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New research shows that men who had ADHD as children are twice as likely to be obese by the time they grow up than men who did not have the mental disorder as kids.
Even when socioeconomic factors were taken into account, men who had ADHD when they were younger still were more likely to be obese as adults, according to a new 30-year study published May 20 in Pediatrics.
"That really seems to be reflective of their early hyperactivity. It doesn't matter what their current diagnosis is so much, so we think these are longstanding issues that likely arose in early adolescence," study co-author Dr. Francisco Xavier Castellanos, a professor of child and adolescent psychiatry in the Child Study Center at NYU Langone Medical Center in New York City, told HealthDay.
ADHD, which stands for attention deficit/hyperactivity disorder, is one of the most common childhood mental disorders. The Centers for Disease Control and Prevention reported earlier this month that 7 percent of U.S. children between the ages of 3 to 17 have been diagnosed with ADHD, the most prevalent mental health diagnosis for kids. Another recent CDC report put that rate closer to 11 percent of kids between ages 4 and 17, with one in five boys receiving the diagnosis. ADHD also affects 4.4 percent of U.S. adults, the National Institutes of Health noted.
For the study, researchers studied 111 men who had been diagnosed with childhood hyperactivity and contacted them at ages 18, 25 and 41. By the time they were adults, 41 percent were obese. Only 22 percent of the control group, made up of people who didn't have hyperactivity as children, were obese.
At 41, the men who had ADHD in their youth had an average BMI of 30.1. The control group on the other hand had a BMI of 27.6. An individual who has a BMI score of over 25 is considered to be overweight, and a score of 30 or over is considered to be obese.
"We are paying attention to obesity more and more these days. It would make a lot of sense to perhaps emphasize that issue with boys who have ADHD as they move into adulthood, no matter what," Dr. Charles Shubin, director of pediatrics for Mercy Family Care, a division of Family Health Centers of Baltimore, Maryland, told MedPage Today.
"We would want to pay attention to anybody who's at risk for obesity and hopefully manage it," Shubin, who was not involved in the study, said.
The authors believe that men who had ADHD may have problems with impulse control and planning, which could make them more prone to poor eating habits and making bad food choices. They may also have problems setting a regular eating pattern.
"It fits with other studies, and suggests that the inability to control one's impulses, the tendency to be relatively reward-driven, may represent a risk of obesity over time," Castellanos said.
ADHD symptoms include difficulty staying focused and paying attention, difficulty controlling behavior and over-activity, otherwise known as hyperactivity. There are three subtypes of ADHD: predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive.
There is no known cause for ADHD, but scientists believe it may be caused by genetic and environmental factors. Brain injuries have sparked ADHD in some children, but the number of children with ADHD who have had a brain injury remains low. High sugar consumption has been speculated as a cause, but research has not linked the two.Read article >>
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.
These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.
The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.
“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”
And even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment. A.D.H.D. is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.
While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates — diversion long tolerated in college settings and gaining traction in high-achieving high schools — are particularly dangerous, doctors say, because of their health risks when abused.
The findings were part of a broader C.D.C. study of children’s health issues, taken from February 2011 to June 2012. The agency interviewed more than 76,000 parents nationwide by both cellphone and landline and is currently compiling its reports. The New York Times obtained the raw data from the agency and compiled the results.
A.D.H.D. has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.
The C.D.C. director, Dr. Thomas R. Frieden, likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.
“We need to ensure balance,” Dr. Frieden said. “The right medications for A.D.H.D., given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”
Experts cited several factors in the rising rates. Some doctors are hastily viewing any complaints of inattention as full-blown A.D.H.D., they said, while pharmaceutical advertising emphasizes how medication can substantially improve a child’s life. Moreover, they said, some parents are pressuring doctors to help with their children’s troublesome behavior and slipping grades.
“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of “How Doctors Think.”
