Delay in Brain Development Associated with ADHD

by Rick Nauert PhD on July 31st, 2012

Delay in Brain Development Associated with ADHDA new NIH study suggests a delay in brain development, rather than a total alteration in normal development, is the instigating factor for attention-deficit/hyperactivity disorder (ADHD).

In the current investigation, researchers expanded an earlier study that found thickening of the brain’s cerebral cortex is delayed in children diagnosed with ADHD.

The cerebral cortex is the folded gray tissue that makes up the outermost portion of the brain, covering the brain’s inner structures. This tissue has left and right hemispheres and is divided into lobes.

Each lobe performs specific and vitally important functions, including attention, cognition, language, and sensory processing.

Two dimensions of this structure are cortical thickness and cortical surface area, both of which mature during childhood as part of the normal developmental process.

In the study, published in Biological Psychiatry, researchers set out to measure whether surface area development is delayed in a similar manner to the thickening process. To do this they recruited 234 children with ADHD and 231 typically developing children.

Each child was scanned with neuroimaging equipment up to four times. The first scan was taken at about age 10, and the final scan was around age 17.

Using advanced neuroimaging technology, researchers were able to map the trajectories of surface area development at over 80,000 points across the brain. They found that the development of the cortical surface is delayed in frontal brain regions in children with ADHD.

For example, the typically developing children attained 50 percent peak area in the right prefrontal cortex at a mean age of 12.7 years, whereas the ADHD children didn’t reach this peak until 14.6 years of age.

“As other components of cortical development are also delayed, this suggests there is a global delay in ADHD in brain regions important for the control of action and attention,” said Dr. Philip Shaw, a clinician studying ADHD at the National Institute of Mental Health and first author of this study.

“These data highlight the importance of longitudinal approaches to brain structure,” commented Dr. John Krystal, Editor of Biological Psychiatry. “Seeing a lag in brain development, we now need to try to understand the causes of this developmental delay in ADHD.”

Investigators believe the finding suggests genes that control the timing of brain development are linked to development of ADHD.

As such, Shaw believes researchers should “search for genes that control the timing of brain development in the disorder, opening up new targets for treatment.”

Source: Elsevier

Comment Comments Off

Monkey Study Suggests Long-Term ADHD Drug Use Appears Safe

by Janice Wood on July 19th, 2012

Monkey Study Suggests Long-Term ADHD Drug Use Appears SafeDrugs used to treat Attention Deficit Hyperactivity Disorder (ADHD) do not appear to have long-term effects on the brain, according to new research done with monkeys.

Between 5 to 7 percent of elementary school children are diagnosed with ADHD, according to researchers from the Wake Forest Baptist Medical Center who undertook the new study.

Many of these children are treated with psychostimulant drugs, and while doctors and scientists know a lot about how these drugs work and their effectiveness, little is known about their long-term effects, the researchers note.

The research team, headed by Linda Porrino, Ph.D., professor and chair of the Department of Physiology and Pharmacology, and fellow professor Michael A. Nader, Ph.D., conducted a study with monkeys to determine what the long-lasting effects may be.

“We know that the drugs used to treat ADHD are very effective, but there have always been concerns about the long-lasting effects of these drugs,” she said. “We didn’t know whether taking these drugs over a long period could harm brain development in some way or possibly lead to abuse of drugs later in adolescence.”

The researchers studied 16 monkeys, whose ages were equivalent to 6- to 10-year-old humans. Eight animals were in the control group that did not receive any drug treatment. The other eight were treated with a therapeutic-level dose of an extended-release form of Ritalin or methylphenidate (MPH) for over a year, which is equivalent to about four years in children.

Imaging of the monkeys’ brains, both before and after the study, was conducted on both groups to measure brain chemistry and structure. The researchers also looked at developmental milestones to address concerns that ADHD drugs adversely affect physical growth.

Once the drug treatment and imaging studies were concluded, the monkeys were given the opportunity to self-administer cocaine over several months. Nader measured their propensity to acquire the drug and looked at what amounts to provide an index of vulnerability to substance abuse in adolescence.

