speech in the transition period. It's a critical period for children, and defines us as human beings."
Winsler also conducted the first-ever study looking at private speech in children with autism. He found that high-functioning autistic children talk to themselves often and in the same ways that non-autistic children do. Talking aloud also improved their performance on tasks.
"Children with autism have problems with their external social speech, so psychologists assumed that their private speech would also be impaired," says Winsler. "But this study shows that it is not the case - that autistic children use their private speech very effectively as a tool to help them with tasks.
Stimulant Treatment For Young Children With ADHD Does Not Lead To Increased Risk Of Substance Abuse In Early Adulthood
Treatment of children with stimulant medications for attention-deficit/hyperactivity disorder (ADHD) does not increase the risk of substance abuse later in adolescence and early adulthood.
A new 17-year study of 176 boys, ages 6 to 12, who were treated with the stimulant medication methylphenidate, marketed as Ritalin and other brand names, confirmed previous findings that the risk of substance abuse during late adolescence and into early adulthood was lower in those receiving stimulant medications for their ADHD, compared with those not receiving stimulants. For the first time, however, the new study shows that risk of substance abuse was lowest in the group of boys who began stimulant treatment for ADHD at an earlier age.
The rate of drug abuse (excluding alcohol dependence or abuse) in those who had started taking methylphenidate early in the disease process at age 6 or 7 early was similar to the rate for the healthy comparison subjects. On the other hand, the rate of drug abuse was statistically significantly higher among those who had begun methylphenidate treatment at later ages, for example, between 8 and 12.
The new findings are detailed in a report which will be published online April 1, 2008, by The American Journal of Psychiatry (AJP),the official journal of the American Psychiatric Association. "Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood" is reported by Salvatore Mannuzza, Ph.D., Rachel G. Klein, Ph.D., Francisco X. Castellanos, M.D., and colleagues at the New York University Child Study Center and the Nathan S. Kline Institute for Psychiatric Research. The report will be available online under AJP in Advance and will appear in the May 2008 print edition of the journal.
Patients, their families, and the clinical community have all expressed concerns that stimulant treatment in early childhood might lead to later substance use disorders, an idea that is theoretically plausible. Stimulant medications and other drugs of abuse increase concentrations of the neurotransmitter dopamine in an area of the brain called the nucleus accumbens. Research has associated the nucleus accumbens with behavioral reinforcement, including the reinforcing actions of abused drugs.
"Several studies by Barkley, Biederman, Loney, and others have now convincingly demonstrated that stimulant treatment of children with ADHD does not contribute to the later development of drug abuse," said lead author Salvatore Mannuzza, Ph.D., who is a professor of child and adolescent psychiatry at the New York University School of Medicine. "Our findings suggest that stimulant treatment as early as ages 6 and 7 does not increase the risk for developing substance abuse or antisocial behaviors later in life, and may have long-term beneficial effects."
Two months ago, a different report by independent investigators also presented evidence against an association between stimulant treatment and substance abuse. That study, presented online under AJP in Advance on March 3, appears along with the new report in the May print edition of AJP. The previous study, by Joseph Biederman, M.D., and colleagues at Harvard Medical School and Massachusetts General Hospital, was a 10-year follow-up of boys with ADHD. Biederman and his colleagues followed 42 boys who were treated with stimulants and compared them with 39 who were not. In early adulthood, these two groups showed no significant differences in the rates of alcohol use disorders, nicotine dependence, or other substance-related disorders. Unlike the current report, in the Biederman study the age when stimulant treatment began was not related to the risk for later substance use disorders.
An editorial addressing both reports by Nora Volkow, M.D., director of the National Institute on Drug Abuse, and James Swanson, Ph.D., director of the Child Development Center at the University of California at Irvine, also appears in the May AJP print edition. Volkow and Swanson discuss the high risk for substance abuse among individuals with ADHD, pointing out that "[t]he evidence that current clinical practice does not increase later substance use or abuse is comforting. But the failure to document that childhood treatment with stimulant medication is able to decrease the high risk of substance abuse in adulthood is distressing. This highlights the need for the development of integrated treatments that target both ADHD and substance abuse."
A new 17-year study of 176 boys, ages 6 to 12, who were treated with the stimulant medication methylphenidate, marketed as Ritalin and other brand names, confirmed previous findings that the risk of substance abuse during late adolescence and into early adulthood was lower in those receiving stimulant medications for their ADHD, compared with those not receiving stimulants. For the first time, however, the new study shows that risk of substance abuse was lowest in the group of boys who began stimulant treatment for ADHD at an earlier age.