Fifteen percent of school-age boys have received an A.D.H.D. diagnosis, the data showed; the rate for girls was 7 percent. Diagnoses among those of high-school age — 14 to 17 — were particularly high, 10 percent for girls and 19 percent for boys. About one in 10 high-school boys currently takes A.D.H.D. medication, the data showed.
Rates by state are less precise but vary widely. Southern states, like Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showed about 23 percent of school-age boys receiving an A.D.H.D. diagnosis. The rates in Colorado and Nevada were less than 10 percent.
The medications — primarily Adderall, Ritalin, Concerta and Vyvanse — often afford those with severe A.D.H.D. the concentration and impulse control to lead relatively normal lives. Because the pills can vastly improve focus and drive among those with perhaps only traces of the disorder, an A.D.H.D. diagnosis has become a popular shortcut to better grades, some experts said, with many students unaware of or disregarding the medication’s health risks.
“There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary A.D.H.D. researchers in the last 20 years. “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”
An A.D.H.D. diagnosis often results in a family’s paying for a child’s repeated visits to doctors for assessments or prescription renewals. Taxpayers assume this cost for children covered by Medicaid, who, according to the C.D.C. data, have among the highest rates of A.D.H.D. diagnoses: 14 percent for school-age children, about one-third higher than the rest of the population.
Several doctors mentioned that advertising from the pharmaceutical industry that played off parents’ fears — showing children struggling in school or left without friends — encouraged parents and doctors to call even minor symptoms A.D.H.D. and try stimulant treatment. For example, a pamphlet for Vyvanse from its manufacturer, Shire, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”
Sales of stimulants to treat A.D.H.D. have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.
Criteria for the proper diagnosis of A.D.H.D., to be released next month in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, have been changed specifically to allow more adolescents and adults to qualify for a diagnosis, according to several people involved in the discussions.
The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that A.D.H.D. is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”
An analysis of the proposed changes published in January by the Journal of Learning Disabilities concluded: “These wording changes newly diagnose individuals who display symptoms of A.D.H.D. but continue to function acceptably in their daily lives."Given that severe A.D.H.D. that goes untreated has been shown to increase a child’s risk for academic failure and substance abuse, doctors have historically focused on raising awareness of the disorder and reducing fears surrounding stimulant medication.
A leading voice has been Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder. But in a recent interview, Dr. Hallowell said that the new C.D.C. data, combined with recent news reports of young people abusing stimulants, left him assessing his role.
Whereas Dr. Hallowell for years would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said last week, “I regret the analogy” and he “won’t be saying that again.” And while he still thinks that many children with A.D.H.D. continue to go unrecognized and untreated, he said the high rates demonstrate how the diagnosis is being handed out too freely.
“I think now’s the time to call attention to the dangers that can be associated with making the diagnosis in a slipshod fashion,” he said. “That we have kids out there getting these drugs to use them as mental steroids — that’s dangerous, and I hate to think I have a hand in creating that problem.”Read article >>
Large population study finds attention-deficit hyperactivity disorder in childhood lingers into adulthood for many and is linked to an increased risk for a wide range of psychiatric disorders.
Almost a third of kids diagnosed with attention-deficit hyperactivity disorder during childhood still had it as adults, and more than half also had another psychiatric disorder, finds one of the largest studies to follow children with ADHD into adulthood.
Twenty-nine percent of children diagnosed with ADHD still had the condition at age 27, says the study in April's Pediatrics, released online Monday. Nearly 57% of those diagnosed during childhood had at least one other psychiatric disorder as adults, compared with 35% of those in a comparison group who did not have childhood ADHD.
The most common adult psychiatric problems among childhood ADHD cases: alcohol abuse/dependence (26%); antisocial personality disorder (17%), other substance abuse/dependence (16%); hypomanic episodes (15%); anxiety disorder (14%) and major depression (13%).
