5 Ugly Lies About ADHD - Which May Be True

Over the years, a lot of rumors have been spread about ADHD, otherwise known as Attention-Deficit Hyperactivity Disorder. Some of these rumors have been exaggerated and many of them have been widely contested, especially by supporters of natural treatments for ADHD. However, the question remains, is it true? Is it true, what you have heard about ADHD? Here a list of truths that have been frequently debunked only to be defended again by higher authorities. What follows the statement is an objective analysis that may help you to form your own opinions as well as a comment on natural cures for ADHD.

1. ADHD Is a Personality Disorder

According to the psychiatric community, ADHD is a neurological disorder, one that can stunt the development of an impressionable mind. Others claim that ADHD is not a disorder but merely a personality trait, and perhaps even a "blessing" since ADHD children show unusual potential in creativity and even intuitiveness. What should you conclude? You must be aware of ADHD and its potential to affect the life of your child, whether you think it is a disorder or not. If your child frequently has problems with others because of ADHD-like symptoms then they can't be ignored. Any obvious problems should be addressed, even if you choose not to pursue medication. Natural treatments for ADHD have recently emerged as a popular alternative to chemical-based drugs.

2. Children will outgrow ADHD.

Some believe that ADHD is mostly a youth-prevalent phase that adults grow out of and eventually become well-adjusted, "normal" individuals. Evidence suggests that ADHD will affect a person for their entire life. However, this should not imply that ADHD is a curse or even a sickness. A child may be able to cope fairly well with ADHD, even if he does require special attention when learning in school. Natural treatments for ADHD have frequently been recommended, as they tend to help maintain positive feelings without taking away any of the energy and imagination that usually accompanies this "disorder."

3. ADHD is Over-Diagnosed

This is an argument you hear often, usually coming from naturalists and concerned parents (and even religious groups) who have become very anti-psychiatry in their beliefs. Obviously, in many cases it is true that histrionic parents have overreacted to symptoms of ADHD and ordered strong medication as treatment. Unfortunately, some of these parents have ignored the child's development, believing that somehow that the drugs would take care of the child's problems. Medication, and even natural cures for ADHD in homeopathic therapy, should never be considered cures to this condition. Proper treatment consists of behavioral modification as well as natural treatments for ADHD, which may only consist of dieting.

4. Poor Parenting Causes ADHD

Is it true that poor parenting causes ADHD? Again, this could be a yes or no answer, depending on circumstances. ADHD is a disorder and often times has genetic origins. On the other hand, when bad parenting is present (for example parents who are overly critical, overly negative or very stern) then this can exacerbate the ADHD condition and increase the risk of comorbid (or related disorders). For the best results, when ADHD is present, you try to be the best parent possible so that you can teach your child coping mechanisms. Natural treatments for ADHD may also help in this regard, especially if there are strong symptoms of ADHD and a defiant oppositional disorder.

5. Drugs are unnecessary and homeopathic natural cures for ADHD merely bring about "placebo" effects.

There are many parents who state that natural treatments for ADHD have helped their children tremendously, while others continue to advocate medicine, and others that state that dieting is all that is necessary. The truth of the matter is that no one knows what will work for your child-only you will, after you try it.

To know more about natural treatments for ADHD, go to this web site: http://www.curing-adhd-naturally.com

My name is Einar Eskeland. I am a norwegian medical doctor and homoeopath. I promote several high quality sources of knowledge and products for self improvement, health, evolution and growth as a part of my practice as a doctor, and as a help for my patients in their struggle to regain health and balance.

http://www.curing-adhd-naturally.com/

Placebo Effects In Caregivers May Change Behavior Of Children With ADHD

ScienceDaily (June 30, 2009) ? Stimulant medications, such as Ritalin and Adderall, are the accepted treatment to stem hyperactivity in children with attention deficit-hyperactive disorder (ADHD) and improve their behavior.

Now a recent review of research by University at Buffalo pediatric psychologists suggests that such medication, or the assumption of medication, may produce a placebo effect -- not in the children, but in their teachers, parents or other adults who evaluate them.

A placebo effect is a positive change in symptoms or behavior after a patient receives a "fake" medication or procedure; in other words, the belief can become the medicine. In this case, the review suggested that when caregivers believed their ADHD patients were receiving ADHD medication, they tended to view those children more favorably and treat them more positively, whether or not medication was actually involved.

"The act of administering medication, or thinking a child has received medication, may induce positive expectancies in parents and teachers about the effects of that medication, which may, in turn, influence how parents and teachers evaluate and behave toward children with ADHD," said UB researcher Daniel A. Waschbusch, Ph.D., lead author of the review.

"We speculate that the perception that a child is receiving ADHD medication may bring about a shift in attitude in a teacher or caregiver. They may have a more positive view of the child, which could create a better relationship. They may praise the child more, which may induce better behavior."

Such a placebo effect in caregivers could have both good and not-so-good results, Waschbusch added. "If teachers treat children more positively if they think they are on medication, that is a good thing. But if the child's medication is increased because caregivers think it is effective, that may not be a good thing."

Waschbusch is an associate professor of psychology in the Department of Pediatrics at UB and conducts his research in UB's Center for Children and Families. The study was published in a recent issue of the Journal of Development & Behavioral Pediatrics.

Waschbusch and colleagues reviewed existing studies that evaluated whether placebos produce significant changes in children with ADHD and assessed four possible ways placebos could have an effect:

Through the child's expectations of a change -- The analysis showed that any change in children's behavior was a direct result of the medication, not the expectation.By producing changes in how caregivers perceive children with ADHD when they think they are on medication -- The researchers determined the studies suggested that this may be a viable mechanism for the placebo effect.By producing changes in how caregivers behave toward children with ADHD who they think are on medication, which in turn, could produce changes in the child -- The analysis supported this hypothesis.Placebos may operate through classical conditioning. "For example," explained Waschbusch, "if a parent routinely gives their child active medication in pill form and then sees their child's behavior immediately improve, they will likely learn to connect administering a pill with improved child behavior. This learned connection could then be generalized to administering a placebo pill."

Waschbusch said the next step in this investigation could be a study that observes parents and children interacting under three different conditions: after children received a pill with real medication, after children received a pill with fake medication (a placebo) and after children didn't receive any pill.

"Comparing these conditions would provide information about the effects of actual medication relative to just getting a placebo," he said.

William E. Pelham, Jr., Ph.D., and James Waxmonsky, M.D., from UB, and Charlotte Johnston, Ph.D., from the University of British Columbia, are co-authors on the study.

When conducting this review, the authors were supported partially by grants from institutes within the U.S. Department of Health and Human Services, the U.S. Department of Education and the Eli Lilly Corporation.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University at Buffalo.

Note: If no author is given, the source is cited instead.

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Exposure to lead, tobacco smoke raises risk of ADHD

ScienceDaily (Nov. 23, 2009) ? Children exposed prenatally to tobacco smoke and during childhood to lead face a particularly high risk for ADHD, according to research done at Cincinnati Children's Hospital Medical Center.

The study estimates that up to 35 percent of ADHD cases in children between the ages of 8 and 15 could be reduced by eliminating both of these environmental exposures. This could translate into up to 800,000 children

"Tobacco and lead exposure each have their own important adverse effect," says Tanya Froehlich, M.D., a physician in the Division of Developmental and Behavioral Pediatrics at Cincinnati Children's and the study's lead author. "But if children are exposed to both lead and prenatal tobacco, the combined effect is synergistic."

The study is to be published online Nov. 23 by Pediatrics.

"Although we tend to focus on ADHD treatment rather than prevention, our study suggests that reducing exposures to environmental toxicants might be an important way to lower rates of ADHD," says Robert Kahn, MD, MPH., a physician and researcher at Cincinnati Children's and the study's senior author.

The researchers found that children exposed prenatally to tobacco smoke were 2.4 times more likely to have ADHD. Those with blood lead levels in the top third had a 2.3 fold increased likelihood of ADHD, despite levels well below the Centers for Disease Control action level of 10 micrograms per deciliter. Dr. Froehlich and her colleagues found the risk of ADHD more than eight times higher for children exposed to both tobacco and lead compared to unexposed children.