The rate of drug abuse (excluding alcohol dependence or abuse) in those who had started taking methylphenidate early in the disease process at age 6 or 7 early was similar to the rate for the healthy comparison subjects. On the other hand, the rate of drug abuse was statistically significantly higher among those who had begun methylphenidate treatment at later ages, for example, between 8 and 12.
The new findings are detailed in a report which will be published online April 1, 2008, by The American Journal of Psychiatry (AJP),the official journal of the American Psychiatric Association. "Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood" is reported by Salvatore Mannuzza, Ph.D., Rachel G. Klein, Ph.D., Francisco X. Castellanos, M.D., and colleagues at the New York University Child Study Center and the Nathan S. Kline Institute for Psychiatric Research. The report will be available online under AJP in Advance and will appear in the May 2008 print edition of the journal.
Patients, their families, and the clinical community have all expressed concerns that stimulant treatment in early childhood might lead to later substance use disorders, an idea that is theoretically plausible. Stimulant medications and other drugs of abuse increase concentrations of the neurotransmitter dopamine in an area of the brain called the nucleus accumbens. Research has associated the nucleus accumbens with behavioral reinforcement, including the reinforcing actions of abused drugs.
"Several studies by Barkley, Biederman, Loney, and others have now convincingly demonstrated that stimulant treatment of children with ADHD does not contribute to the later development of drug abuse," said lead author Salvatore Mannuzza, Ph.D., who is a professor of child and adolescent psychiatry at the New York University School of Medicine. "Our findings suggest that stimulant treatment as early as ages 6 and 7 does not increase the risk for developing substance abuse or antisocial behaviors later in life, and may have long-term beneficial effects."
Two months ago, a different report by independent investigators also presented evidence against an association between stimulant treatment and substance abuse. That study, presented online under AJP in Advance on March 3, appears along with the new report in the May print edition of AJP. The previous study, by Joseph Biederman, M.D., and colleagues at Harvard Medical School and Massachusetts General Hospital, was a 10-year follow-up of boys with ADHD. Biederman and his colleagues followed 42 boys who were treated with stimulants and compared them with 39 who were not. In early adulthood, these two groups showed no significant differences in the rates of alcohol use disorders, nicotine dependence, or other substance-related disorders. Unlike the current report, in the Biederman study the age when stimulant treatment began was not related to the risk for later substance use disorders.
An editorial addressing both reports by Nora Volkow, M.D., director of the National Institute on Drug Abuse, and James Swanson, Ph.D., director of the Child Development Center at the University of California at Irvine, also appears in the May AJP print edition. Volkow and Swanson discuss the high risk for substance abuse among individuals with ADHD, pointing out that "[t]he evidence that current clinical practice does not increase later substance use or abuse is comforting. But the failure to document that childhood treatment with stimulant medication is able to decrease the high risk of substance abuse in adulthood is distressing. This highlights the need for the development of integrated treatments that target both ADHD and substance abuse."
UK Food Standards Agency Cites Southampton Study In New Recommendation On Food Additives
The Food Standards Agency announced its decision to recommend to Ministers the phasing out of six colours in food and drink in the EU. These six colours - sunset yellow (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124) - had been shown to increase hyperactive behaviour of children in a study published by a University of Southampton research team in September 2007 (Jim Stevenson, Donna McCann, Edmund Sonuga-Barke and John Warner).
The FSA Council says that the basis for its recommendation is that:
-- the Southampton study is "a scientific study of the highest quality";
-- there is an accumulating body of evidence that there is an association between the consumption of certain food colours and children's behaviour;
-- all food additives must be safe for use in order to be approved. The available evidence now leaves uncertainty as to whether that safety can be confidently asserted;
-- the technological function of colours in food is about conferring a consumer choice benefit rather than a safety benefit; and
-- a significant part of the UK food industry is already moving away from the use of artificial food colours in responding to consumer demand.
The Southampton research team welcomes the recognition by the FSA of the case for removal of these colours from food. The possible role of food colours in exacerbating the level of hyperactivity in children has been mooted for over 30 years. There has been accumulating evidence for such an effect on children with more extreme levels of hyperactivity or attention deficit hyperactivity disorder (ADHD). The Southampton team has now completed two studies showing an effect in children from the general population. The first of these was conducted with colleagues from the David Hide Asthma and Allergy Research Centre on the Isle of Wight(1). The more recent study was published in September 2007 in the Lancet(2).
More research is needed to clarify the possible effects of sodium benzoate on behaviour, they say. This additive was included in the Isle of Wight and Southampton studies but its effects could not be isolated from that of the food colours and a double-blind placebo-controlled food challenge study of sodium benzoate alone is called for. There also needs to be a more detailed examination of the role of histamine release as a possible biological mechanism for the effects of colours on hyperactivity, they add.
