Brain Scans Link ADHD to Biological Flaw Tied to Motivation

For decades, attention-deficit hyperactivity disorder has sparked debate. Is it a biological illness, the dangerous legacy of genes or environmental toxins, or a mere alibi for bratty kids, incompetent parents and a fraying social fabric?

With 4.5 million U.S. children having received a diagnosis of the disorder -- and more than half of them taking prescription drugs to control it -- the question has divided doctors and patients, parents and teachers, and mothers and fathers.

Scientists maintain that they've been narrowing in on the origins and mechanics of disabling distraction, while gathering increasing evidence that ADHD is as real as such less controversial disorders as Down syndrome and schizophrenia. Their most recent progress is described in a Sept. 9 report in the Journal of the American Medical Association, based on a new study that indicates a striking difference in the brain's motivational machinery in people with ADHD symptoms.

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No Data Supporting Antipsychotic Drug for Low-IQ Kids With ADHD

A new Cochrane review finds no evidence to support the use of risperidone to treat attention- deficit/hyperactivity disorder (ADHD) in people with intellectual disabilities, even though the review authors say this is a common prescribing pattern.

Risperidone, or Risperdal, is a second-generation antipsychotic drug. Long-term use of these drugs is associated with serious side effects, including weight gain and increased risk for type 2 diabetes.

“People who have intellectual disability are more likely to receive treatment with second- generation antipsychotics for ADHD,” said lead review author Dr. Alex Thomson. “Doctors should be aware that there is no research to demonstrate the effectiveness of risperidone for ADHD in people with intellectual disability, and should carefully monitor each case and consider alternative treatments before trying risperidone.”

Laurel Leslie, M.D., an associate professor at Tufts University School of Medicine whose research centers on pediatric mental health, concurred: “This study demonstrates that we have a gap between what we’re doing clinically and what we have any research evidence for. It’s an important study, as it highlights the need for careful consideration of how we treat children’s mental health issues.” Leslie has no affiliation with the Cochrane review.

Thomson’s research group did not find one study that met their criteria for inclusion among more than 2,000 studies that they initially identified. The group analyzed 15 studies in depth, but ultimately rejected them all.

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Hallucinations Are Rare Side Effects of ADHD Medications

Children who take medications for attention-deficit hyperactivity disorder (ADHD) may rarely experience some disturbing side effects, such as hallucinations.

U.S. government experts reviewed clinical trials and post-marketing reports of side effects from the commonly prescribed ADHD stimulant medications, such as Concerta, Ritalin and Strattera. They found that out of every 100 "person-years" of treatment, one or two children will experience serious side effects, such as hallucinations of bugs or snakes.

"Patients and physicians should be aware that psychosis or mania arising during drug treatment of attention-deficit hyperactivity disorder may represent adverse drug reactions, the study's authors wrote in the February issue Pediatrics.

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ADHD Medication: Can Your Child Go Without? Behavioral therapy for ADHD—and parent retraining, too—can be good alternatives to medication

Attention deficit hyperactivity disorder can be a distressing diagnosis, but families have more treatment options than they might realize. Although Ritalin and other stimulant drugs are the most common prescription, ADHD treatments that don't involve medication have a proven track record. And here's a surprise: One of the most beneficial options treats the parents, not the child. For children, skills training programs and ADHD summer camps can help teach techniques to overcome everyday problems that often make life miserable, such as remembering to bring assignments home from school or to listen without interrupting.

How training parents helps the child. Parent skills training has been used for years to improve the behavior of children, and multiple clinical trials have validated its effectiveness. Those same programs improve the behavior of kids with ADHD. Although it may seem odd to be changing parents' behavior to treat what's considered a medical condition in children, research has found that for children with ADHD, having parents who use effective parenting techniques is one of the best predictors of success in adulthood. These programs teach parents to make clear, specific requests of children, for instance, and to use praise and rewards for good behavior far more often than punishment.

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Genetic Determinants Of ADHD Examined

A special issue of American Journal of Medical Genetics (AJMG): Part B: Neuropsychiatric Genetics presents a comprehensive overview of the latest progress in genetic research of Attention Deficit/Hyperactivity Disorder (ADHD). The issue covers major trends in the field of complex psychiatric genetics, underscoring how genetic studies of ADHD have evolved, and what approaches are needed to uncover its genetic origins.