The study is based on data of 8 to 15 years olds gathered between 2001 and 2004 from the National Health and Nutrition Examination Survey (NHANES) from the National Center for Health Statistics at the Centers for Disease Control and Prevention. NHANES is a nationally representative sample of the United State population, designed to collect information about the health and diet of people in the U.S.

Prenatal tobacco exposure was measured by maternal reports of cigarette use during pregnancy. Lead exposure was assessed using current blood lead level. Some 8.7 percent of the 3,907 children in the study met diagnostic criteria for ADHD. The diagnosis for ADHD was based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, considered the "gold standard" for defining specific mental health conditions.

The study was funded by grants from the National Institutes of Health and the Academic Pediatrics Association, and a Robert Wood Johnson Generalist Physician Faculty Scholars Award.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Cincinnati Children's Hospital Medical Center, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

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Did Mozart Really Have ADHD? History Of Hyperactivity Off-base, Says Researcher

ScienceDaily (May 28, 2009) ? A Canadian researcher working in the U.K. says doctors, authors and educators are doing hyperactive children a disservice by claiming that hyperactivity as we understand it today has always existed.

Matthew Smith says not only is that notion wrong, it misleads patients, their parents and their physicians. Smith, who is from Edmonton, is finishing up his PhD at the Centre for Medical History at the University of Exeter.

Hyperactivity disorder, or ADHD, is currently the most commonly diagnosed childhood psychiatric disorder, says Smith, and millions of children are prescribed drugs such as Ritalin to treat it. Yet prior to the 1950s, it was clinically and culturally insignificant.

He argues in a paper presented at the Congress for the Humanities and Social Sciences taking place at Ottawa's Carleton University this week, that hyperactivity disorder as we understand it today is a modern construct that was first described as a disorder in 1957.

Before that, Smith says hyperactive behaviour existed ? but it wasn't always thought of as a disorder or pathology worth treating.

However, Smith says many today assert that hyperactivity is a universal phenomenon, and say evidence of hyperactivity can be seen in historical figures such as Mozart or Einstein. Smith argues that hyperactivity as we understand it is rooted in social, cultural, political and economic changes of the last half century.

"When history is extended back beyond 1957, it overlooks all the social factors that contributed to the idea that children were hyperactive ? and that that was a problem," he says.

"We need to refocus the history of hyperactivity on the period starting from the late 1950s and 60s. "By doing so, we start to understand why people started to think there was a problem with children, why they thought that problem needed to be fixed, and why it became acceptable to fix that problem with drugs."

Smith says that whether you consider hyperactivity a disease worth treating often depends on context ? and the context changed in the late 1950s when the U.S. refocused its education system in response to the space race.

"If a child's playing soccer, there's a chance hyperactivity isn't going to be a problem. But if they are stuck in a classroom, it is a problem.

"We have to look at the social and historical factors that created the idea that children were distractible and that these were pathologies that needed to be treated.

"For patients and their parents, what this means is that the process by which their children are diagnosed is not rooted in a long history. If they understand that, they can develop the tools to question the diagnosis."

Organized by the Canadian Federation for the Humanities and Social Sciences, Congress 2009 brings together over 8,000 researchers from Canada and around the world.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Canadian Federation for the Humanities and Social Sciences, via EurekAlert!, a service of AAAS.

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ADHD Tied To Obesity In Adulthood

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Main Category: ADHD
Also Included In: Obesity / Weight Loss / Fitness;??Pediatrics / Children's Health
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Researchers who followed more than 15,000 young Americans from adolescence into adulthood found that the symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood are linked to an increased risk of obesity in adulthood, and that the greater the symptoms, the higher the risk.

The study was the work of researchers from Duke University Medical Center in Durham, North Carolina, and was published in the advanced online issue of the International Journal of Obesity in late October.

Co-author Dr Scott Kollins, who is director of the Duke ADHD Program, told the press that this was the first study to show that it's not just the diagnosis of ADHD that matters, but the symptoms, that is the amount of hyperactivity, inattention and impulsivity of the behaviors associated with ADHD.

Lead author Dr Bernard Fuemmeler, who is director of the Pediatric Psychology & Family Health Promotion Lab in the Department of Community and Family Medicine at Duke said "it's a dose effect":

"We showed that as the number of symptoms increase, the prevalence of obesity also increases," he added.

The researchers found that having three or more of any of the symptoms of ADHD significantly increased the odds of being obese.

For the study, they examined data on 15,197 adolescents taking part in the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample (including Hawaii and Alaska) of American adolescents followed from 1995 when they were in high school (in grades 7 to 12) to 2009, when they were in their mid-20s to early 30s.

Add Health has an enormous set of data, gathered in four "waves" that included comprehensive in-home interviews, physical measurements, and biological specimen collection.

During wave III, which took place in 2001-2002, when the participants on average were in their early 20s, they were also asked questions on "Retrospective ADHD", which essentially asked them about any ADHD symptoms, such as inattention, hyperactivity and impulsivity, in their childhood when they were aged between 5 and 12.

Fuemmeler and colleagues looked for any links between these retrospective ADHD symptoms of childhood and physical measurements in adulthood, which were taken in wave IV of Add Health, conducted in 2007 and 2008, when the participants were aged beween 24 and 32.

They found that: The number of inattentive and hyperactive/impulsive symptoms in childhood went up in line with increasing waist size, BMI, and blood pressure (diastolic and systolic) in adulthood, such that more symptoms were linked with higher waist size, BMI and blood pressure.
After taking into account demographics, exercise, use of alcohol and tobacco, and depressive symptoms, participants who had three or more inattentive and hyperactive/impulsive symptoms in childhood had the highest odds of being obese in adulthood.
Among participants with only hyperactive or impulsive symptoms in childhood, the odds of being obese in adulthood was 63 per cent.
Hyperactive or impulsive symptoms were also tied to greater weight gain in the transition from adolescence to adulthood.Thus the findings suggest that a history of some ADHD symptoms in childhood, namely hyperactive or impulsive behavior, as opposed to inattention, is significantly tied to obesity in adulthood. Fuemmeler said that research like this may give us some ideas about what's driving the obesity epidemic.

"The findings support the idea that certain self-regulation capacities, like the ability to regulate one's impulses, could be a relevant trait to understanding why some people may be more vulnerable to obesity," he said.

The researchers concluded that while there appeared to be a link between ADHD symptoms and high blood pressure, it was more likely to be related to weight rather than ADHD symptoms.

Kollins said:

"The most exciting thing about this research is it gives us a thread to follow in determining why kids with ADHD symptoms might be at risk for developing obesity."

"It establishes the path for identifying these kids earlier and focusing on intervention methods," he added.

"Association between attention-deficit/hyperactivity disorder symptoms and obesity and hypertension in early adulthood: a population-based study."
B F Fuemmeler, T Østbye, C Yang, F J McClernon, S H Kollins.
International Journal of Obesity Advanced online publication 26 October 2010.
DOI:10.1038/ijo.2010.214

Additional sources: Add Health (UNC), Duke Medicine News and Communications.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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ADHD and Adults - New Survey Reveals Greater Problems

Children, teens, and adults can all suffer from Attention Deficit Hyperactivity Disorder. ADHD impacts about 5% of the children and teenagers, and about 3% of all adults. Less than half of children with ADHD ever out-grow it in adolescence or adulthood. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

It is important to remember that many, or most, children with ADHD will never really out-grow the problems that ADHD brings. This has been well documented, and has been further discussed in detail through recent studies on ADHD and Depression in females.

Recently another reminder of this was published in a national survey of 1,007 adults with ADHD. The survey looked at how adults with ADHD cope at home, at work, and in relationships with others. The survey was published just in time for the 2008 ChADD Conference, and the 2008 ADHD National Awareness Day.