"The change of regulation recommended by the FSA to remove these six colours will be welcomed by parents, especially those wanting to avoid exposing their children to artificial colours and who were trying to achieve this by monitoring the constituents of the food bought for the family," says study member Professor Jim Stevenson. "It must be emphasised that the eventual removal of these colours from food will not by itself eliminate hyperactivity and certainly not for all children. Artificial colours are just one of a wide range of social and biological influences on hyperactivity. However it is the view of the Southampton team that removing the colours from food will improve the health of children."
1 Bateman B, Warner JO, Hutchinson E, Dean T, Rowlandson P, Gant C, Grundy J, Fitzgerald C, Stevenson J (2004). The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood, 89, 506-511.
2 McCann D. Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchen E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO & Stevenson J (2007). Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo controlled trial. Lancet, 370, 1560-1567.
The FSA Council says that the basis for its recommendation is that:
-- the Southampton study is "a scientific study of the highest quality";
-- there is an accumulating body of evidence that there is an association between the consumption of certain food colours and children's behaviour;
-- all food additives must be safe for use in order to be approved. The available evidence now leaves uncertainty as to whether that safety can be confidently asserted;
-- the technological function of colours in food is about conferring a consumer choice benefit rather than a safety benefit; and
-- a significant part of the UK food industry is already moving away from the use of artificial food colours in responding to consumer demand.
The Southampton research team welcomes the recognition by the FSA of the case for removal of these colours from food. The possible role of food colours in exacerbating the level of hyperactivity in children has been mooted for over 30 years. There has been accumulating evidence for such an effect on children with more extreme levels of hyperactivity or attention deficit hyperactivity disorder (ADHD). The Southampton team has now completed two studies showing an effect in children from the general population. The first of these was conducted with colleagues from the David Hide Asthma and Allergy Research Centre on the Isle of Wight(1). The more recent study was published in September 2007 in the Lancet(2).
More research is needed to clarify the possible effects of sodium benzoate on behaviour, they say. This additive was included in the Isle of Wight and Southampton studies but its effects could not be isolated from that of the food colours and a double-blind placebo-controlled food challenge study of sodium benzoate alone is called for. There also needs to be a more detailed examination of the role of histamine release as a possible biological mechanism for the effects of colours on hyperactivity, they add.
"The change of regulation recommended by the FSA to remove these six colours will be welcomed by parents, especially those wanting to avoid exposing their children to artificial colours and who were trying to achieve this by monitoring the constituents of the food bought for the family," says study member Professor Jim Stevenson. "It must be emphasised that the eventual removal of these colours from food will not by itself eliminate hyperactivity and certainly not for all children. Artificial colours are just one of a wide range of social and biological influences on hyperactivity. However it is the view of the Southampton team that removing the colours from food will improve the health of children."
1 Bateman B, Warner JO, Hutchinson E, Dean T, Rowlandson P, Gant C, Grundy J, Fitzgerald C, Stevenson J (2004). The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood, 89, 506-511.
2 McCann D. Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchen E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO & Stevenson J (2007). Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo controlled trial. Lancet, 370, 1560-1567.
Medication Improves Driving Ability ADHD Patients
The use of the medication methylphenidate considerably improves the driving ability of people with ADHD. This was shown in research done by Joris Verster of Utrecht University, The Netherlands. The study will appear in the May 2008 issue of Journal of Psychopharmacology.
People with ADHD are often prescribed methylphenidate (brand name Ritalin) to counteract hyperactive behavior and attention dysfunction that may negatively affect their driving ability. Although little was known about the influence methylphenidate had on driving ability, a number of studies using driving simulators did indicate that the medication had a positive effect on driving ability.
Driving test
As part of his research, Verster had 18 ADHD patients take a test drive on a motorway under normal traffic conditions. The patients were asked to drive as safely as possible at a steady speed and fixed position on the road over a distance of 100 km. The test drives were done both with and without medication. The study shows that weaving of the car is much less when patients use their medication than when they drive without medication.
Verster's research shows methylphenidate improves driving ability of ADHD patients.
UTRECHT UNIVERSITY
Postbus 80125
3508 TC Utrecht
http://www.uu.nl
People with ADHD are often prescribed methylphenidate (brand name Ritalin) to counteract hyperactive behavior and attention dysfunction that may negatively affect their driving ability. Although little was known about the influence methylphenidate had on driving ability, a number of studies using driving simulators did indicate that the medication had a positive effect on driving ability.
Driving test
As part of his research, Verster had 18 ADHD patients take a test drive on a motorway under normal traffic conditions. The patients were asked to drive as safely as possible at a steady speed and fixed position on the road over a distance of 100 km. The test drives were done both with and without medication. The study shows that weaving of the car is much less when patients use their medication than when they drive without medication.