The researchers found that there were no differences between the two groups — monkeys treated with Ritalin during adolescence were not more vulnerable to later drug use than the control animals.

“After one year of drug therapy, we found no long-lasting effects on the neurochemistry of the brain, no changes in the structure of the developing brain. There was also no increase in the susceptibility for drug abuse later in adolescence,” Porrino said.

“We were very careful to give the drugs in the same doses that would be given to children. That’s one of the great advantages of our study is that it’s directly translatable to children.

The research was conducted simultaneously with a “sister study” at John Hopkins with slightly older animals and different drugs and their findings were similar, she added.

“We feel very confident of the results because we have replicated each other’s studies within the same time frame and gotten similar results,” she said. “We think that’s pretty powerful and reassuring.”

This study is published online in the journal Neuropsychopharmacology.

Source: Wake Forest Baptist Medical Center

Comment Comments Off

Timing of ADHD Meds Influences Academic Performance

by Rick Nauert PhD on June 26th, 2012

Timing of ADHD Meds Influences Academic PerformanceNew research has found a correlation between the age at which children with attention-deficit hyperactivity disorder (ADHD) begin taking medication, and how well they perform on standardized tests.

Researchers from the Mount Sinai School of Medicine and University of Iceland discovered medication initiation during the fourth grade was linked to better academic performance than when ADHD meds were started in the sixth or seventh grade.

The study appears in the journal Pediatrics.

Researchers studied 11,872 Icelandic children born between 1994 and 1996. The children started medication for ADHD at different times between fourth and seventh grades.

The findings showed that children who began drug treatment within 12 months of their fourth-grade test declined 0.3 percent in math by the time they took their seventh-grade test, compared with a decline of 9.4 percent in children who began taking medication 25-to-36 months after their fourth-grade test.

The data also showed that girls benefited only in mathematics, whereas boys had marginal benefits in math and language arts.

“Children who began taking medications immediately after their fourth-grade standardized tests showed the smallest declines in academic performance,” said the study’s lead author Helga Zoega, Ph.D.

“The effect was greater in girls than boys and also greater for children who did poorly on their fourth grade test.”

While the use of medications for ADHD is relatively widespread in America (and to a lesser degree in Iceland), research tracing the stimulant use and academic performance is limited.

Source: The Mount Sinai Hospital / Mount Sinai School of Medicine

Comment Comments Off

Memory Practice Does Not Help ADHD or Improve IQ

by Rick Nauert PhD on June 1st, 2012

Memory Practice Does Not Help ADHD or Improve IQMemory training does not appear to be helpful for children suffering from dyslexia or attention-deficit/hyperactivity disorders.

Researchers also determined memory practice does not appear to provide significant benefit to healthy adults who want to improve school performance or enhance their cognitive skills.

“The success of working memory training programs is often based on the idea that you can train your brain to perform better, using repetitive memory trials, much like lifting weights builds muscle mass,” said the study’s lead author, Monica Melby-Lervåg, Ph.D., of the University of Oslo.

“However, this analysis shows that simply loading up the brain with training exercises will not lead to better performance outside of the tasks presented within these tests.”

The study is found online in the journal Developmental Psychology.

Working memory enables people to complete tasks at hand by allowing the brain to retain pertinent information temporarily. Activities to train working memory generally involve trying to get people to remember information presented to them while they are performing distracting activities.

For example, participants may be presented with a series of numbers one at a time on a computer screen. The computer presents a new digit and then prompts participants to recall the number immediately preceding. More difficult versions might ask participants to recall what number appeared two, three or four digits ago.

In the current review, researchers from the University of Oslo and University College London examined 23 peer-reviewed studies with 30 different comparisons of groups that met their criteria.

The studies were randomized controlled trials or experiments that involved some sort of working memory treatment and a control group. The studies involved a variety of participants including young children, children with cognitive impairments, such as ADHD, and healthy adults. Most of the studies had been published within the last 10 years.