What the survey found was that, of those adults with Attention Deficit Hyperactivity Disorder:


75% reported that ADHD strongly impacted their ability to stay focused to a task long enough to complete it;
70% reported that ADHD strongly impacted their ability to focus on what others were saying;
65% reported that ADHD strongly impacted their responsibilities at home;
60% reported that ADHD strongly impacted their ability to stay seated through a business meeting, or to organized projects, or follow through with projects until they are completed;
57% reported that ADHD strongly impacted their relationships with their families and friends;
56% reported that ADHD strongly impacted their ability to advance in their work place or career;
47% reported that ADHD caused them to have to work harder than others just to accomplish the same amount of work as those without ADHD;

The survey group was asked about what they would like to accomplish, or treatment goals:


50% reported that they would like to get their house organized, and 28% reported that they needed to get their personal finances more organized;
38% reported that they needed to get their moodiness under control, and 26% wanted to improve their relationships with others;
36% felt that their ADHD symptoms were still not under control, and many report feeling depressed thinking about how hard it is to be an adult with ADHD.

The study was headed up by two big names in the ADHD community: Ed (Ned) Hallowell, M.D., who has written important books such as "Driven to Distraction," and Natalie Knochenhauer, who as a mother of ADHD children has become an important advocate in the Philadelphia area.

The study was funded by McNeill Pediatrics, which, by the way, markets CONCERTA (methylphenidate HCI) for the treatment of ADHD in adults, as well as in children. Hallowell and Knochenhauer are both paid consultants for McNeill Pediatrics. So there is an element of this study that is designed to market CONCERTA to those adults who are not receiving any treatment, feel that their ADHD is not under control, and etc.

But this study should be more than that.


IF conservatively 5% of the children in the USA have ADHD, and
IF conservatively 50% of the children in the USA will "out-grow" their ADHD symptoms by the age of 20 or so, and
IF there are approximately 300 million people in the USA,
THEN there are conservatively 7,500,000 adults in the USA alone dealing with "adult ADHD." And if 38% of them feel that their ADHD is not under control, or are depressed by their ADHD, and so on, well that's a lot of people suffering from ADHD even into adulthood (38% of 7.5 million adults with ADHD is 2,850,000 adults who feel it is out of control or feel depressed because of their ADHD).

If you are an adult with ADHD, and you are feeling that you can't get ahead at work because of it, or you can't get organized, or motivated, or get your moods under control, there is help for you.

Yes, medications like Concerta can help. Stimulant medications can help to increase time on task, focus to boring tasks, and so on. Consider medications as a treatment option and talk to your doctor about it.

We also like people to try the combination of an ADHD diet (including high protein, low carbohydrate breakfasts and some caffeine), with ATTEND, Extress or Deprex (for mood stabilization) and Memorin for memory improvement.

With either of the approaches above, counseling or coaching for ADHD as well as for skills and strategies to improve relationships and work performance are essential.

Douglas Cowan, Psy.D., is the Clinical Editor of the ADHD Information Library at http://newideas.net and its family of ADHD related web sites. He is also the author of the very popular ADHD Diet. Try Dr. Cowan's free online screening tool for ADHD or view his ADHD videos on YouTube. Further information on ATTEND is available here. For more information on ADHD support groups visit ChADD.

1 in 10 US Kids Have ADHD; More Awareness Cited

A government survey says 1 in 10 U.S. children has ADHD, a sizable increase from a few years earlier that researchers think might be explained by growing awareness and better screening.

ADHD, or attention deficit hyperactivity disorder, makes it hard for kids to pay attention and control impulsive behavior. It's often treated with drugs, behavioral therapy, or both.

The new study found that about two-thirds of the children who have ADHD are on medication.

The estimate comes from a survey released Wednesday that found an increase in ADHD of about 22 percent from 2003 to the most recent survey in 2007-08. The Centers for Disease Control and Prevention interviewed parents of children ages 4 through 17 in both studies.

In the latest survey, 9.5 percent said a doctor or health care provider had told them their child had ADHD. The earlier study found that fewer than 8 percent of kids had been diagnosed with it.

Researchers calculate about 5.4 million kids have been diagnosed with ADHD, which suggests that about 1 million more children have the disorder than a few years earlier.

Scientists don't have clear answers about why there was such a significant increase. Study lead author Susanna Visser of the CDC suggests greater awareness and stepped-up screening efforts as part of the explanation.

"Regardless of what's undergirding this, we know more parents are telling us their children have ADHD," Visser said.

One expert found it hard to believe that so many kids might have ADHD. "It sounds a little high," said Howard Abikoff, a psychologist who is director of the Institute for Attention Deficit Hyperactivity and Behavior Disorders at New York University's Child Study Center.

Other studies have suggested more like 5 percent of kids have ADHD, and there are no known biological reasons for it to be on a recent increase, he added.

Abikoff noted the CDC study is based on parents saying that a health care provider told them their child had ADHD, but it's not known who the health-care provider was or how thorough the assessment was.

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Shionogi Announces FDA Approval Of KAPVAY™ - The First And Only Therapy Approved For Use With Stimulant Medication For The Treatment Of ADHD

Main Category: ADHD
Also Included In: Regulatory Affairs / Drug Approvals;??Pharma Industry / Biotech Industry
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Shionogi Inc., the U.S.-based group company of Shionogi & Co., Ltd., announced the U.S. Food and Drug Administration approval of the non-stimulant medication KAPVAY™ (clonidine hydrochloride) extended-release tablets, an extended-release oral formulation for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents ages 6-17 years. KAPVAY™ is the only formulation of clonidine hydrochloride approved by the FDA for the treatment of ADHD, and is the first and only FDA-approved ADHD treatment indicated for use as add-on therapy to stimulant medication. KAPVAY™ can also be used as monotherapy when treating ADHD.

An oral, non-stimulant, twice-daily therapy, KAPVAY™ is a centrally acting alpha2-adrenergic receptor agonist. While the mechanism of action of alpha2 agonists in ADHD is not known, it is believed to involve the pre-frontal cortex (PFC) of the brain. Studies suggest that the PFC regulates attention and plays a critical role in impulse control, working memory and executive function.

"The FDA approval of KAPVAY™ represents an exciting milestone in the field of ADHD," said Donald C. Manning, MD, PhD, Chief Medical Officer of Shionogi Inc. "The extended-release formulation of KAPVAY™ minimizes the peaks and troughs in blood levels, thereby decreasing overactivation of the alpha receptors in the brain and periphery. We look forward to providing this important, beneficial treatment for ADHD to patients, both as monotherapy and add-on therapy to stimulants."

"ADHD is a complex disorder that requires individualized treatment. While there are prescription treatment options available, many ADHD patients on stimulants do not achieve adequate control of symptoms," explained Rakesh Jain, MD, MPH, Director of Psychiatric Drug Research for R/D Clinical Research at Lake Jackson, Texas, and an investigator in the clinical trials. "KAPVAY™, when added to a stimulant, addresses an unmet need, and improves ADHD symptoms beyond what is achieved by stimulants alone. This is a significant step forward for the treatment of ADHD to have an approved product for add-on therapy in our treatment armamentarium."

ADHD is a neurobehavioral disorder that occurs in childhood and may continue into adolescence and adulthood, which affects more than 4.5 million children ages 3-17 in the U.S. alone. Approximately 3-7 percent of U.S. school-aged children are believed to suffer from this disorder. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity/over-activity.

This approval is based on two Phase III studies, which demonstrated efficacy at 5-weeks that children and adolescents (6-17 years) with ADHD treated with KAPVAY™ experienced statistically significant improvements in core symptoms of ADHD inattention, hyperactivity and impulsivity. The most common and drug related adverse reactions (incident at least 5% and twice the rate of placebo) included somnolence, fatigue, upper respiratory tract infection (cough, rhinitis, sneezing), irritability throat pain (sore throat), insomnia, nightmares, emotional disorder, constipation, nasal congestion, increased body temperature, drug mouth and ear pain. Maintenance efficacy has not been systemically evaluated and patients who are continued on longer-term treatment require periodic reassessment.

About KAPVAY™

Administered orally, clonidine hydrochloride exerts its pharmacological effects as a centrally acting alpha2-adrenoceptor agonist. The formulation in KAPVAY™ is designed to delay the absorption of active drug in order to decrease peak to trough plasma concentration differences.

Important Safety Information

KAPVAY™ should not be used in patients with known hypersensitivity to clonidine.