Verster's research shows methylphenidate improves driving ability of ADHD patients.
UTRECHT UNIVERSITY
Postbus 80125
3508 TC Utrecht
http://www.uu.nl
Heart Tests Should Be Carried Out Before Treatment With Stimulant Drugs For Children With ADHD
Children with attention deficit hyperactivity disorder (ADHD) should get careful cardiac evaluation and monitoring - including an electrocardiogram (ECG) - before treatment with stimulant drugs, a new American Heart Association statement recommends.
The scientific statement on Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs is published online in Circulation: Journal of the American Heart Association.
In 1999, concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants, but including stimulants, prompted an American Heart Association Scientific Statement: Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs. However, no specific cardiovascular monitoring was recommended for the use of stimulant medications. Warnings from the U. S. Food and Drug Administration (FDA) about stimulant medications and public concern for the safety of using them have prompted the current statement.
Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. These side effects are insignificant for most children with ADHD; however, they're an important consideration for children who have a heart condition. Certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn't pump blood through the body.
Doctors usually use a physical exam and the patient and family history to detect the risk for or presence of health problems before beginning new treatments, including prescribing medication. But some of the cardiac conditions associated with SCD may not be noticed in a routine physical exam. Many of these conditions are subtle and do not result in symptoms or have symptoms that are vague such as palpitations, fainting or chest pain.
That's why the statement writing group recommends adding an ECG to pre-treatment evaluations for children with ADHD. An ECG measures the heart's electrical activity and can often identify heart rhythm abnormalities such as those that can lead to sudden cardiac death.
"After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death," said Victoria L. Vetter, M.D., head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.
Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.
If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.
"Children can have undiagnosed heart conditions without showing symptoms," Vetter said. "Furthermore, a child's body changes constantly, with some conditions not appearing until adolescence."
If the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG after the child is over age 12 years, the statement says.
Widespread use of ECGs to detect heart abnormalities, including screenings for competitive athletes, is not routinely recommended by the American Heart Association. However, the writing group found using ECG screening in this specific population of children prescribed ADHD medication is medically indicated and reasonably priced. That said, however, lack of an ECG shouldn't mean that kids who need ADHD treatment can't get it.
"While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment," said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.
In 2003, an estimated 2.5 million children took medication for ADHD. Surveys indicate that ADHD affects an estimated 4 percent to 12 percent of all school-aged children in the United States, and it appears more common in children with heart conditions. Studies report that, depending on the specific cardiac condition, 33 percent to 42 percent of pediatric cardiac patients have ADHD, Vetter said. The number of undiagnosed children with heart conditions is unknown as routine heart screening is not performed, but Vetter said that a recent pilot study she presented at the American Heart Association's 2007 Scientific Session indicated that up to 2 percent of healthy school aged children had potentially serious undiagnosed cardiac conditions identified by an ECG.
Data from the FDA showed that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests and heart palpitations. Since February 2007, the FDA has required all manufacturers of drug products approved for ADHD treatment to develop Medication Guidelines to alert patients to possible cardiovascular risks.
Future studies are necessary to assess the true risk of SCD in association with stimulant drugs in children and adolescents with and without heart disease, Vetter said. However, studying SCD associated with drugs is difficult because the government's reporting system is voluntary, which means local data on these types of deaths isn't always reported nationally.
A registry of SCD events is necessary for further investigating this issue, the writing committee said. Such a registry would allow for a more accurate understanding of SCD, including the true incidence of it and the potential effectiveness of universal ECG testing and pre-participation screening questionnaires.
The statement writing committee said its recommendations are not intended to limit the appropriate use of stimulants in children with ADHD.
"Our intention is to provide the physician with some tools to help identify heart conditions in children with ADHD, and help them make decisions about the use of stimulant medications and the follow-up of children who take them," Vetter said. "The goal is to allow treatment of ADHD, while attempting to lower the cardiac risk of these products in susceptible children."
The scientific statement on Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs is published online in Circulation: Journal of the American Heart Association.
In 1999, concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants, but including stimulants, prompted an American Heart Association Scientific Statement: Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs. However, no specific cardiovascular monitoring was recommended for the use of stimulant medications. Warnings from the U. S. Food and Drug Administration (FDA) about stimulant medications and public concern for the safety of using them have prompted the current statement.
Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. These side effects are insignificant for most children with ADHD; however, they're an important consideration for children who have a heart condition. Certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn't pump blood through the body.