Comparing and consolidating multiple studies in the form of a meta-analysis improves generalizability of the research, helping to translate research findings into practical advice.

Researchers determined that working memory training improved performance on tasks related to the training itself, but did not have an impact on more general cognitive performance such as verbal skills, attention, reading or arithmetic.

“In other words, the training may help you improve your short-term memory when it’s related to the task implemented in training, but it won’t improve reading difficulties or help you pay more attention in school,” said Melby-Lervåg.

The findings cast a dark shadow on the commercial, computer-based working memory training programs that conceptually have been developed to benefit students suffering from ADHD, dyslexia, language disorders, poor academic performance or other issues.

Some of the software claim to boost people’s IQs. These programs are widely used around the world in schools and clinics, and most involve tasks in which participants are given many memory tests that are designed to be challenging, the study said.

“In the light of such evidence, it seems very difficult to justify the use of working memory training programs in relation to the treatment of reading and language disorders,” said Melby-Lervåg.

“Our findings also cast strong doubt on claims that working memory training is effective in improving cognitive ability and scholastic attainment.”

Source: American Psychological Association

Memory mind illustration photo by shutterstock.

Comment Comments Off

Change of Diet Helps Some Kids with ADHD

by Rick Nauert PhD on April 25th, 2012

Change of Diet Helps Some Kids with ADHDA new report suggests a change in diet can relieve attention deficit hyperactivity disorder (ADHD) symptoms in some children.

ADHD is a developmental disorder characterized by the co-existence of attention problems and hyperactivity with symptoms typically beginning before the age of seven. ADHD is believed to affect about 3 to 5 percent of children globally and is diagnosed in about 2 to 16 percent of school aged children.

Although more research is necessary, some studies show that by changing their diet, it is possible to improve the condition for some ADHD children, said Kim Fleischer Michaelsen, Ph.D., from the Department of Human Nutrition at the University of Copenhagen.

“Several of the studies show, for example, that fatty acids from fatty fish moderate the symptoms. Other studies detect no effect. Elimination diets are also promising. These look at whether there is anything in the diet which the children cannot consume without adverse side effects.

“However, we still lack knowledge about which children with ADHD benefit from dietary changes, how positive the effect is in the long term and what the changes mean for children’s health.”

In the research report, investigators found that not all ADHD children benefit from changes to their diet, and that there are still many unknown factors. This finding is consistent with the premise that multiple factors may contribute to ADHD development.

Tine Houmann, M.D., a consultant at the Centre for Child & Adolescent Psychiatry, said:

“There are different types of ADHD, and the disturbance is probably due to both genetic and environmental factors. We know that children with ADHD react very differently to both medication and dietary changes. We therefore need to study which children benefit from dietary changes, and whether we can identify genetic or environmental factors that can predict this.”

Researchers believe future studies will allow clinicians to reduce the use of medications and/or substitute dietary advice for some children.

“It is promising that many research results indicate that dietary changes can help some ADHD children. However, it is crucial that bigger studies on dietary changes are conducted on children with ADHD to see how effective this is and how long the benefits last,” said Michaelsen.

Researchers stress that parents should always seek professional advice before changing their children’s diet.

Source: University of Copenhagen

Child in school balancing a pencil on his nose photo by shutterstock.

Comment Comments Off

ADHD Drug Shortage to End Soon

by Psych Central News Editor on April 6th, 2012

ADHD Drug Shortage to End SoonAfter months of Americans being unable to fill their drug prescriptions for medications that are commonly used to treat attention deficit hyperactivity disorder (ADHD), the U.S. Food and Drug Administration (FDA) said yesterday that the shortages are expected to end this month.

Many ADHD medications, such as Adderall, have been in short supply since 2011.

Two federal government agencies have been finger-pointing to lay the blame. The Drug Enforcement Administration (DEA) has the final say over the active ingredients in many ADHD medications, however, because the active ingredients are considered controlled substances. Active ingredients include amphetamine salts and methylphenidate.