KAPVAY™ has not been studied in children with ADHD less than 6-years old.

Use KAPVAY™ with caution in patients at risk for hypotension, bradycardia and heart block. Measure heart rate and blood pressure prior to initiation of therapy, following dose increases, and periodically while on therapy. Advise patients to avoid becoming dehydrated or overheated.

Somnolence and sedation have been observed with KAPVAY™. Consider the potential for additive sedative effects with CNS depressant drugs. Caution patients against operating heavy equipment or driving until they know how they respond to KAPVAY™.

Patients should be instructed not to discontinue KAPVAY™ therapy without consulting their physician due to the potential risk of withdrawal effects. KAPVAY™ should be discontinued slowly in decrements of no more than 0.1 mg every 3 to 7 days.

In patients who have developed localized contact sensitization or other allergic reaction to clonidine in a transdermal system, substitution of oral clonidine hydrochloride therapy may be associated with the development of a generalized skin rash, urticaria or angioedema.

Use in patients with vascular disease, cardiac conduction disease, or chronic renal failure: Monitor carefully and uptitrate slowly.

Clonidine may potentiate the CNS-depressive effects of alcohol, barbiturates or other sedating drugs.

Caution is warranted in patients receiving clonidine concomitantly with agents known to affect sinus node function or AV nodal conduction (e.g., digitalis, calcium channel blockers and beta-blockers) due to a potential for additive effects such as bradycardia and AV block.

Do not use KAPVAY™ concomitantly with other products containing clonidine.

About Alpha2 Agonists

The prefrontal cortex (PFC) which regulates attention appears to be an important area of the brain affected in patients with ADHD. Specifically, studies suggest that the PFC plays a critical role in impulse control, working memory and executive function. Postsynaptic alpha2-adrenoceptors are one of several biological receptors important for PFC function.

About ADHD

ADHD is a neurobehavioral disorder that most often occurs in childhood and may continue into adolescence and adulthood. There are three subtypes of ADHD: predominantly hyperactive-impulsive, predominately inattentive, and combined hyperactive-compulsive and inattentive, with the latter being the most common. ADHD symptoms fall under three main categories: inattention, hyperactivity and impulsivity, which can include behaviors such as trouble focusing, frequent daydreaming, excessive talking, fidgeting/squirming, chronic impatience and difficulty waiting their turn, depending on the category.

The cause of ADHD is not yet known. However, research has shown potential links to genetic and environmental factors. While there is no cure for ADHD, the disorder can be managed with a variety of treatments including parental education and training, behavioral therapy and prescription medication.

ADHD is one of the most common childhood psychiatric disorders. In the United States alone, more than 4.5 million children ages 3-17 have been diagnosed, as of 2006. Approximately 3-7 percent of U.S. school-aged children are believed to suffer from this disorder. Boys are also more than twice as likely to be diagnosed (11 percent) as girls (4 percent).

Forward Looking Statements

This announcement contains forward-looking statements. These statements are based on expectations in light of the information currently available, assumptions that are subject to risks and uncertainties which could cause actual results to differ materially from these statements. Risks and uncertainties include general domestic and international economic conditions such as general industry and market conditions, and changes of interest rate and currency exchange rate. These risks and uncertainties particularly apply with respect to product-related forward-looking statements. Product risks and uncertainties include, but are not limited to, completion and discontinuation of clinical trials; obtaining regulatory approvals; claims and concerns about product safety and efficacy; technological advances; adverse outcome of important litigation; domestic and foreign healthcare reforms and changes of laws and regulations. Also for existing products, there are manufacturing and marketing risks, which include, but are not limited to, inability to build production capacity to meet demand, unavailability of raw materials and entry of competitive products. The company disclaims any intention or obligation to update or revise any forward-looking statements whether as a result of new information, future events or otherwise.

Source: Shionogi Inc

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Widely used chemicals linked to ADHD in children

ScienceDaily (July 20, 2010) ? A new study led by a team of Boston University School of Public Health researchers suggests a link between polyfluoroalkyl chemicals (PFCs), industrial compounds which are widely used in many consumer products, and attention deficit hyperactivity disorder (ADHD) in children.

Published online, ahead of print, in the journal Environmental Health Perspectives, the researchers found "increased odds of ADHD in children with higher serum PFC levels." The researchers used data from the National Health and Nutrition Examination Survey (NHANES) to compare the PFC levels found in serum samples taken from 571 children, ages 12 to 15. The parents of 48 of these children reported their children were diagnosed with ADHD, one of the most common neurodevelopmental disorders in children.

NHANES is an ongoing national survey of a representative sample of the U.S. population that gathers data on dietary and health factors conducted by the Centers for Disease Control and Prevention.

PFCs are highly stable compounds used in industrial and commercial products like stain-resistance coatings, food packaging, and fire-fighting foams. In a 2003-2004 survey, NHANES examined 2,094 blood samples taken from the U.S. population and found more than 98 percent of the sample had detectable serum levels of PFCs, according to the study. Once absorbed into the body, it can take years for some types of PFCs to be partially eliminated.

Although the study indicates there is a link between PFCs and ADHD, lead author Kate Hoffman said it is not known if there is a causal relationship between the two.

"There's a link between this exposure and outcome but we're not really sure what way that goes," said Hoffman, PhD, who conducted the study while completing her doctorate in environmental health at BUSPH. "What we can say is children with this outcome tend to have higher levels of PFCs in their blood." Because the PFC measurements were collected at the same time as the parental report of ADHD diagnosis, Hoffman said it is unknown whether children with ADHD engage in behavior leading to increased PFC exposure or if higher serum PFC levels in children result in ADHD.

The researchers examined the connection between four PFCs, perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) and samples from children in which there were parental reports of ADHD diagnosis.

The authors focused on ADHD because studies on animals have suggested exposure to PFCs can have neurotoxic effects. There is little information, however, on the chemicals' effects on human development.

ADHD is one of the most common neurodevelopmental disorders, Hoffman said. It is also unknown what causes ADHD, she said, but genetic and environmental factors have been associated with the disorder.

"Given the extremely prevalent exposure to PFCs, further investigation into the impact of PFC exposure on ADHD and other neurodevelopmental endpoints is warranted," the authors wrote.

Co-authors of the article include Boston University School of Public Health faculty members Thomas Webster, DSc, associate professor of environmental health; Janice Weinberg, ScD, associate professor of biostatistics; Veronica Vieira, MS, DSc, associate professor of environmental health; and Marc G. Weisskopf, PhD, of the Harvard School of Public Health. The study was funded in part by the Boston University Center for Interdisciplinary Research in Environmental Exposures and Health and by a grant from the National Institute of Environmental Health (NIEHS), National Institutes of Health (NIH).

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Boston University Medical Center.

Journal Reference:

Kate Hoffman, Thomas F. Webster, Marc G. Weisskopf, Janice Weinberg, Veronica M. Vieira. Exposure to Polyfluoroalkyl Chemicals and Attention Deficit Hyperactivity Disorder in U.S. Children Aged 12-15 Years. Environmental Health Perspectives, 2010; DOI: 10.1289/ehp.1001898

Note: If no author is given, the source is cited instead.

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Eating Licorice In Pregnancy May Affect A Child's IQ And Behavior

ScienceDaily (Oct. 7, 2009) ? Expectant mothers who eat excessive quantities of licorice during pregnancy could adversely affect their child's intelligence and behavior, a study has shown.

A study of eight year old children whose mothers ate large amounts of licorice when pregnant found they did not perform as well as other youngsters in cognitive tests.

They were also more likely to have poor attention spans and show disruptive behavior such as ADHD (attention deficit hyperactivity disorder).

It is thought that a component in licorice called glycyrrhizin may impair the placenta, allowing stress hormones to cross from the mother to the baby.

High levels of such hormones, known as glucocorticoids, are thought to affect fetal brain development and have been linked to behavioral disorders in children.

The results of the study are published in the American Journal of Epidemiology. Eight-year-olds whose mothers had been monitored for licorice consumption during pregnancy were tested on a range of cognitive functions including vocabulary, memory and spatial awareness.