Doctors usually use a physical exam and the patient and family history to detect the risk for or presence of health problems before beginning new treatments, including prescribing medication. But some of the cardiac conditions associated with SCD may not be noticed in a routine physical exam. Many of these conditions are subtle and do not result in symptoms or have symptoms that are vague such as palpitations, fainting or chest pain.
That's why the statement writing group recommends adding an ECG to pre-treatment evaluations for children with ADHD. An ECG measures the heart's electrical activity and can often identify heart rhythm abnormalities such as those that can lead to sudden cardiac death.
"After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death," said Victoria L. Vetter, M.D., head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.
Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.
If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.
"Children can have undiagnosed heart conditions without showing symptoms," Vetter said. "Furthermore, a child's body changes constantly, with some conditions not appearing until adolescence."
If the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG after the child is over age 12 years, the statement says.
Widespread use of ECGs to detect heart abnormalities, including screenings for competitive athletes, is not routinely recommended by the American Heart Association. However, the writing group found using ECG screening in this specific population of children prescribed ADHD medication is medically indicated and reasonably priced. That said, however, lack of an ECG shouldn't mean that kids who need ADHD treatment can't get it.
"While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment," said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.
In 2003, an estimated 2.5 million children took medication for ADHD. Surveys indicate that ADHD affects an estimated 4 percent to 12 percent of all school-aged children in the United States, and it appears more common in children with heart conditions. Studies report that, depending on the specific cardiac condition, 33 percent to 42 percent of pediatric cardiac patients have ADHD, Vetter said. The number of undiagnosed children with heart conditions is unknown as routine heart screening is not performed, but Vetter said that a recent pilot study she presented at the American Heart Association's 2007 Scientific Session indicated that up to 2 percent of healthy school aged children had potentially serious undiagnosed cardiac conditions identified by an ECG.
Data from the FDA showed that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests and heart palpitations. Since February 2007, the FDA has required all manufacturers of drug products approved for ADHD treatment to develop Medication Guidelines to alert patients to possible cardiovascular risks.
Future studies are necessary to assess the true risk of SCD in association with stimulant drugs in children and adolescents with and without heart disease, Vetter said. However, studying SCD associated with drugs is difficult because the government's reporting system is voluntary, which means local data on these types of deaths isn't always reported nationally.
A registry of SCD events is necessary for further investigating this issue, the writing committee said. Such a registry would allow for a more accurate understanding of SCD, including the true incidence of it and the potential effectiveness of universal ECG testing and pre-participation screening questionnaires.
The statement writing committee said its recommendations are not intended to limit the appropriate use of stimulants in children with ADHD.
"Our intention is to provide the physician with some tools to help identify heart conditions in children with ADHD, and help them make decisions about the use of stimulant medications and the follow-up of children who take them," Vetter said. "The goal is to allow treatment of ADHD, while attempting to lower the cardiac risk of these products in susceptible children."
FDA Approves VYVANSE(TM) (lisdexamfetamine Dimesylate), The First And Only Once-Daily Prodrug Stimulant To Treat ADHD In Adults
Shire plc (LSE: SHP) (NASDAQ: SHPGY,), the global specialty biopharmaceutical company, announced that it has received approval from the U.S. Food and Drug Administration (FDA) for VYVANSE(TM) (lisdexamfetamine dimesylate), for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults. VYVANSE, introduced in July 2007 for the treatment of ADHD in children aged 6 to 12 years, is now the first and only once-daily prodrug stimulant approved to treat adults with ADHD. In its first eight months of availability, more than one million VYVANSE prescriptions have been filled.(2)
"We are very pleased with this FDA approval of the adult indication for VYVANSE," said Matthew Emmens, Chief Executive Officer of Shire. "This approval provides physicians a new treatment option that can help their adult patients by significantly improving their ADHD symptoms. VYVANSE has been well accepted by the medical community. With Shire's experience as a leader in the development and commercialization of ADHD medications, we are confident that this approval for adult patients will help continue to increase prescription share and volume of VYVANSE."
"Many people may think of ADHD as only a childhood disorder but the fact is that the majority of children diagnosed with ADHD still have symptoms as an adult. These symptoms can significantly impact them at work, home and in relationships, where they have important responsibilities," said David W. Goodman, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland. "The good news is that in a clinical study with adults, one daily dose of VYVANSE significantly improved ADHD symptoms of inattention, such as the ability to focus and organize, as well as hyperactivity and impulsivity."
Since VYVANSE became available for children with ADHD in July 2007, the product has achieved a U.S. market share of 6.9 percent based on weekly branded prescription volume VYVANSE formulary coverage has been positive, with the top six managed care plans now covering the product in a preferred formulary position.