"The risk for persistent ADHD is considerable, and the risk for at least one mental health condition, including ADHD, is extraordinarily high," says lead investigator William Barbaresi, a developmental medicine specialist at Boston Children's Hospital. "Only 37.5% of the children we contacted as adults were free of these really worrisome outcomes."
The study also found the risk for suicide was nearly five times higher among those diagnosed with ADHD than in the comparison group, and nearly 3% of study participants were in jail when recruited for the adult portion of the study.
ADHD is one of the most common neuro-developmental disorders of childhood, affecting as many as 9% of kids ages 3 to 17 (5 million children) and between 2% and 4% of adults, according to the National Resource Center on ADHD. Symptoms include excessive inattention, hyperactivity and impulsivity.
Other studies have also highlighted long-term effects of ADHD, but this one "is particularly telling because it used a community sample of children with ADHD followed to adulthood and not a clinical sample of individuals seeking treatment for their problems," says J. Russell Ramsay, co-director of the University of Pennsylvania's Adult ADHD Treatment and Research Program in Philadelphia. He was not involved in the study.
"It is chilling to see evidence, at least in this study, of the increased risk for death by suicide among children diagnosed with ADHD, with most of these tragic cases also having a history of substance abuse and at least one co-existing psychiatric diagnosis," Ramsay says.
Conducted with researchers at the Mayo Clinic in Rochester, Minn., the study drew from all 5,718 children born between 1976 and 1982 and still residing in Rochester at age 5 and whose families allowed access to their medical records. Among that population, 367 who had documented ADHD participated; 232 who met the study's criteria for adult ADHD participated in the follow-up study at age 27.
Although 29% of the childhood ADHD cases continued to have ADHD as adults, 71% did not, and it's unclear what accounts for that difference, Barbaresi says.
He notes that among children whose ADHD persisted into adulthood, 81% had at least one additional mental health problem. Among those whose childhood ADHD did not persist, 47% had at least one other mental health problem. One preliminary suggestion, he says, is that having "an associated mental health problem" may increase the likelihood that ADHD will persist into adulthood.
The cause of ADHD is unknown, but current research shows that genetics play an important role, according to the Centers for Disease Control and Prevention. Symptoms can be controlled by a combination of behavioral therapy and medication.
This study "shows that the adverse effects of ADHD are persistent and long-term in a substantial proportion of those with a childhood diagnosis," says Tanya Froehlich, a developmental-behavioral pediatrician at Cincinnati Children's Hospital Medical Center. She was not involved in the study. The disorder and its associated conditions "have serious public health consequences," she says.
When it comes to treatment, ADHD warrants the same approach as chronic health problems such as diabetes, Barbaresi says. In those cases, "when a child is diagnosed, we immediately institute strategies aimed at keeping the child engaged in appropriate treatment for the long haul."
For many reasons, including "a huge problem with regard to health care coverage of appropriate assessment and treatment ... that's not really happening at a systematic level with ADHD," he says.
Some insurance plans categorize ADHD as a behavioral condition and not a medical condition, thereby limiting coverage for treatment, says Tim MacGeorge, director of the National Resource Center on ADHD.
Growing up with ADHD
Among those age 27 who had been diagnosed with ADHD as children:
-- 37.5% had no ADHD and no psychiatric disorders
-- 33.2% had no ADHD and one or more psychiatric disorders
-- 23.7% had ADHD and one or more psychiatric disorders
-- 5.6% had ADHD and no psychiatric disorders
Source: PediatricsRead article >>
For most preschoolers diagnosed with attention-deficit/hyperactivity disorder (ADHD) with moderate-to-severe symptoms, the condition persists at least through elementary school, researchers found.
Among participants in a randomized ADHD treatment trial, nearly 90% of those initially diagnosed when they were 3 to 5 years old still met criteria for the condition 6 years later, according to Mark Riddle, MD, of Johns Hopkins University, and colleagues.
