Archive for the ‘ADHD’ Category

Drugs to treat attention deficit hyperactivity disorder, (stimulants such as Ritalin/methylphenidate or Adderall/ amphetamine) for ADHD, don’t appear to put kids at higher risk of heart problems or death.

Scattered reports of sudden deaths among children on the medications have caused concern among parents and doctors in recent years, and several of the drugs now carry warnings about heart complications and behavioral side effects.

New research findings are reassuring.Funded by Shire, the researchers examined claims data from Medicaid and a commercial insurer. The study includes more than 240,000 kids ages three to 17, who received ADHD drugs and were followed for 135 days on average.

The researchers then compared those children to more than 965,000, who didn’t take the drugs but were of similar age and gender and came from the same states as the users.

That weasy officially for the researchers, because often the claims data didn’t match the hospital records.

Based on the data they could calculate, investigators estimated that there would be six sudden deaths or cardiac arrests per 1,000,000 kids taking ADHD drugs for a year.

That’s slightly more than the four per 1,000,000 kids in the comparison group. But because the numbers are so small, the difference could easily have been due to chance.

There were no strokes or heart attacks in the ADHD group, and the researchers estimate it’s very unlikely that the true rates would exceed 24 cases per 1,000,000 per year.

Rates of death “from any cause,” which were the most reliable numbers in the insurance data, were 179 per 1,000,000 kids per year in the ADHD group and 300 per 1,000,000 in the comparison group.

“For kids who would benefit from ADHD medications, the potential cardiovascular risks should not dissuade physicians from prescribing the drugs,” Hennessy told Reuters Health.

The findings, published in the journal Pediatrics, are in line with two previous reports that didn’t find evidence of a link between sudden death and ADHD drugs.

However, they run counter to one small 2009 study that found stimulant use was more common (1.8 percent) in children who died suddenly from cardiac arrest than in those who died in car accidents (0.4 percent).

One expert who was not involved in the current study said the results were hard to interpret due to the small number of deaths and heart problems.

“The new findings confirm that if there is an association between stimulants and cardiac events, it is quite rare,” Almut Winterstein, of the University of Florida College of Pharmacy in Gainesville, told Reuters Health.

But she added that at this point, there is no telling how the millions of kids on ADHD medicines will fare down the road.

“We will need to wait another decade to understand whether even slightly increased blood pressure and heart rate over several years during childhood results in increased cardiovascular risk in later life,” she said in an email.

The risk of death is certainly no higher in children who take ADHD medications than in children who don’t,” said Sean Hennessy, a pharmacist at Philadelphia’s University of Pennsylvania, who led the work.

Hennessy acknowledged that studying cardiovascular events using insurance data in youth is complex, and that he awaits the results of The U.S. Food and Drug Administration’s large safety study on stimulants.

There are a number of  current integrative and complementary treatment studies for children and adolescents.

Timothy Culbert is the medical director of the integrative medicine program at Minneapolis-based Children’s Hospitals and Clinics of Minnesota, one of the largest hospital-based, pediatric complementary medicine programs in the country.  Dr. Culbert and his colleagues are about to launch a study at four hospitals in the U.S. and Canada to examine in greater depth the use of nondrug coping skills in kids with cancer.

Several years ago, they developed a “Comfort Kit” designed to teach children coping skills including: deep-breathing relaxation techniques; aromatherapy, in which patients inhale chemicals produced by plant oils; and acupressure, a variant of acupuncture with pressure applied to certain points in the body. 

In several pilot studies, Dr. Culbert’s team found that kids can learn such skills and appear to find them helpful. In one study of 150 kids who underwent surgery , 87% said the techniques helped them cope with pain after the procedure. Another study found that a majority of kids with cancer felt relief from their nausea with accupressure. 

 At the University of Alberta in Edmonton, Canada, Sunita Vohra is running a clinical trial with 80 participants to examine whether a self-calming strategy can help children with a variety of diagnoses, including attention-deficit hyperactivity disorder and opposition-defiant disorder. The aim is to teach children to focus on “their presence in the moment”—by paying attention to breathing and other sensations and blocking out external commotion.

Vohra is beginning an individualized study of the use of probiotics—micro-organisms thought to be healthy for the person that consumes them—with gastrointestinal diseases. Dr. Vohra is also studying whether melatonin aids sleep in kids with attention-deficit hyperactivity disorder. 