The FDA only oversees the safety and efficacy of prescription drugs in the U.S.; it has no control over drug availability.

In 2011, the DEA steadfastly refused to raise the annual manufacturing quotas of these ingredients, suggesting it was the manufacturers to blame for the shortages. In January 2012, the DEA finally relented after increasing public pressure to fix the shortage, and raised manufacturers’ quotas by one-third.

The problem resulted in a shortage of lower-dose ADHD drugs, such as 5 mg pills and too many larger-dose versions of ADHD medications being available on the market that couldn’t be split into smaller doses.

In continuing to lay the blame at the feet of manufacturers, a DEA spokesperson said, “Companies take their allotments and produce various sorts of Adderall-type products — extended relief, extra strength — in different amounts.

“Sometimes their calculations are not what they had hoped.”

The DEA apparently assumes market conditions for medications remains static and has no allowances for market shortages.

The symptoms of attention deficit disorder include inattention, impulsivity and hyperactivity, or a combination of these. They must occur in more than one setting (e.g., at work or school and at home), and the symptoms usually must be present for more than six months in order for a diagnosis of ADHD to be made.

There are two options for people looking to fill their ADHD prescription. One is to call around to different pharmacies and drugstores, as you may find a pharmacy that has access to the drug while another one does not.

Second is to talk to your doctor about switching to a different ADHD medication in the meantime, as some medications are more readily available than others.

Source: FDA

Comment Comments Off

Multiple Forms of ADHD?

by Rick Nauert PhD on April 3rd, 2012

Multiple Forms of ADHD?New research may help explain the dramatic increase in attention-deficit hyperactivity disorder cases. The answer, according to Oregon Health & Science University researchers, is that ADHD is more than one disorder.

Investigators believe ADHD symptoms may actually represent an entire family of disorders, similar to the classification of various subtypes of cancer.

The research, which highlights various versions of the disease, each with differing impacts, demonstrates that there is likely not going to be a “one-size-fits-all” approach to treating patients.

Experts believe that new methods will be required to improve the diagnosis, prognosis and treatment of the disease.

Researchers believe scientists will need to shift their thinking when it comes to conducting research. New objectives should be directed at understanding the cause and impacts of ADHD. Moreover, experts believe that child behaviors should be examined in a more comprehensive format including non-affected children as well.

The research, led by OHSU scientists Damien Fair, Ph.D., and Joel Nigg, Ph.D., will be published online this week in the Proceedings of the National Academy of Sciences.

“Traditionally, physicians and psychologists have diagnosed patients through the use of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM,” explained Fair. “The problem with this approach is that it often relies on secondary observations of parents or teachers, where even if the descriptions are accurate, any given child may be behaving similarly, but for different reasons. Just as if there might be many reasons why someone might have chest pain, there might be many reasons why a child presents with ADHD.

“However, unlike diagnosing countless other well-understood diseases, there is no one test that can differentiate individuals when it comes to psychiatric and developmental conditions like ADHD.

“The data here highlights ways to recognize such individual variability and shows promise that we might be able to identify why any given child presents with ADHD, thus allowing for future examinations of more personalized treatments.”

In the study, Fair, Nigg and colleagues used an approach to isolate ADHD’s variations to allow a better understanding of the various disorder permutations. Their methodology compared test results for several cognitive skills among a large sampling of ADHD patients and a control group. The testing focused on memory, inhibition, attention, comprehension, and several other categories.

“We have known for some time that there is wide performance variation in both the ADHD group and the control group,” explained Nigg, “but this has never been formally described.”

Although, overall, the ADHD group did more poorly than the control group on all the measures, they noted that in some areas, certain control group patients outperformed the ADHD patients.

However, in those same areas, other ADHD patients outperformed the control group. Simply put, not all study participants – ADHD and control – consistently showed the same strengths and weakness.