Symptom severity, which initially dropped from baseline to 3 years but then remained stable for the next 3 years, was not significantly associated with medication use, the researchers reported online in the Journal of the American Academy of Child & Adolescent Psychiatry.
"Because ADHD is highly stable in preschoolers with moderate-to-severe ADHD, and because frequent dissatisfaction with ADHD treatment leads to drop-out, especially in younger children, early and intensive interventions are needed," the authors wrote.
"This could include more effective use of medication, longer or more intensive parent training ... and/or addition of behavioral interventions at school," they wrote.
Most longitudinal studies of ADHD have followed children from elementary school or later, with little research starting as early as preschool age, when the first signs of the condition often arise, according to the researchers.
To help fill the gap, they turned to the follow-up study of the Preschool ADHD Treatment Study (PATS), a randomized trial evaluating the safety and efficacy of long-term methylphenidate treatment in children ages 3 to 5.5 years. At baseline, the children all had moderate-to-severe ADHD symptoms.
The current analysis included 207 children -- representing 68% of the participants from the original trial -- who entered into the follow-up study, which included assessments at 3, 4, and 6 years. The average age of the participants was 4.4 at baseline, 7.4 at 3 years, 8.3 at 4 years, and 10.4 at 6 years.
The most common medication classes used were stimulants (58.7%), norepinephrine reuptake inhibitors (10.7%), and antipsychotics (8.3%) at 3 years and stimulants (62.9%), antipsychotics (12.9%), and selective serotonin reuptake inhibitors (8.6%) at 6 years.
From baseline to 3 years, the severity of inattention and hyperactivity/impulsivity symptoms as rated by parents and teachers fell (P<0.0001 for both), but then there were no further reductions through 6 years. Girls tended to have worse symptom ratings at baseline and greater improvements through the first 3 years.
Most of the participants who entered the follow-up study (84.8%) continued to meet criteria for an ADHD diagnosis at 3 years, a percentage that increased slightly by 6 years (89.2%).
After adjustment for prior ADHD diagnosis, IQ, and medication status, the only significant predictor of having an ADHD diagnosis at 6 years was the presence of oppositional defiant disorder, conduct disorder, or both (risk ratio 1.30, 95% CI 1.10 to 1.46).
The authors acknowledged some limitations of the study, including the lack of a control group, the fact that treatment was not controlled during most of the 6-year follow-up period, and the relatively long interval between the original study and the start of the follow-up study. Other limitations were attrition and selection bias, and the fact that not all of the demographic characteristics of the study sample were representative of the larger U.S. population.Read article >>
A new study published online in the Journal of the American Academy of Child and Adolescent Psychiatry revealed a significantly higher prevalence of substance abuse and cigarette use by adolescents with attention deficit hyperactivity disorder (ADHD) histories than in those without ADHD. Researchers from the University of Pittsburgh School of Medicine and six other health centers across the United States also found that, contrary to previous findings, current medications for ADHD do not counter the risk for substance abuse and substance use disorder (SUD) among teenagers.
This study is the first to examine teenage substance abuse and treatment for ADHD in a large multi-site sample. It also is the first to recognize that increased use of cigarettes in teenagers with ADHD histories commonly occurs with use of other substances such as alcohol and marijuana.
“This study underscores the significance of the substance abuse risk for both boys and girls with childhood ADHD,” said Brooke Molina, Ph.D., professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and lead author of the report. “These findings also are the strongest test to date of the association between medication for ADHD and teenage substance abuse.”
Researchers studied nearly 600 children over an eight-year period from childhood through adolescence to test the hypothesis that children with ADHD have increased risk of substance use and abuse or dependence in adolescence. Molina and colleagues also examined substance abuse patterns, the effects of ADHD medications over time, and the relationship between medication and substance use.
The findings showed:
• When the adolescents were an average of 15 years old, 35 percent of those with ADHD histories reported using one or more substances, as compared to only 20 percent of teens without ADHD histories.