Behavior was assessed using an in-depth questionnaire completed by the mother, which is also used by clinicians to evaluate children's behavior.

The study, carried out by the University of Helsinki and the University of Edinburgh, looked at children born in Finland, where consumption of licorice among young women is common.

Professor Jonathan Seckl, from the University of Edinburgh's Centre for Cardiovascular Science, said: "This shows that eating licorice during pregnancy may affect a child's behavior or IQ and suggests the importance of the placenta in preventing stress hormones that may affect cognitive development getting through to the baby."

Women who ate more than 500mg of glycyrrhizin per week ? found in the equivalent of 100g of pure licorice ? were more likely to have children with lower intelligence levels and more behavioral problems.

"Expectant mothers should avoid eating excessive amounts of licorice," said Professor Katri Raikkonen, from the University of Helsinki's Department of Psychology.

Of the children who took part in the study, 64 were exposed to high levels of glycyrrhizin in licorice, 46 to moderate levels and 211 to low levels.

The research followed on from a study which showed that licorice consumption was also linked to shorter pregnancies. Laboratory studies have also shown a link between the placenta not working to prevent stress hormones from passing through to the fetus, as well as a link to cardiac and metabolic disorders and behavioral problems in later life.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Edinburgh, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

View the original article here

An Overview of Inattentive ADHD and ADD (Attention Deficit Disorder)

This overview discusses the differences between Inattentive ADHD and the other subtypes of ADHD.

Overview:

Inattentive ADHD is one of the three subtypes of Attention Deficit Hyperactivity Disorder (ADHD).

Inattentive ADHD is sometimes referred to as ADD which is short for Attention Deficit Disorder. This subtype of ADHD is also called ADHD predominantly inattentive (ADHD-I, ADHD-PI).

Symptoms:

ADD differs from the other two subtypes in several ways. The characteristic symptoms of the inattentive subtype are inattention, easy distractibility, disorganization, procrastination and forgetfulness.

About a third of people with the Inattentive subtype also have coexisting lethargy and fatigue and people with this variant of ADD are said to have Sluggish Cognitive Tempo or SCT.

People with ADD and Sluggish Cognitive Tempo have fewer or no symptoms of hyperactivity or impulsiveness and they are less likely to have a co-existing diagnosis of Oppositional Defiance Disorder or Conduct disorder. Hyperactivity and Impulsiveness are symptoms that are the hallmark of the other two subtypes of ADHD, the Combined type of ADHD referred to as ADHD-C and the Hyperactive/Impulsive subtype of ADHD which is referred to as ADHD-HI.

People with this condition have been shown in studies to perform more poorly in school than people with the other subtypes of ADHD but they are less likely to suffer the adverse life outcomes, such as substance abuse disorder or law enforcement problems, seen more commonly in people with the other two subtypes of ADHD.

Causes:

The cause of ADHD-PI is unknown but genetic influences are thought to play a major role. It is estimated that up to 70% of people with ADD have a relative with Inattentive ADD. Other factors that may play a causative roll in ADD and SCT include:

Dietary allergies-It is possible that certain people may have increased ADHD-PI symptoms after consuming certain foods or food dyes.

Environmental Factors and Toxins - pesticides and lead have both been implicated in causing increased symptoms.

Prematurity and Traumatic head injuries- may be related to an increased risk of symptoms.

Social Influences- maternal separation and other social factors are being studied to determine their role in causing this condition.

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Testing:

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ADHD questionnaires are standardly administered to diagnose this condition. These questionnaires consist of a series of symptoms questions where parents and teachers rate the severity of symptom sand the perceived degree of disability caused by each symptom.

Other diagnostic methods include computerized programs that measure attention, hyperactivity and impulsive behavior. The computerized test can give a more objective view of symptoms which is important because parent and teacher questionnaires responses can vary greatly and often do not agree on the severity of disabling characteristic of the ADHD symptom.

Treatment:

The appropriate dose of medication, which may be lower in the case of treating ADD than it is for the other subgroups of ADHD.

The following is a list of medications used to treat Inattention:

Dextroamphetamine (Adderall, Dexedrine,Vyvanse) - most commonly used stimulant treatment (along with methylphenidate) for all subtypes of this condition.

Methylphenidate (Ritalin, Concerta, Focalin, Daytrana,Metadate) - some people may have a genetic basis for NOT responding to methylphenidate.

Atomexitine (Strattera) - non-stimulant therapy.

Alpha-2A-Adrenoceptor Agonist (Intuniv, Clonidine) - especially useful for combined ADHD and Tourette's syndrome

Selective Serotonin Re-uptake Inhibitors (Paxil, Zoloft, Prozac) - useful for the treatment of associated depression or as a second line treatment for ADHD-PI when stimulants fail.

Try-cyclic Antidepressants (Norparmine,Tofranil) - also used for treating co-existing depression but the try-cyclics can have unpleasant side effects and must be used with extreme caution in children.

Bupropion (Wellbutrin) - Wellbutrin is a norepinephrine and dopamine reuptake inhibitor and is another second line treatment for the inattentive subtype.

Behavioral therapy is useful sometimes alone and sometimes combined with medication to better treat issues related to motivation, persistence, academic issues and social skill problems. Behavioral therapy may be more useful for ADHD-PI than it is for the other subtypes.

Lifestyle skills treatment generally addresses lifestyle issues such as diet, exercise and stress reduction.

Classroom treatment methods include: Classroom management, parent support training and classroom accommodation.

Additional useful treatment methods include:

Vitamin supplementation - to address potential deficiencies in Omega-3 fatty acids, iron or zinc.

Behavioral therapy and Coaching.

Psychotherapy - to treat the problems that can co-exist with Inattentive ADHD such as anxiety, depression and social phobias.

Cognitive-behavioral therapy (CBT) - to address common areas of cognitive weaknesses.

Social skills training methods - to address the problems that result socially from the inattentive symptoms of ADHD-PI.

The symptoms and treatment for Inattentive ADHD are different from the symptoms and treatment of the other subtypes of ADHD. People with Inattentive ADHD and parents of children with ADHD must assure that an appropriate diagnosis of ADHD is made in order that this subtype of ADHD be appropriately managed.

For more information on Primarily Inattentive ADHD please visit Tess Messer at http://www.primarilyinattentiveadd.com/2010/02/why-blog.html. There you will find information on ADHD symptoms, ADHD treatment, alternatives to medications, Information on ADHD vitamins and supplements and much more. Looking forward to meeting you there!!

ADHD: A Dialogue With a Non-Believer, Part Three

Dear Sir,

It was with some interest that I read the article What You Should Know About Attention Deficit Disorder by Edward W. after having it handed to me by a member of our church. There were elements of the article that were insightful, helpful, and needed to be said in a public forum, especially the discussion of the moral and spiritual dimensions of behavior. For this part of the article I applaud Mr. W.

However, Mr. W's discussion on the physiological/biological aspects of ADD ADHD was lacking to the point of being misleading to the readers. I am sure that Mr. Welch had no intention of misleading any readers, as that would hardly reflect the "biblical guidelines with which to understand ADD" that he seeks to communicate. Therefore, for the sake of clarifying some details, may I present the following evidence. Perhaps in the near future you would run an article that would present some of this information to your readers, so that they have an accurate understanding of the disorder.

We continue the dialogue here in part three.

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are... unsupported by evidence."

There are, in fact, biological causes for the behaviors.

Now, what are the "behaviors" that we are talking about? The "behaviors" of the diagnostic criteria. We are not talking about behaviors with a moral basis such as hitting your sister. We are talking about the specific behaviors of the DSM-IV diagnostic criteria for ADHD.

"Although there are dozens of biological theories to explain ADD, there are presently no physical markers for it;..."

Just because there are dozens of theories, most of which will prove to be wrong and go away, does not mean that one (or more) of the theories are not accurate descriptions of reality. In fact, research shows that there are several "physical markers" of ADHD.