Furthermore, researchers found that ADHD patients can be subcategorized depending on their deficits and relative strengths, showing unique subgroups among all children with ADHD.

Researchers believe some of the testing methods may lead to a more precise way in which to sub-categorize and perhaps diagnose children with ADHD. Psychologists and physicians could provide patients with a series of cognitive tests, determine their strengths and weaknesses, and subcategorize them based on these traits.

Source: Oregon State University

Comment Comments Off

Is ADHD Overdiagnosed?

by Rick Nauert PhD on April 2nd, 2012

Is ADHD Over-diagnosed?Depending on whom you ask, attention-deficit hyperactivity disorder (ADHD) is either over- or underdiagnosed. A new European study weighs in on the question suggesting gender, both of the clinician and of the client, plays a significant role in the diagnosis.

German researchers from Ruhr-Universität Bochum (RUB) and University of Basel  believe the study shows that child and adolescent psychotherapists and psychiatrists tend to give a diagnosis based on heuristics or rules of thumb, rather than adhering to recognized diagnostic criteria. This suggests that ADHD is over-diagnosed.

Clinical psychologists Drs. Silvia Schneider and Jürgen Margraf (both from RUB) and Dr. Katrin Bruchmüller (University of Basel) believe that boys in particular are substantially more often misdiagnosed compared to girls.

In the study, researchers presented one of four available case vignettes to 473 child and adolescent psychotherapists and psychiatrists across Germany. The practitioners were asked to give a diagnosis and a recommendation for therapy.

In three out of the four case vignettes, the described symptoms and circumstances did not fulfill ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable resulting in eight different case vignettes.

As the result, when comparing two identical cases with a different gender, the difference was clear: Sam has ADHD, Sarah doesn’t.

The researchers believe that many child and adolescent psychotherapists and psychiatrists seem to proceed heuristically and base their decisions on prototypical symptoms. The prototype is male and shows symptoms such as motoric restlessness, lack of concentration and impulsiveness.

In connection with the gender of the patient, these symptoms lead to different diagnoses. A boy with such symptoms, even he does not fulfill the complete set of diagnostic criteria, will receive a diagnosis for ADHD, whereas a girl will not.

Also the therapist’s gender plays a role in the diagnostic: Male therapists give substantially more diagnoses for ADHD than their female counterparts.

In Europe, as in the U.S., diagnoses for ADHD have exploded over the past two decades. Between 1989 and 2001, the number of diagnoses in German clinical practice increased by 381 percent.

The costs for ADHD medication, such as for the performance-enhancing psychostimulant methylphenidate (Ritalin), have grown nine times between 1993 and 2003. In Germany, the government health insurance company, Techniker, reports an increase of 30 percent in methylphenidate prescriptions for its clients between the ages of 6 and 18. Similarly, the daily dosage has increased by 10 percent on average.

Researchers say that despite these statistics, there is a remarkable lack of research on the diagnostics of ADHD. In spite of strong public interest, very few empirical studies have addressed the issue, Schneider and Bruchmüller noted.

Nevertheless, the current study shows that in order to avoid a misdiagnosis of ADHD and premature treatment, it is crucial for therapists not to rely on intuition but strictly adhere to well-defined, established diagnostic criteria.

The researchers recommend that standardized diagnostic instruments, such as diagnostic interviews be used to determine a definitive diagnosis.

Their research is published in the Journal of Consulting and Clinical Psychology.

Source: Ruhr-University Bochum

Comment Comments Off

ADHD Diagnoses Up 66 Percent Since 2000

by Rick Nauert PhD on March 20th, 2012

ADHD Diagnoses Up 66% Since 2000According to a new study, the number of children diagnosed with attention deficit hyperactivity disorder (ADHD) has increased by 66 percent over the past 10 years.

Researchers analyzed changes in the diagnosis of youth ADHD and treatment of the disorder from 2000 to 2010. Only youth under the age of 18, and cared for by office-based physicians, were included in the evaluation.