ADHD is a complex condition with environmental and genetic causes. It is characterized by developmentally inappropriate levels of inattention, hyperactivity and impulsivity that has an onset in childhood. It is one of the most common psychiatric diseases, affecting between 8-12 percent of children worldwide. The drugs used to treat ADHD are highly effective, making ADHD one of the most treatable psychiatric disorders.

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ADHD Medications Do Not Cause Genetic Damage in Children

In contrast to recent findings, two of the most common medications used to treat attention deficit hyperactivity disorder (ADHD) do not appear to cause genetic damage in children who take them as prescribed, according to a new study by researchers at the National Institutes of Health (NIH) and Duke University Medical Center.

The study published online this month in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) provides new evidence that therapeutic doses of stimulant medications, such as methylphenidate and amphetamine, do not cause cytogenetic (chromosomal) damage in humans. The researchers looked at three measures of cytogenetic damage in white blood cells of each child participating in the study and found no evidence of any changes after three months of continuous treatment.

"This is good news for parents," said Kristine L. Witt, M.Sc., a genetic toxicologist at the National Institute of Environmental Health Sciences (NIEHS) and co-author on the study, which was funded through the Best Pharmaceuticals for Children Act by NIEHS and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), both parts of NIH. "Our results indicate that methylphenidate- and amphetamine-based products do not induce cytogenetic damage in children."

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U.S. Kids Take More Psychotropic Drugs Than Europeans

American children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease than European children are, a new study finds.

Differences in regulatory practices and cultural beliefs about the benefit of medication for emotional and behavioral problems may explain this dramatic difference, the U.S. researchers added.

"There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe," said lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland. "Since most of the use is 'off-label' -- without adequate evidence of benefits and risks, close monitoring should be considered when these medications are used."

The report was published in the Sept. 24 online edition of Child and Adolescent Psychiatry and Mental Health.

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ADHD children have greater risk of being overweight

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for being overweight, regardless of whether or not they are currently receiving medications for the condition.

The results of prior research has suggested that the impulsivity and poor behavioral regulation that is common in children with ADHD may promote certain eating patterns that increase the risk of obesity, co-authors Molly E. Waring and Dr. Kate L. Lapane, from Brown Medical School in Providence, Rhode Island, note.

To investigate further, the researchers analyzed data from 62,887 children and adolescents included in the 2003-2004 National Survey of Children's Health.

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Herbal Remedy No Better Than Placebo in Treating ADHD

Parents of children and adolescents with ADHD should give their offspring physician-prescribed treatments rather than herbal remedies, according to the results of a new placebo-controlled trial.

One popular botanical compound is no more effective than placebo for treating symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, according to a report in the June 11 Journal of the American Medical Association.

Some parents have attempted to treat their children and adolescents with the herbal remedy because of the side effects associated with stimulant medications or because stimulants have not been effective in reducing the symptoms associated with ADHD in their offspring, stated the report.

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Ritalin-style Drug Set For Wider Role In Adult Mental Illness

A significant number of adults with unresolved depression, anxiety or addiction may actually have Attention Deficit Hyperactivity Disorder (ADHD), a condition that has been widely considered to resolve in late adolescence.

Armed with the correct diagnosis, adult ADHD sufferers could soon be prescribed Ritalin-style stimulant medications for a range of mental health problems that are not usually associated with the disorder, the Royal College of Psychiatrists' annual meeting was told on Friday 4 July.

Stimulant medication is currently only licensed for children with ADHD. However, the National Institute for Health and Clinical Excellence (NICE) is expected to recommend that this class of drug can be prescribed adults with ADHD in September 2008 - following the recognition that the condition persists into adulthood in about 20 per cent of cases diagnosed in childhood.

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ADHD Gene Doesn't Predict Response to Drugs

Canadian researchers report that their discovery of a gene variant that seems to affect the severity of attention-deficit hyperactivity disorder did not help them predict which patients are likely to respond to a class of drugs widely used to treat the disorder.

The lack of a connection between the variant and response to methylphenidates was a blow for researchers, who have hoped to use genetic data to better predict who might be the best candidates for this treatment. Ritalin is one example of a methylphenidate.