Here are a few articles, both from peer reviewed journals and from the media discussing peer reviewed journal articles, that might be of interest to your readers. They are just 15 studies or articles about the various biological underpinnings of ADHD. It is certainly not a comprehensive list, as there have probably been more than 200 similar studies published in the past ten years alone. These are just the studies that I looked up last weekend for another project and already had in my word processor:

Brain Scan Found Effective in Diagnosing Attention Disorder

New York Times Syndicate - December 16, 1999

RICHARD SALTUS

Brain scans have identified a clear-cut chemical abnormality in people with attention deficit-hyperactivity disorder, a problem that makes life difficult for an estimated 3 to 5 percent of US schoolchildren, scientists say.. It could be a first step toward a long-sought objective test for ADHD, say researchers at Harvard Medical School and Massachusetts General Hospital.

Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test

J Abnorm Child Psychol 2000 Oct;28(5):403-14

Clark C, Prior M, Kinsella GJ

School of Psychological Science, La Trobe University, Victoria, Australia.

Two neuropsychological measures of executive functions--Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)-were administered to 110 adolescents, aged 12-15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35). ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.

Executive functions and developmental psychopathology.

J Child Psychol Psychiatry 1996 Jan;37(1):51-87

Pennington BF, Ozonoff S

Department of Psychology, University of Denver, CO 80208, USA.

In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS). Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.

Brain Differences in Attention Deficit Disorder

Scientists have strong new evidence that attention deficit disorder (ADD)--a condition in which children are hyperactive and have difficulty concentrating--stems from an abnormality in the brain. According to a report in today's Proceedings of the National Academy of Sciences, children with ADD have elevated nerve firing in a brain region involved in motor activity. In addition, the researchers found, Ritalin--the drug most commonly prescribed for the disorder--triggers a surprisingly different biochemical response in the brains of children with ADD than in those without the condition.

Reduction of (3H)-imipramine binding sites on platelets of conduct-disordered children.

Neuropsychopharmacology 1987 Dec;1(1):55-62

Stoff DM, Pollock L, Vitiello B, Behar D, Bridger WH

Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Department of Psychiatry.

Binding characteristics of tritiated imipramine on blood platelets were determined in daytime hospitalized prepubertal children who had mixed diagnoses of conduct disorder (CD) plus attention deficit disorder hyperactivity (ADDH) and in inpatient adolescents who had a history of aggressive behavior. The number of (3H)-imipramine maximal binding sites (Bmax) was significantly lower in the prepubertal patient group of CD plus ADDH; the dissociation constant (Kd) was not significantly different. There were significant negative correlations between Bmax and the Externalizing or Aggressive factors of the Child Behavior Checklist when the CD plus ADDH prepubertal patients were combined with their matched controls and within the adolescent inpatient group. We propose that a decreased platelet imipramine binding Bmax value, as an index of disturbed presynaptic serotonergic activity, is not specific to depression and may be used as a biologic marker for the lack of behavioral constraint in heterogeneous. populations of psychiatric patients.

Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder.

J Neuropsychiatry Clin Neurosci 1994 Summer;6(3):245-9

Aronowitz B, Liebowitz M, Hollander E, Fazzini E, Durlach-Misteli C, Frenkel M, Mosovich S, Garfinkel R, Saoud J, DelBene D, et al

Department of Psychiatry, New York State Psychiatric Institute, New York.

Neuropsychiatric and neuropsychological evaluations were performed in a pilot study of adolescents with DSM-III-R disruptive behavior disorders, including conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD). The following comparisons were made: 1) CD comorbid with ADHD vs. CD only; 2) all subjects with ADHD vs. all non-ADHD; and 3) all subjects with CD vs. all non-CD. The CD + ADHD group had increased left-sided soft signs compared with the CD group. CD + ADHD subjects significantly underperformed CD subjects on several executive functioning measures, with no differences on Verbal IQ subtests. Results are discrepant with previous findings of deficient verbal functioning in delinquent populations.

NIMH: Genetics Fact Sheets:Attention-Deficit Hyperactivity Disorder

Phenotype:Attention-deficit hyperactivity disorder (ADHD) has its onset in childhood and is characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.

Epidemiology: In a large sample from the U.S. population, the prevalence of ADHD (male: female ratio) in school-age children was 6.7 percent (5.1:1)[2]. Depending on the use of adaptive functioning ratings to define definite maladjustment, prevalence estimates of 6.6 percent and 9.5 percent

Family Studies: Several studies demonstrate that ADHD aggregates in families [13-15]. The rates in probands' sibs in three older studies [16-18] ranged from 17 percent to 41 percent, with respective rates in controls' sibs ranging from zero to 8 percent [16, 17]. Rates of childhood ADHD in parents of hyperactive probands in several older studies ranged from 15 percent to 44 percent for fathers and 4 percent to 38 percent for mothers [19-22], although one study found no evidence of an increased rate of childhood ADHD in parents of ADHD probands

Twin Studies: Two small twin studies found that 4 of 4 [34] and 3 of 3 [35] MZ twins were concordant for ADHD. A larger twin study [33] reported respective MZ and dizygotic (DZ) probandwise concordance rates of 51 percent and 33 percent, with a heritability estimate of 64 percent.

Adoption Studies: Increased rates of hyperactivity or a history of hyperactivity have been found among both adopted-away sibs of children with ADHD [43] and the biological parents of hyperactive boys compared with controls [21, 44, 45].

Mode of Inheritance: Deutsch and colleagues found limited evidence in a small sample [46] for an incompletely penetrant autosomal dominant single major locus transmission. A segregation analysis of a different data set [25] also resulted in statistical evidence -- including estimates of transmission parameters that were not significantly different from Mendelian expectations -- for an incompletely penetrant dominant or additive autosomal single major locus [47]. Low penetrance estimates predicted that only 46 percent of boys and 31 percent of girls with the ADHD gene would develop the disorder.

Molecular Genetic Studies: A population-based association study reported evidence of an association between ADHD and an allele at the dopamine D2 receptor gene on 11q (p = 0.0003) [48], but this finding has not been replicated and was most likely an artifact of population stratification. The Tranmission Disequilibrium Test (TDT) [49] was used in a family-based association study to identify an association between ADHD and a specific allele at the dopamine transporter locus on 5p (p = 0.006) [50]. Another population-based association study found an association between ADHD and an allele at the dopamine D4 receptor on 11p (p = 0.01) [51].

Quantitative EEG and Auditory Event-Related Potentials in the Evaluation of Attention-Deficit/Hyperactivity Disorder: Effects of Methylphenidate and Implications for Neurofeedback Training

J. F. Lubar, M. O. Swartwood, J. N. Swartwood, D. L. Timmermann

University of Tennessee

Neurophysiological correlates of Attention Deficit Disorder with and without Hyperactivity (ADD/HD) and effects of methylphenidate are explored using electroencephalographic (EEG) and auditory eventrelated potentials (ERPs). In the first of four studies, a database of ADD/HD individuals of varying ages and matched adolescent/adult controls is presented. Study 2 compares controls and age-matched children with ADD, and children with ADHD on and off methylphenidate. Study 3 examines habituation of the auditory ERPs of controls and children with ADHD both on and off methylphenidate. The relationship between successful neurofeedback training and EEG changes is presented in Study 4. Overall, these studies support a neurologic basis for ADD/HD and raise questions regarding the role of methylphenidate in modulating cortical processing.

Establishing an EEG Norm-Base for ADD v. non-ADD

Review of a journal article by Troy Janzen, Ken Graap, Stephan Stephanson, Wilma Marshall, and George Fitzsimmons, "Differences in Baseline EEG Measures for ADD and Normally Achieving Preadolescent Males" Biofeedback and Self-Regulation, Vol. 20, No. 1, 1995, pp. 65-82.