• Ten percent of the ADHD group met criteria for a substance abuse or dependence disorder, which means they experienced significant problems from their substance use, as compared to only 3 percent of the non-ADHD group.
• When the adolescents were an average of 17 years old, marijuana was particularly problematic with 13 percent versus 7 percent of the ADHD and non-ADHD groups, respectively, having marijuana abuse or dependence.
• Daily cigarette smoking was very high at 17 percent of the ADHD group, a significantly higher rate than national estimates for this age. The smoking rate of non-ADHD teens was only 8 percent.
• Alcohol use was high in both groups, highlighting its common occurrence for teenagers in general.
• Substance abuse rates were not different for children who were still being treated with ADHD medication compared to children who were not.
The authors noted the important finding that substance abuse rates were the same in teenagers still taking medication and in those no longer on medication, even after considering multiple factors that might cause teenage medication use. They noted that these results suggest a need to identify alternative approaches to substance abuse prevention and treatment for boys and girls with ADHD.
“We are working hard to understand the reasons why children with ADHD have increased risk of drug abuse. Our hypotheses, partly supported by our research and that of others, is that impulsive decision making, poor school performance, and difficulty making healthy friendships all contribute,” added Molina.
“Some of this is biologically driven because we know that ADHD runs in families. However, similar to managing high blood pressure or obesity, there are non-medical things we can do to decrease the risk of a bad outcome. As researchers and practitioners, we need to do a better job of helping parents and schools address these risk factors that are so common for children with ADHD.”
This research was supported by cooperative agreement grants and contracts from the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse.Read article >>
Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.
It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”
It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.
Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.
Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.
Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”
Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.
“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”Read article >>
From 2001 to 2010, the rate of ADHD diagnosis among children notably has increased over time. The rate increased among whites, blacks, and Hispanics.
Note that patients with ADHD were more likely to be white or black, come from families earning $70,000 or more annually, and were more likely to be male than female.
The rates of childhood attention deficit/hyperactivity disorder (ADHD) diagnosis has increased by nearly 25% over the past decade, researchers found.
From 2001 to 2010, the rate of ADHD diagnosis increased from 2.5% to 3.1%, according to Darios Getahun, MD, PhD, of Kaiser Permanente Southern California Medical Group in Pasadena, and colleagues.
Increases were significant among whites (relative risk 1.3, 95% CI 1.2 to 1.4), blacks (RR 1.7, 95% CI 1.5 to 1.9), and Hispanics (RR 1.6, 95% CI 1.5 to 1.7), but did not change significantly among Asians, Pacific Islanders, and other racial groups over the 10-year period, Getahun and colleagues reported online in JAMA Pediatrics.
They noted that, over the previous decade, the prevalence of ADHD reached epidemic proportions in the U.S.
"It is one of the most common chronic childhood psychiatric disorders, affecting 4% to 12% of all school-age children and persisting into adolescence and adulthood in approximately 66% to 85% of children," they wrote. "This large cohort study with children from diverse racial/ethnic and socioeconomic backgrounds provides assurance on the generalizability of our findings."
The researchers examined trends in ADHD by race, age, sex, and household income among 842,830 children, ages 5 to 11, with an ADHD diagnosis in the Kaiser Permanente Southern California health plan.
The primary diagnosis of ADHD was made based on International Classification of Diseases, Ninth Revision, coding on child hospitalization, outpatient office visits, and emergency department visits across all Kaiser facilities.
They looked at increases in rates of ADHD prevalence among other races compared with white race and among children of higher socioeconomic status across all age groups. They also investigated whether the "sex gap in ADHD diagnosis has narrowed over time."
Prevalences were calculated in 2-year intervals from January 2001 to December 2010. Outcomes were stratified by age, race, sex, and household income.
There was an overall 4.9% prevalence of ADHD among children treated at Kaiser Permanente over the 10-year study period (39,200 of 842,830). From 2001 to 2010, prevalence of ADHD increased from 6,869 (2.5%) to 8,006 (3.1%).