Wake Forest’s Dr. Kemper has investigated the pediatric use of music therapy, chiropractic care that involves manipulating the body, and “healing touch,” which is based on the premise that the presence of one person’s electromagnetic energy field has an affect on another person. 

Dr. Kemper’s research, including one published in the journal Pediatric Research, has shown that music helps soothe kids with cancer. In 2008, she and her colleagues published findings on eight premature infants showing that live harp music can help them gain weight. Previous findings depicting this effect puzzled them, because such babies can’t increase the number of calories they are eating on their own.

To figure out what was going on, Dr. Kemper’s group put devices called actimeters, which measure very small movements, on the legs of the infants and found that those babies who were exposed to the music were alert and paying attention compared to those in a quiet room or getting the usual care. Soothed babies exhibit fewer tiny muscle movements compared with more tense babies, which reduces the amount of calories they burn.

 It isn’t always clear from these studies what the active ingredient is that’s responsible for the apparent benefit of the therapy. Recent preliminary findings from Dr. Kemper’s group show that kids with cancer report feeling calmer, less anxious and more comfortable in the presence of someone performing healing touch. Yet the study can’t tease apart whether it is the mere presence of a calm person in the room or the actual healing touch that appears to affect the patient.

A method that is safe can be utilized even if it is not shown to be effective, because it gives children and families a sense that they are doing something. The caution is that if a therapy has side effects,expensive, or is used in place of a therapy known to be effective, then the risks outweight the benefits.

 According to the CDC 5 million children have received a diagnosis of ADHD

•  Some say it’s being overdiagnosed and children are being overmedicated
•  Some appreciate that their children’s day care facilities and schools have suggested that ADHD is a possible diagnosis
•  Although this is a medical condition with medical treatments available, doctors are not always identifying it.  

Many parents begin their struggles with treating their children’s ADHD with a suggested diagnosis from a school or day care setting.

• It is important to recognize that there can be many other factors contributing to a child’s behavioral difficulties, such as anxiety, depression, or psyhosocial stressors such as domestic vioence or abuse at home.  Thus, many physicians caution that children may be receiving medication for the wrong problem.  
•  Often parents ask their pediatrician for a prescription for ADHD medications based on a recommendation from school. It is important that the physician investigate alternative explanations to explain the difficulties with attention, concentration, frustration tolerance, listening to adult requests, etc.
• Experts agree that ADHD does exist as a real disorder, and that some children really do benefit from medication. Studies have shown a biological basis to the disorder and a genetic component, suggesting it can be passed down in families.

Teachers and related school personnel have an important role in identifying learning and social challenges faced by students, including those with ADHD, says Clarke Ross, CEO of CHADD (Children and Adults with Attention Deficit / Hyperactivity Disorder). But teachers should never give a diagnosis for the purpose of medication use, or advise the use of medications, he said.

Medication to treat symptoms of ADHD is only a part of the treatment.

• Some students benefit  from  special adjustments in school, a tutor, or a different environment for doing homework. 
• Children with ADHD may need more one on one attention, or they may need larger assignments to be broken down into smaller steps.
• There is also a relationship between learning disorders and ADHD, so that if a child is noted to have a learning disorder, they should be evaluated as well for ADHD, and vice versa, to make certain that they are able to achieve to their full potential.

It’s helpful for parents to get informed about the condition and become advocates for their children — but some may make the situation worse by having a closed mind to interventions and denying that there’s anything wrong.

• Without treatment, kids with ADHD may get a lot more negative feedback from the adults around them.
• They may want to behave and to do well in school, and  still they may receive negative feedback.
• They may be told they are lazy, or not working up to their potential.

Teachers have an excellent frame of reference for what is typical or normal development. They may see children start to anticipate failure, avoid tasks, and underachieve, so it is important for teachers to consider the possibility of ADHD in the children that they work with.

When there are kids with ADHD in a classroom, teachers can use various strategies to minimize their challenges, such as considering special seating arrangements, cueing transitions, providing homework modifications, providing more immediate feedback and reward about a child’s behaviors. Teachers are facing greater challenges when trying to provide  an environment conducive to helping kids with conditions such as ADHD, as budget-tightening schools are increasing class sizes, and decreasing resources that might help.

 Parents can help their children (both those with and those without ADHD) by helping with homework, assisting with organization, and communicating with teachers.