"It is a negative study," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y. "The goal is to try and better identify patients who are best going to respond to which medicine, and they didn't get the findings they were hoping to find. Their theory wasn't supported by the data."

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Mutation Related To ADHD Drug Metabolism Discovered

Researchers within the Darby Children’s Research Institute at the Medical University of South Carolina (MUSC) have discovered a gene mutation directly involved in the metabolism of the most common and perhaps most known medication used to treat ADHD, methylphenidate (MPH), or Ritalin. The discovery may open the door to pre-testing of patients for the appropriate ADHD medication, instead of having to undergo trial and error.

It’s not unusual for scientists to focus their work in one direction, only to discover something unexpected. Researchers within the Darby Children’s Research Institute at the Medical University of South Carolina (MUSC) have discovered a gene mutation directly involved in the metabolism of the most common and perhaps most known medication used to treat ADHD, methylphenidate (MPH), or Ritalin®. This research is described in full detail in the June 2008 issue of the American Journal of Human Genetics.

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ADHD Drugs Won't Raise Risk of Substance Abuse

Parents of children who are prescribed psychostimulants for attention deficit-hyperactivity disorder (ADHD) might have one less thing to worry about now that a new study concludes these kids are no more likely than their peers to abuse drugs and alcohol as young adults.

The report, which was funded by the National Institutes of Health, is published in the March issue of the American Journal of Psychiatry.

"The results should reassure clinicians who might be hesitant to treat ADHD because of concerns about future substance abuse," said study co-author Michael C. Monuteaux, assistant director of research at the pediatric psychopharmacology program at Massachusetts General Hospital.

Past research looking for a link between ADHD medications and substance abuse has produced conflicting conclusions.

"Some previous studies showed an increased risk of substance abuse associated with stimulant treatment, and other studies showed both no association and also a protective effect from treatments," Monuteaux said. "But those studies had some methodological limitations, and not all of them followed their samples well into late adolescence and early adulthood."

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Ritalin: The scandal of kiddy coke

When he was in the throes of his worst tantrums, Daniel Fletcher would rip wallpaper off the walls at home and hit and kick anyone who came near him.

Once, he put his pet mouse in the microwave. On another occasion he jumped out of a moving car.

He was first diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) at the age of two, and just three years later the little boy was prescribed the amphetamine-like drug Ritalin.

The effect, says his mother Hayley, was a loss of appetite but no difference in his behaviour.

"So the doctor kept upping the doses until he was on six times the normal dose, yet he was still hyperactive."

Eight months ago, Daniel, now 14, was put on Risperdal - an antipsychotic drug usually given to schizophrenics.

"It was as if my son had been replaced by a doped-up zombie,' says Hayley, 35, who took him off it a month later.

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ADHD Drugs Ineffective Over The Long Term

Apart from being ineffective over the long term, ADHD (attention deficit/hyperactivity disorder) drugs may also undermine your child's physical growth, a BBC television program, Panorama, has revealed. Scientists seem to be saying that claims made about ADHD drugs some years ago were overstated.

A long-term monitoring program involving 600 kids across the United States since the beginning of the 1990s was shown in the TV program - with some of its results. It is called the Multimodal Treatment Study of Children with ADHD. The study concluded that over the long term, such ADHD drugs as Concerta and Ritalin have no demonstrable benefit for children - long term means after three years of taking the drug(s).

The use of ADHD drugs in much of the developed world has doubled over the last five years - many say it has become a cure-all for bad behavior.

READ MORE @ MEDICAL NEWS TODAY

ADHD Drugs Ineffective Over The Long Term

Apart from being ineffective over the long term, ADHD (attention deficit/hyperactivity disorder) drugs may also undermine your child's physical growth, a BBC television program, Panorama, has revealed. Scientists seem to be saying that claims made about ADHD drugs some years ago were overstated.

A long-term monitoring program involving 600 kids across the United States since the beginning of the 1990s was shown in the TV program - with some of its results. It is called the Multimodal Treatment Study of Children with ADHD. The study concluded that over the long term, such ADHD drugs as Concerta and Ritalin have no demonstrable benefit for children - long term means after three years of taking the drug(s).