Three well known tests (WISC-R, WRMT-R, WRAT-R) were administered to all subjects prior to the main part of the study, a series of cognitive tests performed while connected to a 19 lead EEG cap. Findings:

The most consistent finding was that ADD subjects have significantly higher theta amplitudes (p learn more about Attention Deficit Hyperactivity Disorder by visiting the ADHD Information Library's family of web sites.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

Investigational Data Presented For INTUNIV™ (Guanfacine) Extended-Release Tablets

Main Category: ADHD
Article Date: 29 Oct 2010 - 2:00 PDT window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Shire plc (LSE: SHP, Nasdaq: SHPGY), the global specialty biopharmaceutical company, presented research results of once-daily INTUNIV™ (guanfacine) Extended-Release Tablets, coadministered with stimulants in children and adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) who had suboptimal response to treatment with a long-acting stimulant alone. At study end point, patients receiving INTUNIV coadministered with a stimulant had significantly reduced symptoms on the ADHD Rating Scale IV (ADHD-RS-IV) compared with those receiving placebo with a stimulant, regardless of morning or evening dosing. These data were presented in a poster session at a major national scientific meeting of psychiatry in New York, NY.

"This study looked at patients who were taking a stable dose of a long-acting stimulant medicine but who continued to experience ADHD symptoms," said Timothy Wilens, MD, Staff in the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Associate Professor of Psychiatry at Harvard Medical School, who led the study. "These findings provide greater insight into the use of INTUNIV when combined with a stimulant."

INTUNIV is a selective alpha-2A agonist approved for the treatment of ADHD in children and adolescents ages 6 to 17. Efficacy was based on two pivotal studies (8 and 9 weeks in duration) of INTUNIV administered as monotherapy. INTUNIV is indicated as an integral part of a total treatment program that may include counseling or other measures.

These data presented today were included as part of a supplemental New Drug Application (sNDA) submitted to the Food and Drug Administration (FDA) on April 28, 2010, seeking approval for INTUNIV as an ADHD treatment combined with stimulants in this same patient population. The application is currently under review. The target FDA action date is February 28, 2011.

In This Investigational Study, Coadministration of INTUNIV With a Stimulant Showed Significant ADHD Symptom Improvement Over Stimulant Alone When Dosed Either in the Morning or Evening

This multicenter, double-blind, randomized, placebo-controlled study took place over 9 weeks in 455 patients aged 6 to 17 years with ADHD who had suboptimal response* to treatment with a stimulant.

Throughout this dose-optimized study, patients continued to take their prescribed dose of a stimulant, with the addition of a morning or evening dose of INTUNIV (1 mg, 2 mg, 3 mg, or 4 mg) or placebo. The primary efficacy measure for the study was the ADHD-RS-IV. ADHD-RS-IV is a standardized tool for evaluating symptoms of ADHD and assessing response to treatment, in which clinicians can rate patients within a scoring range of 0 to 54, depending on the severity of symptoms. At end point, a significantly greater percentage of patients in the morning and evening administration of INTUNIV and stimulant groups compared with those taking placebo with a stimulant met criteria for symptomatic remission (ADHD-RS-IV less than or equal to 18). Data from the primary efficacy analysis of the study were previously presented at a national meeting of psychiatry in May 2010.

Secondary efficacy measures were based on scores from the Conners' Global Index - Parent (CGI-P) morning and evening assessment, and the exploratory Before-School Functioning Questionnaire (BSFQ). On a weekly basis, parents completed 2 assessments of the CGI-P, each composed of 10 questions. The first assessment evaluated patient behaviors in the morning before school, and during the week before the study visit. The second assessment evaluated patient behaviors in the evening, before bedtime. The groups that received INTUNIV coadministered with a stimulant showed greater improvement compared with those taking placebo and a stimulant on the CGI-P at both morning and evening assessments. Additionally, at end point, patients receiving INTUNIV coadministered with a stimulant showed greater improvement on the BSFQ compared with subjects who received placebo and a stimulant.

In this investigational study, INTUNIV given in the morning or evening when coadministered with a stimulant resulted in significant improvement in ADHD symptoms overall and at morning and evening time points.

In this study, the most commonly reported treatment-emergent adverse events (TEAEs) among patients treated with INTUNIV and a stimulant (greater than or equal to 5 percent) were headache, somnolence, upper respiratory tract infection, fatigue, insomnia, upper abdominal pain, dizziness, decreased appetite, cough, irritability, and nausea. The most commonly reported TEAEs among patients in the placebo/stimulant group (greater than or equal to 5 percent) were headache, upper respiratory tract infection, and irritability. The majority of TEAEs were mild or moderate in severity. No unique TEAEs were observed with INTUNIV given with a stimulant compared with those reported historically for either treatment alone.

Serious adverse events (SAEs) were reported in 3 patients taking INTUNIV and 1 sibling of a study participant (including one event of syncope). All SAEs were considered unrelated to INTUNIV.

"We are currently awaiting FDA review of these data and our application for a change in the product labeling for INTUNIV to include coadministration with a stimulant for the treatment of ADHD," said Michael Yasick, Senior Vice President of Shire's ADHD Business Unit. "Shire is pleased with the results of this trial and will continue to research and develop new treatments for ADHD as part of our commitment to patients and their families."

This study was supported by funding from Shire Development Inc. Dr Timothy Wilens was a speaker for, received grant support from, and is a consultant for Shire.

*Suboptimal response was defined as treatment with a stable dose of stimulant for at least four weeks with improvement, yet persistence of mild to moderate ADHD symptoms in the opinion of the investigator (defined as an ADHD-RS-IV total score of at least 24, Clinical Global Impressions-Severity of illness scale score of at least three). Patients with no response to stimulants prior to study enrollment were excluded from participating in this study.

About INTUNIV

INTUNIV™ (guanfacine) Extended-Release Tablets is a nonstimulant approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents ages 6 to 17. INTUNIV was approved by the US Food and Drug Administration (FDA) in September 2009 and comes in 4 doses-1 mg, 2 mg, 3 mg, and 4 mg. INTUNIV should be taken once a day.

The active ingredient in INTUNIV is guanfacine. INTUNIV is not a central nervous system (CNS) stimulant or a controlled substance. It is not likely to cause dependence or be abused.

Additional information about INTUNIV and Full Prescribing Information are available here.

Indication

INTUNIV is indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents ages 6 to 17. Efficacy was established in two controlled clinical trials (8 and 9 weeks in duration). The physician electing to use INTUNIV for extended periods should periodically reevaluate its long-term usefulness for the individual patient.

INTUNIV is indicated as an integral part of a total treatment program for ADHD that may include other measures (psychological, educational, and social).

Important Safety Information

INTUNIV should not be used in patients with a history of hypersensitivity to guanfacine or any of its inactive ingredients or by patients taking other products containing guanfacine.

Hypotension, bradycardia, and syncope were observed in clinical trials. Use INTUNIV with caution in treating patients who have experienced hypotension, bradycardia, heart block, or syncope, or who may have a condition that predisposes them to syncope; are treated concomitantly with antihypertensives or other drugs that can reduce blood pressure or heart rate or increase the risk of syncope. Heart rate and blood pressure should be measured prior to initiation of therapy, following dose increases, and periodically while on therapy. Patients should be advised to avoid becoming dehydrated or overheated.

Sedation and somnolence were commonly observed in clinical trials. The potential for additive sedative effects with CNS depressant drugs should be considered. Patients should be cautioned against operating heavy equipment or driving until they know how they respond to INTUNIV. Advise patients to avoid use with alcohol.

Common adverse reactions in patients taking INTUNIV that may be dose related over the range of 1 to 4 mg/day include somnolence, sedation, abdominal pain, dizziness, hypotension/decreased blood pressure, dry mouth, and constipation.

Please see INTUNIV Full Prescribing Information.

About ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric behavioral disorder in which patients exhibit symptoms of hyperactivity, impulsivity, and/or inattention. ADHD is one of the most common psychiatric disorders in children and adolescents. The prevalence of ADHD is approximately 3 to 7 percent in school-age children. Worldwide prevalence of ADHD is estimated at 5.3 percent (with large variability), according to a review of this topic published in 2007.

There is no single test to determine if someone has ADHD; instead, a comprehensive evaluation is required. This evaluation may include a physical examination, psychological testing, review of school and medical records, as well as parent- and teacher-related behavior scales and family interviews.

Although there is no cure for ADHD, there are accepted treatments that help reduce symptoms. Treatments include educational approaches, behavioral modification, and/or stimulant or nonstimulant medication.