Mean age of patients at diagnosis remained stable at 8.4 to 9.5 years over the course of the study. Patients with ADHD were more likely to be white or black, come from families earning $70,000 or more annually, and were more likely to be male than female.
Over the 10 years, blacks had the highest relative increase in ADHD diagnosis rates (69.6%) followed by Hispanics (60.4%), and whites (29.8%). These increases were all significant at P<0.001. The authors noted that despite the higher increases in prevalence, "white children had substantially higher ADHD diagnosis rates than children of other races in every age group."
By race and gender, black girls had a significant increase in ADHD prevalence over the study period (RR 1.9, 95% CI 1.5 to 2.3). The sex gap in ADHD prevalences remained stable among other races.
"The findings of this study suggest increasing trends in the clinical diagnosis of ADHD among children in the health plan," they concluded, adding that they "observed disproportionately high ADHD diagnosis rates among white children and notable increases in rates among black girls over time."
The study was limited by missing race data for some participants, they noted.Read article >>
Lower school grades among depressed adolescents are linked to behavior problems, not their depression, a new study finds.
Researchers examined data from thousands of U.S. teens who were tracked through their middle and high school years and as they moved into early adulthood.
Unlike students with depression, those with behavior problems such as attention issues, delinquency or substance use had lower GPAs than others. The study also found that delinquency and substance use were associated with receiving lesser educational degrees, while depression was not.
Students with two of these problems typically earned lower GPAs and lesser degrees than those with one problem, and some combinations of problems had more harmful effects than others, according to the study, which was published in the December issue of the Journal of Health and Social Behavior.
For instance, substance use worsened the educational risks associated with depression, attention issues and delinquency. Having depression did not, however, increase the educational risks associated with attention issues, delinquency or substance use.
"Behavior problems including attention issues, delinquency and substance use are associated with diminished achievement, but depression is not," study lead author Jane McLeod, a sociology professor and associate dean at Indiana University, in Bloomington, said in a journal news release.
"Certainly, there are depressed youths who have trouble in school, but it's likely because they are also using substances, engaging in delinquent activities or have attention issues," she added.
"There's a fairly sizable literature that links depression in high school to diminished academic achievement," McLeod noted. "The argument we make in our study is what's really happening is that youths who are depressed also have other problems, and it's those other problems that are adversely affecting their achievement."
McLeod said the findings suggest that schools should reconsider the approach they take to dealing with students with behavior issues.
"Perhaps, they should think about moving away from punitive approaches toward approaches aimed at integrating these students into the school community," she suggested.Read article >>
As academic pressures become too much to handle, some students go to dangerous lengths to stay in the game. Worse yet, many of these students aren’t aware of the risks they’re taking.
High school students nationwide are turning to attention deficit treatments like Adderall and Ritalin to improve their focus and help them maintain attention.
Although these drugs are only prescribed to patients who are diagnosed with ADHD, an attention disorder commonly found among adolescents, some people without the disorder take the drug without a prescription to improve focus and productivity while studying and taking tests.
“The people who abuse it are the teens who may take a pill and think it’s going to help them study for finals,” said Greenbrae pediatrician Jan Maisel.
Although it may seem like a good idea to overworked teens, Corte Madera psychiatrist Michael Freeman said that people without ADHD put themselves at serious risk by taking the drugs without a prescription.
“If you don’t have ADHD, if feels just like taking speed,” Freeman said. “If you have ADHD, then it doesn’t feel like speed, it actually has a more calming, centering effect. How it does it, very simply, is that there are some chemical differences in the brain with ADHD that are corrected and rebuilt by the medication.”
Freeman said that the more serious side effects put people who don’t have ADHD at a great risk of cardiovascular complications.
“The drugs can give you heart attacks, can cause cardiac arrest, they can do all kinds of things,” Freeman said. “They can cause you to have a stroke, and they can raise your blood pressure. They have very serious consequences.”