The use of ADHD drugs in much of the developed world has doubled over the last five years - many say it has become a cure-all for bad behavior.

ADHD Brains Might Need More Growing Time

Scientists are divided on what causes attention deficit hyperactivity disorder, which affects 3 to 5 percent of school-age children. Some say it's a developmental delay, while others argue that the brains of children with ADHD are abnormal from the start. One puzzle: Some, but not all, kids seem to "grow out" of the disorder, which can cause restlessness, inattention, and difficulty focusing. An intriguing new finding by researchers at the National Institute of Mental Health, reported in today's Proceedings of the National Academy of Sciences, suggests that for about half of kids with ADHD, the troubling symptoms they experience in childhood could be a result simply of slower—but otherwise normal—maturation of the brain.

What should harried parents make of the findings? U.S. News asked Judith Rapoport, a coauthor of the study and chief of the child psychology branch at the National Institute of Mental Health. She has pioneered efforts to study the relationship between brain structure and mental disorders.

Rapoport cautions that the research is in the early stages. The delays, which put areas of the brain used in higher order decision making behind schedule by an average of three years, were most evident in areas at the front of the brain's outer covering, or cortex, that house the ability to control thinking, attention, and planning. In some of the children and teens with ADHD, the brain regions reached peak thickness when the children averaged 10.5 years old, compared with 7.5 in children without ADHD.

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ADHD Medication Doesn't Work on Some Preschoolers - Children May Not Respond If They Have Other Disorders

Children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) may not respond to methylphenidate, otherwise known as brand name Ritalin, if the child suffers from other behavioral and social disorders. The number of coexisting conditions can diminish the effectiveness of the medication, according to a new look at a study from the National Institutes of Health's National Institute of Mental Health (NIMH).

The Preschoolers with ADHD Treatment Study (PATS) was released last October, and showed that young children between the ages of 3 and 5 who were diagnosed with ADHD responded well to doses of methylphenidate. However, a new article published in the latest issue of the Journal of Child and Adolescent Psychopharmacology reports that the effectiveness of methylphenidate lessens if the child has other disorders, such as anxiety disorders, conduct disorder, and/or oppositional defiant disorder.

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Are ADHD Medications and Cardiac Risks Linked?

According to a September 17th AHRQ press release, The Agency for Health Research and Quality (AHRQ) together with the Food and Drug Administration (FDA) plan to conduct a huge examination of data from 500,000 patients who are taking medication for Attention Deficit Hyperactivity Disorder (ADHD) to see if the medication increases the risk of cardiovascular problems. The data of both children and adults will be examined, and the study is expected to last two years.

It is already known that medications for ADHD can increase heart rate and blood pressure in patients taking the drug regime, and there have been case study reports of cardiac incidents, according to Dr. Gerald D. Pan, MD of the FDA's Office of Surveillance and Epidemiology, as stated in the AHRQ press release. The study is to determine whether there is a causal relationship between cardiac problems and a person's taking ADHD medications or whether cardiovascular problems are due to the person's already being at risk for the cardiac incidents. The data to be examined is from a preliminary seven FDA year study which ended in 2005.

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Kids with ADHD have reason to hope

A.J. Copeland, 13, of Washington, D.C., started eighth grade this month with an announcement: "He said, 'I'm going to make all A's this year,' " recalls his mother, Tamara Copeland.

For a boy who was diagnosed at age 6 with attention deficit/hyperactivity disorder (ADHD) and who has struggled with school, that statement might seem unrealistic. But his mother is cautiously optimistic: Thanks to years of trial and error with medications and behavior-changing strategies, A.J. may well be turning a corner, she says. Though improvements have been "erratic," A.J.'s new attitude is a good sign, she says. "It says to me that he is beginning to understand he is part of controlling his destiny."

The Copelands and millions of other families have reason for hope as another challenging school year begins for children with the common disorder: According to a study updated this summer, most children treated for ADHD — whether with medication, behavioral therapy or both — do improve over time.

The roles of specific therapies and educational strategies remain unclear. Children who received medication, with frequent checkups to adjust doses and drug choices, did best in the first 14 months of the study. But that advantage waned by the three-year mark, according to a set of reports in the August Journal of the American Academy of Child and Adolescent Psychiatry.

READ MORE @ USA TODAY