VYVANSE is a therapeutically inactive prodrug, in which d-amphetamine is covalently bonded to l-lysine, and after oral ingestion it is converted to pharmacologically active d-amphetamine.(3) The conversion of VYVANSE to d-amphetamine is not affected by gastrointestinal pH and is unlikely to be affected by alterations in normal GI transit times.(4)
VYVANSE is currently available in three dosage strengths of 30 mg, 50 mg and 70 mg, each for once-daily dosing. Additional dosage strengths of 20 mg, 40 mg and 60 mg VYVANSE have also been FDA-approved and are expected to be available in pharmacies this summer.
"We are very pleased with this FDA approval of the adult indication for VYVANSE," said Matthew Emmens, Chief Executive Officer of Shire. "This approval provides physicians a new treatment option that can help their adult patients by significantly improving their ADHD symptoms. VYVANSE has been well accepted by the medical community. With Shire's experience as a leader in the development and commercialization of ADHD medications, we are confident that this approval for adult patients will help continue to increase prescription share and volume of VYVANSE."
"Many people may think of ADHD as only a childhood disorder but the fact is that the majority of children diagnosed with ADHD still have symptoms as an adult. These symptoms can significantly impact them at work, home and in relationships, where they have important responsibilities," said David W. Goodman, assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland. "The good news is that in a clinical study with adults, one daily dose of VYVANSE significantly improved ADHD symptoms of inattention, such as the ability to focus and organize, as well as hyperactivity and impulsivity."
Since VYVANSE became available for children with ADHD in July 2007, the product has achieved a U.S. market share of 6.9 percent based on weekly branded prescription volume VYVANSE formulary coverage has been positive, with the top six managed care plans now covering the product in a preferred formulary position.
VYVANSE is a therapeutically inactive prodrug, in which d-amphetamine is covalently bonded to l-lysine, and after oral ingestion it is converted to pharmacologically active d-amphetamine.(3) The conversion of VYVANSE to d-amphetamine is not affected by gastrointestinal pH and is unlikely to be affected by alterations in normal GI transit times.(4)
VYVANSE is currently available in three dosage strengths of 30 mg, 50 mg and 70 mg, each for once-daily dosing. Additional dosage strengths of 20 mg, 40 mg and 60 mg VYVANSE have also been FDA-approved and are expected to be available in pharmacies this summer.
Simplicity Of Working Memory Study Could Help With ADD And Other Attention Difficulties
A mind is a terrible thing to waste, but humans may have even less to work with than previously thought. University of Missouri researchers found that the average person can keep just three or four things in their "working memory" or conscious mind at one time. This finding may lead to better ways to assess and help people with attention-deficit and focus difficulties, improve classroom performance and enhance test scores.
"Most people believe the human mind is incredibly complex," said Jeff Rouder, associate professor of psychology in the MU College of Arts and Science. "We were able to use a relatively simple experiment and look at how many objects can be maintained in the human conscious mind at any one time. We found that every person has the capacity to hold a certain number of objects in his or her mind. Working memory is like the number of memory registers in a computer. Every object takes one register and each individual has a fixed number of registers. Limits in working memory are important because working memory is the mental process of holding information in a short-term, readily accessible, easily manipulated form where it can be combined, rearranged and stored more productively."
"We know that this kind of memory is really important in daily life," said co-author Nelson Cowan, psychology professor at Mizzou and an expert in working memory theory. "If a person is trying to do a math problem, there are partial results to keep in mind as that person solves the problem. When people are going to do any tasks in the house - like remembering the location of keys, turning off the stove, combining ingredients for a cake or recalling a phone number - they use working memory to keep in mind all the different aspects of the tasks."
Rouder said that to remember a series of items, people will use "chunking," or grouping, to put together different items. It can be difficult for someone to remember nine random letters. But if that same person is asked to remember nine letters organized in acronyms, IBM-CIA-FBI, for example, the person only has to use three slots in working memory. The difficulty in measuring working memory capacity is assuring that each item presented cannot be grouped together with others to form a larger chunk.
The researchers conducted a simple experiment involving an array of small, scattered, different-colored squares, to test their theory of working memory. The participant saw two, five or eight squares in the array, depending on the trial. The array was then "wiped out" by another display consisting of the same squares, minus the colors. Finally, the participant was shown a single color in one location and was asked to indicate whether the color in that spot had changed from the original array.
"How an individual does this test depends on working memory," Cowan said. "The results indicating that people have a fixed capacity provide evidence of simplicity in the mind. Many other theorists have suggested that the amount of working memory is circumstance-dependent, depends on a particular test, that there is nothing general we can get out of it, and that it's complex. We found the mind to be less complex in this case and that should be of great use in the future."