Source:
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How to measure attention span of a fly: Implications for ADHD, autism in humans

ScienceDaily (Jan. 26, 2010) ? An Australian-German team of scientists at Freie Universitat and the Queensland Brain Institute in Brisbane, Australia, has found a way to measure the attention span of a fly. The findings could lead to further advances in the understanding of attention-deficit hyperactivity disorder (ADHD) and autism in humans.

Associate Professor Bruno van Swinderen at the Queensland Brain Institute in Brisbane and Dr. Bjorn Brembs at Freie Universitat combined genetic techniques with brain recordings and behavioral testing. They found different mutations that either increase or decrease a fly's attention span.

Using the genetic fruit fly model, Drosophila melanogaster, van Swinderen found that a fly's level of distractibility is finely tuned to allow "normal" behavioral responses to a constantly changing environment. He said, "We now have the two ends of an attention spectrum in our model. We have a fly memory mutant that is hard to distract and another fly memory mutant that's too distractible. They both have the same result -- they don't learn well but for completely different reasons, not unlike human patients afflicted with autism and ADHD."

The fruit flies were fed methylphenidate, which is sold under the brand name Ritalin and is used to treat patients with ADHD. The researchers found the drug had similar effects on fruit flies as it did on people: it helped the distractible flies to pay attention to visual stimuli.

"It suggests there may be similar pathways in the brains of fruit flies and humans, which means we now have a simple reductionist model, with all the genetic tools that go along with it, to try to understand what exactly this drug is doing," according to van Swinderen.

Heisenberg fellow Brembs agrees: "These surprising parallels between insects and humans may point to a general, common functional organization of brains."

The research is reported in the Journal of Neuroscience.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Freie Universitaet Berlin, via AlphaGalileo.

Journal Reference:

Bruno van Swinderen, Bjorn Brembs. Attention-Like Deficit and Hyperactivity in a Drosophila Memory Mutant. Journal of Neuroscience, 2010; 30 (3): 1003 DOI: 10.1523/JNEUROSCI.4516-09.2010

Note: If no author is given, the source is cited instead.

View the original article here

Introduction To ADHD In Young Child - How To Deal With ADHD Child

Attention deficit hyperactivity disorder (ADHD) also called "Hyperkinetic Syndrome" in many areas of the world, and on average ADHD is found more commonly in young children than in adults.

HISTORY AND EPIDEMIOLOGY

It is impossible to pinpoint exactly the earliest time when ADHD came into existence, or part another way, when it was readily recorded by the medical profession. The most reliable testimony was first recorded in 1845 by Heinrich Hoffman who had noticed his son had exhibited certain symptoms.

It is impossible to pinpoint exactly the earliest time when ADHD came into existence, or part another way, when it was readily recorded by the medical profession. The most reliable testimony was first recorded in 1845 by Heinrich Hoffman who had noticed his son had exhibited certain symptoms. Because of this, Hoffman created a poem called "The Story of Fidgety Philip" which served as an accurate account of the symptoms of ADHD.

In 1902, Sir George F Still published a series of lectures for viewing and academic study concerning the issue of ADHD, stating that a child with ADHD had a genetic dysfunction, which caused impulsiveness with the child, general hostility and made the child unruly and difficult to discipline.

Approximately 3-5% of all children across the globe who are currently at preschool age currently have ADHD, and according to one recent study, almost 14% of all the children suffering from different psychological disorders are diagnosed with ADHD. Statistically, males are more predisposed to contracting ADHD than females.

ETIOLOGY OF ADHD

ADHD is classed as a developmental neurological disorder due to the fact that is genetically influenced, and inheritable, 20% of all ADHD children are not genetically predisposed which means that the ADHD has subsequently been caused by result of a trauma to the head or exposure to some toxin. It is imperative to note that any complications during the course of a pregnancy or indeed the actual birth itself will very heavily influence the development whether it is actual or potential of ADHD.

Premature births, as well as smoking and or drinking alcohol during pregnancy are all major factors in the course of development of ADHD.

DISORDERS FREQUENTLY ASSOCIATED WITH ADHD

Sadly, a child suffering from ADHD has to bear the burden of not only dealing with ADHD, but other associated depression in child with adhd and conditions all of which can take a major toll on the child. The following is a list of some of the most commonly encountered symptom of adhd in child

LEARNING DISABILITIES:

20-30% of children with ADHD are reported to have learning disabilities, however it should be noted that because of the very nature of ADHD means that learning is limited, so if a child struggles with reading writing or other areas of study this should not present too grave a concern.

TOURETTE SYNDROME:

A small percentage of children with ADHD will have Tourette syndrome as well, a disorder manifested by a number of different tics and twitches, with facial tics the most commonly observed.

OPPOSITIONAL DEFIANT DISORDER:

Between 33-50% of all children who suffer from ADHD will also suffer another associated disorder known as Oppositional defiant disorder. This means that these children will be difficult to control and discipline, will often clash with authority figures and will generally be unruly.

CONDUCT DISORDER: Roughly 30-45% of children who suffer from ADHD wil develop Conduct disorders, meaning that behavior becomes sporadic and inappropriate, with poor impulse control and a propensity to physical aggression.




DYSLEXIA: This is a reading disorder, which hinders and retards the ability of a child with ADHD to properly appreciate and distinguish between similar sounding letters and words. Problems grasping and understanding basic arithmetic and similar looking letters like b,d,m,n,g,q,p are common.




ANXIETY AND DEPRESSION: Anxiety and depression tend to manifest themselves when the child with ADHD subsequently attends school, due to a feeling of inferiority and frustration in comparison with their academic abilities as opposed to those of their peers. Usually starts when the child living with ADHD starts going to school. Inability to read, write and compete with other students makes him depressive and anti social.




BIPOLAR DISORDER: There is not a great deal of reliable information that exists for this, though in some cases, bipolar disorder is present in classical form in some patients suffering from ADHD.

Discover how to provide vitamin for child with adhd and prepare child recipe for adhd when you visit http://www.adhdchildparenting.com, a portal which caters for child living with adhd and help for adhd child.

Sleep-disordered breathing is common but hard to detect in pediatric patients

ScienceDaily (June 5, 2010) ? According to new research presented on June 5, at the 19th Annual Meeting of the American Academy of Dental Sleep Medicine, an estimated 18 percent of pediatric patients in a University of North Carolina-based study were at risk for sleep-related breathing disorders (SRBD). Importantly, pediatric risk was not associated with any demographic or craniofacial characteristics, as it is in adults, making it difficult to detect.

The study included 100 children between seven and 17 years of age, of which 43 percent were male and 57 percent were female. The group was 73 percent Caucasian, 10 percent Hispanic, nine percent African American, five percent Asian, and two percent American Indian.

Researchers used a previously validated survey, the Pediatric Sleep Questionnaire (PSQ), to estimate the risk of SRBD. Each patient's parent or guardian completed the PSQ for his or her child. A score of 0.33 suggested risk for SRBD. Results indicated that 18 percent of the participants were at risk for sleep-disordered breathing.

Orthodontic records including information on craniofacial characteristics were obtained for each patient. The researchers looked for an association between risk for SRBD and craniofacial features. They also examined the effect of gender, race, age, and body mass index on SRBD risk. No significant associations were found for either demographic or craniofacial characteristics.

"We were surprised that our findings suggested that the risk for pediatric sleep disordered breathing was as high as it was, since our review of the literature suggested that the prevalence of pediatric obstructive sleep apnea was one to three percent. We speculate that either our sample size was too small, or that additional factors contribute to the condition in children," said principle investigator Kristen Fritz.

Early diagnosis of pediatric SRBD is critical because signs and symptoms often lead to misdiagnosis of sleep disorders as other clinical conditions such as attention deficit disorder or attention deficit hyperactivity disorder.

SRBD are serious conditions with major health-related consequences for children. This study alerts health care providers to the fact that it is not possible to predict risk for SRBD by looking at certain demographic or craniofacial characteristics in children.

"Screening tools such as the PSQ, or specific inquiry about suspected risk factors such as snoring, sleepiness or behavioral problems, offer dentists who treat children an opportunity to recognize, educate and refer pediatric patients that may be at risk for SRBD," said Fritz.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Academy of Sleep Medicine, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

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