Northwestern University researchers also discovered that specialists, instead of primary care physicians, have begun treating an increasing number of these young patients.

Psychostimulants such as methylphenidate (Ritalin) remain the most common medication prescribed to children with ADHD. Psychostimulants were used in 96 percent of treatments in 2000 and 87 percent in 2010.

“ADHD is now a common diagnosis among children and teens,” said lead author Craig Garfield, M.D. “The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD, which may have caused more physicians to recognize symptoms and diagnose the disorder.”

Symptoms of ADHD, such as trouble paying attention and controlling impulsive behaviors and being overly active, can affect children and teens both academically and socially, Garfield said.

In the past decade several important regulatory and clinical changes regarding ADHD and the medications used to treat it have occurred, yet it was unknown how these factors have affected ADHD management, Garfield said.

For the study, Garfield and his team of researchers quantified ADHD diagnosis and treatment patterns among people under 18 using the IMS Health National Disease and Therapeutic Index. This is a nationally representative sample of office-based visits and included 4,300 office-based physicians in 2010.

According to the study, in 2010, 10.4 million children and teens under age 18 were diagnosed with ADHD at physician outpatient visits, versus 6.2 million in 2000.

Investigators were unable to explain the reduction in use of psychostimulants during the decade studied although they did note that there was not an increase in treatment with other, substitute medications.

Although the majority of children and teens with ADHD are still managed by primary physicians, researchers determined a significant shift away from primary doctors and toward specialists, such as pediatric psychiatrists.

“Recently, there’s been more public health advisories issued about problems or side effects of different ADHD medications,” Garfield said. “It may be that general pediatricians are shying away from treating patients themselves and instead rely on their specialist colleagues to provide the treatment and management of these medications.”

Given the short supply of psychiatrists specializing in pediatric ADHD, Garfield said this trend might make it difficult for many children to receive medical treatment for ADHD in the future.

The study will be published in the March/April issue of the journal Academic Pediatrics.

Source: Northwestern University

Doctor with child photo by shutterstock.

Comment Comments Off

ADHD Linked to Pregnant (Mouse) Mom’s Use of Cellphone

by Psych Central News Editor on March 16th, 2012

ADHD Linked to Pregnant (Mouse) Moms Use of CellphoneA new mouse study out of Yale suggests that cell phone radiation during pregnancy may trigger attention deficit symptoms in their unborn child.

But other researchers warn extrapolating results from a single mouse study to humans is unwarranted, and confuses the public. Attention deficit hyperactivity disorder (ADHD) is a disorder usually first diagnosed in childhood and is characterized by a child’s inability to pay attention or concentrate in multiple environments.

“We have shown that behavioral problems in mice that resemble ADHD are caused by cell phone exposure in the womb,” said Hugh Taylor, lead author and a member of the Yale School of Medicine’s Department of Obstetrics, Gynecology & Reproductive Sciences.

“The rise in behavioral disorders in human children may be in part due to fetal cellular telephone irradiation exposure,” he added.”

In the new study, Yale researchers exposed pregnant mice to radiation from muted and silenced cell phones, as well as active phone calls, during the study. These phones were placed above the cage of the pregnant mice during the entire duration of their pregnancy, about 19 days.

A control group of mice was kept under the same conditions, but exposed to phones that were deactivated and turned off during the entire duration of their pregnancy.

When the baby mice became adults, researchers measured their brain electrical activity. They also conducted a battery of psychological and behavioral tests in all the mice.

Researchers found that the mice that were exposed to radiation coming from the active, turned-on cellphones tended to be more hyperactive and had reduced memory capacity.

While the researchers acknowledge that further research is needed in humans, Taylor says he still thinks that limiting exposure of the fetus ‘seems warranted.’

“It’s probably safer for a pregnant woman not to carry their cell phone clipped to their belt or sleep with the phone near their abdomen unless it’s turned off,” suggested Taylor.

The study was published in the March 15 issue of Scientific Reports.

Source: Scientific Reports

Comment Comments Off