Working memory is closely related to attention because it requires attention to hold a number of items in mind at once. People with high working memory capacity have more focus. Those with a lower attention span are more easily distracted. This fact may help researchers help people with attention deficit disorders.
The researchers emphasized that the unique result of their study was that "the data were explained to surprising accuracy by a very simple mental model in which participants either used a register of working memory or, if all registers were full, guessed randomly."
"Most people believe the human mind is incredibly complex," said Jeff Rouder, associate professor of psychology in the MU College of Arts and Science. "We were able to use a relatively simple experiment and look at how many objects can be maintained in the human conscious mind at any one time. We found that every person has the capacity to hold a certain number of objects in his or her mind. Working memory is like the number of memory registers in a computer. Every object takes one register and each individual has a fixed number of registers. Limits in working memory are important because working memory is the mental process of holding information in a short-term, readily accessible, easily manipulated form where it can be combined, rearranged and stored more productively."
"We know that this kind of memory is really important in daily life," said co-author Nelson Cowan, psychology professor at Mizzou and an expert in working memory theory. "If a person is trying to do a math problem, there are partial results to keep in mind as that person solves the problem. When people are going to do any tasks in the house - like remembering the location of keys, turning off the stove, combining ingredients for a cake or recalling a phone number - they use working memory to keep in mind all the different aspects of the tasks."
Rouder said that to remember a series of items, people will use "chunking," or grouping, to put together different items. It can be difficult for someone to remember nine random letters. But if that same person is asked to remember nine letters organized in acronyms, IBM-CIA-FBI, for example, the person only has to use three slots in working memory. The difficulty in measuring working memory capacity is assuring that each item presented cannot be grouped together with others to form a larger chunk.
The researchers conducted a simple experiment involving an array of small, scattered, different-colored squares, to test their theory of working memory. The participant saw two, five or eight squares in the array, depending on the trial. The array was then "wiped out" by another display consisting of the same squares, minus the colors. Finally, the participant was shown a single color in one location and was asked to indicate whether the color in that spot had changed from the original array.
"How an individual does this test depends on working memory," Cowan said. "The results indicating that people have a fixed capacity provide evidence of simplicity in the mind. Many other theorists have suggested that the amount of working memory is circumstance-dependent, depends on a particular test, that there is nothing general we can get out of it, and that it's complex. We found the mind to be less complex in this case and that should be of great use in the future."
Working memory is closely related to attention because it requires attention to hold a number of items in mind at once. People with high working memory capacity have more focus. Those with a lower attention span are more easily distracted. This fact may help researchers help people with attention deficit disorders.
The researchers emphasized that the unique result of their study was that "the data were explained to surprising accuracy by a very simple mental model in which participants either used a register of working memory or, if all registers were full, guessed randomly."
Sensory Treatment Reduces Autistic Mannerisms
Parents of children with autism are increasingly turning to sensory integration treatment to help their children deal with the disorder, and they're seeing good results. In 2007, 71 percent of parents who pursued alternatives to traditional treatment used sensory integration methods, and 91 percent found these methods helpful.
A new study from Temple University researchers, presented this month at the American Occupational Therapy Association's 2008 conference, found that children with autistic spectrum disorders who underwent sensory integration therapy exhibited fewer autistic mannerisms compared to children who received standard treatments. Such mannerisms, including repetitive hand movements or actions, making noises, jumping or having highly restricted interests, often interfere with paying attention and learning.
The children assigned to the sensory integration intervention group also reached more goals specified by their parents and therapists, said study authors Beth Pfeiffer, Ph.D., OTR/L, BCP, and Moya Kinnealey, Ph.D., OTR/L, from the Occupational Therapy Department in Temple University's College of Health Professions. The children made progress toward goals in the areas of sensory processing/regulation, social-emotional and functional motor tasks.
Sensory integration is the ability of the brain to properly integrate and adapt to the onslaught of information coming in through the senses. Dysfunction in this area makes it difficult for people with autism to adapt to and function like others in their environment. They may be hypersensitive to sound or touch, or unable to screen out distracting noise or clothing textures. Their response might be impulsive motor acts, making noises or running away.
Pfeiffer and Kinnealey are part of a group of researchers seeking to bring more scientific understanding to occupational therapy using a sensory integration approach.
"It's been heavily documented that children on the autistic spectrum have differences in the way they process sensory information and respond motorically," Pfeiffer said. "While more families are seeking out the sensory integration approach because of its positive results, more research is needed to scientifically establish its effectiveness."
Children receiving sensory integration therapy typically participate in sensory-based activities to enable them to better regulate their behavioral responses to sensations and situations that they find disturbing or painful. A child who is oversensitive to light touch may enjoy rolling and playing in a giant foam pillow, after which he might be more able to calmly explore, touch and play with other textures. This in turn makes self-care such as dressing and washing and classroom activities that require touch more manageable.