 In the ideal circumstances parents, physicians and teachers would be able to conference together to review impressions, appropraite interventions, and to review what efforts proved to be successful or unsuccessful. However, with the limited access to mental health providers who are stretched thin, and with the ever-increasing class sizes for teachers, parents must often serve as the mediator between clinician and teacher.  Often, checklists that allow teachers to provide feedback about symptoms can be a helpful way of keeping the physician informed.

Does your husband or wife constantly forget chores and lose track of the calendar? Do you sometimes feel that instead of living with a spouse, you’re raising another child? Your marriage may be suffering from attention deficit hyperactivity disorder.

Is ADHD affecting your marriage?  Mental health experts note that attention problems can take a toll on adult relationships.

In a marriage, the common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness, and a lack of love and concern.

It is estimated that at least 4 percent of adults have ADHD; about 10 million U.S. adults, with only about 1.2 million of affected adults in treatment, and with many adults having never received the diagnosis as children.

As many as half of all children with A.D.H.D. do not fully outgrow it and continue to struggle with symptoms as adults.

Symptoms can include trouble with maintaining employment or completing schooling, marital difficulties,  financial challenges, repeated driving violations/tickets,

Adults with attention disorders often learn coping skills to help them stay organized and focused at work, but experts say many of them struggle at home, where their tendency to become distracted is a constant source of conflict.

Some research suggests that adults with ADHD are  twice as likely to be divorced; another study found high levels of distress in 60 percent of marriages where one spouse had the disorder.

Spouses of adults with ADHD often feel they cannot count on their partner. They may feel that the spouse is not dependable such that the unaffected spouse must take responsibility for everything.

Sometimes the unaffected spouse can become chronically angry, frustrated that they dont help around the house, that they are inconsiderate, or that they cannot count on the spouse to complete simple tasks such as running to the bank, paying bills on time, or picking up the kids. They may feel they have no choice but to constantly nag to make sure things get done.

Spouses with attention deficit, meanwhile, are often unaware of their latest mistake, confused by their partner’s simmering anger. A lengthy to-do list or a messy house feels overwhelming to the A.D.H.D. brain, causing the person to experience paralysis, and they accomplish nothing, which further infuriates their spouse. This does not happen due to laziness or selfishness, it happens due to the difficulty with task planning and organization.

Although treatment often starts with medication, it typically doesn’t solve a couple’s problems. Talk therapy may be needed to unpack years of accumulated resentments.

Behavioral therapy and coping strategies — for both partners — are essential. Long, to-do lists given to the spouse with ADHD will not be productive. instead, asking that one task at a time be targeted is more helpful.

A new device, called the Quotient, uses a motion tracker to try to help determine whether a child has Attention Deficit Hyperactivity Disorder.  The device was invented by  Dr. Martin Teicher,  Harvard Medical School associate professor.The designers feel that this is a more objective test to use for the diagnosis of ADHD than anything else that currently exists, and this is important because the lack of a reliable test to help parents and clinicians be certain of the diagnosis of ADHD has made it difficult for parents to feel comfortable about deciding to use medications in the treatment of their children.

BioBehavioral Diagnostics, of Westford and Philadelphia, says its device can distinguish between the restlessness and jitters of a child with ADHD and the movements of one who does not have the disorder, to help parents and clinicians feel more confident about the diagnosis.

Some skeptics believe that the Quotient is very similar to the continuous performance test, (CPT), where a patient works at a computer to complete tasks while the computer records the number and types of errors the patient makes. Use of the CPT has diminished greatly, due to concerns that the results do not closely correlate to a diagnosis of ADHD.  The developer of the Quotient feels that the camera greatly improves the accuracy of the test, compared to the older CPT.  The patient will play a simple game while sitting at the computer, and is asked to touch the space bar when stars flash on the screen. Impulsivity and concentration are measured by the task, while the infrared cameras in the kiosk record the movements of the patient. The developers say that while persons with and without ADHD complete the attention task, their movements are very different. A person with ADHD moves more, but also moves more simply, while a person without ADHD moves more erratically.

In a study published in the Journal of the American Academy of Child and Adolescent Psychiatry in 1996, Teicher reported that the device accurately identified 16 of the 18 children who had been previously diagnosed with ADHD, and all 11 controls without ADHD.

In 2004, BioBehavioral Diagnostics approached McLean to develop Teicher’s work into a marketable diagnostic tool

The test has been approved by the Food and Drug Administration, and currently 60 Quotient kiosks are in use across the country.The device costs clinicians $19,500; the company then charges $50 per child and $55 for adults for providing a computer-generated report for each patient.