Interpreting the child's behavior as intentional and controllable and not recognizing the underlying cause and hypersensitivities is common in educational and home settings, but is an approach that Kinnealey discourages as stressful for the child.
The study took place this past summer at a camp near Allentown, Pa., for children with autism. Participants were between the ages of 6 and 12 years old and diagnosed with autism or Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS).
One group (17) received traditional fine motor therapy and the other group (20) received sensory integration therapy. Each child received 18 treatment sessions over a period of six weeks.
A statistician randomly assigned the participants to groups; this information was provided to the project coordinator at the site. The primary researchers were blinded to group assignment and served as evaluators before and after the study.
Parents were also blinded to the interventions that their children were assigned to and were not on site. However, there was the potential for the verbal children to talk about the activities that they participated in, which may have influenced the blinding for the parents.
For their outcome data, researchers used a series of scales that measure behavior. While both groups showed significant improvements, the children in the sensory integration group showed more progress in specific areas at the end of the study.
"This pilot study provided a foundation for how we should design randomized control trials for sensory integration interventions with larger sample sizes," Pfeiffer said. "Specifically, it identified issues with measurement such as the sensitivity of evaluation tools to measure changes in this population.
"Sensory integration treatment is a widely used intervention in occupational therapy. There is a real need for research such as randomized control trials to validate what we are doing with sensory integration in the profession," she added.
A new study from Temple University researchers, presented this month at the American Occupational Therapy Association's 2008 conference, found that children with autistic spectrum disorders who underwent sensory integration therapy exhibited fewer autistic mannerisms compared to children who received standard treatments. Such mannerisms, including repetitive hand movements or actions, making noises, jumping or having highly restricted interests, often interfere with paying attention and learning.
The children assigned to the sensory integration intervention group also reached more goals specified by their parents and therapists, said study authors Beth Pfeiffer, Ph.D., OTR/L, BCP, and Moya Kinnealey, Ph.D., OTR/L, from the Occupational Therapy Department in Temple University's College of Health Professions. The children made progress toward goals in the areas of sensory processing/regulation, social-emotional and functional motor tasks.
Sensory integration is the ability of the brain to properly integrate and adapt to the onslaught of information coming in through the senses. Dysfunction in this area makes it difficult for people with autism to adapt to and function like others in their environment. They may be hypersensitive to sound or touch, or unable to screen out distracting noise or clothing textures. Their response might be impulsive motor acts, making noises or running away.
Pfeiffer and Kinnealey are part of a group of researchers seeking to bring more scientific understanding to occupational therapy using a sensory integration approach.
"It's been heavily documented that children on the autistic spectrum have differences in the way they process sensory information and respond motorically," Pfeiffer said. "While more families are seeking out the sensory integration approach because of its positive results, more research is needed to scientifically establish its effectiveness."
Children receiving sensory integration therapy typically participate in sensory-based activities to enable them to better regulate their behavioral responses to sensations and situations that they find disturbing or painful. A child who is oversensitive to light touch may enjoy rolling and playing in a giant foam pillow, after which he might be more able to calmly explore, touch and play with other textures. This in turn makes self-care such as dressing and washing and classroom activities that require touch more manageable.
Interpreting the child's behavior as intentional and controllable and not recognizing the underlying cause and hypersensitivities is common in educational and home settings, but is an approach that Kinnealey discourages as stressful for the child.
The study took place this past summer at a camp near Allentown, Pa., for children with autism. Participants were between the ages of 6 and 12 years old and diagnosed with autism or Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS).
One group (17) received traditional fine motor therapy and the other group (20) received sensory integration therapy. Each child received 18 treatment sessions over a period of six weeks.
A statistician randomly assigned the participants to groups; this information was provided to the project coordinator at the site. The primary researchers were blinded to group assignment and served as evaluators before and after the study.
Parents were also blinded to the interventions that their children were assigned to and were not on site. However, there was the potential for the verbal children to talk about the activities that they participated in, which may have influenced the blinding for the parents.
For their outcome data, researchers used a series of scales that measure behavior. While both groups showed significant improvements, the children in the sensory integration group showed more progress in specific areas at the end of the study.
"This pilot study provided a foundation for how we should design randomized control trials for sensory integration interventions with larger sample sizes," Pfeiffer said. "Specifically, it identified issues with measurement such as the sensitivity of evaluation tools to measure changes in this population.
"Sensory integration treatment is a widely used intervention in occupational therapy. There is a real need for research such as randomized control trials to validate what we are doing with sensory integration in the profession," she added.
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