According to Freeman, side effects of the drug can also include dryness of mouth, appetite suppression, insomnia, high levels of energy, increased motivation, and irritability.
Both Maisel and Freeman said that on a long-term basis, the drug does not improve one’s ability to learn if taken non-medically.
“On a short-term basis, it might improve your results. You stay up all night, pull an all-nighter, read more, finish more problems,” Freeman said. “But on a long-term basis, it interrupts your sleep/wake cycles.”
Freeman said that when people are on the drug, they are learning in an “altered state.” Someone who studies in an altered state may not remember the information when he or she returns to a non-altered state.
According to Freeman, this is called state-dependent learning, and it can change the way one’s brain functions.
“When you you learn something when you’re in one state of mind, it’s hard to remember it when you’re in a different state of mind,” Freeman said.
Maisel said that the drug can also hinder one’s ability to study and retain information because one of its symptoms is difficulty falling asleep.
“If someone stays up all night, whether assisted by a medicine or not, and does all this work, and then goes off to take a test on this work, if they haven’t slept sufficient hours, they are much less able to put the work that they did into their long-term memory,” Maisel said.
Maisel said that she does not think that ADHD drugs are addictive, and that she has never had a patient who was addicted to the drugs.
However, Freeman said that taking drugs of any kind, including ADHD drugs, without a prescription can cause damage to the brain, especially in young people.
“Your brain is a very, very sensitive organ that we don’t fully understand. Once it’s damaged, it doesn’t get undamaged,” Freeman said. “Young adults and teenagers have no idea what they’re doing to their brains, and it’s causing irreversible damage and it’s really tragic.”
Both Freeman and Maisel agreed that taking Adderall to increase a test score isn’t worth the risk.
“You’re entering a whole different world where you’re no longer in charge of your own life,” Freeman said. “You’re messing up your brain in order to achieve some social effect that’s just not in your best interest.”Read article >>
Older teens and adults with attention deficit disorder are much less likely to commit a crime while on ADHD medication, a provocative study from Sweden found.
It also showed in dramatic fashion how much more prone people with ADHD are to break the law - four to seven times more likely than others.
The findings suggest that Ritalin, Adderall and other drugs that curb hyperactivity and boost attention remain important beyond the school-age years and that wider use of these medications in older patients might help curb crime.
"There definitely is a perception that it's a disease of childhood and you outgrow your need for medicines," said Dr. William Cooper, a pediatrics and preventive medicine professor at Vanderbilt University in Nashville. "We're beginning to understand that ADHD is a condition for many people that really lasts throughout their life."
He has researched ADHD but had no role in the new study, which was led by Paul Lichtenstein of the Karolinska Institute in Stockholm. The findings were published in Thursday's New England Journal of Medicine.
About 5 percent of children in the U.S. and other Western countries have attention deficit hyperactivity disorder, which can cause impulsive behavior and difficulty paying attention. Many youngsters are given medication to help them sit still and focus in school. Some people have symptoms into adulthood.
"It's well known that individuals with ADHD have much higher rates of criminality and drug abuse than people without ADHD," but the effect of treatment on this is not well known, Lichtenstein said.
Using Swedish national registers, researchers studied about 16,000 men and 10,000 women ages 15 and older who had been diagnosed with ADHD. The country has national health care, so information was available on all drugs prescribed.
Court and prison records were used to track convictions from 2006 through 2009 and see whether patients were taking ADHD drugs when their crimes were committed. A patient was considered to have gone off medication after six months or more with no new prescription.
For comparison purposes, researchers matched each ADHD patient with 10 similar people without the disorder from the general population.
- About 37 percent of men with ADHD were convicted of at least one crime during that four-year period, compared with just 9 percent of men without ADHD. For women, the crime rates were 15 percent with ADHD and 2 percent without it.
- Use of ADHD medicines reduced the likelihood of committing a crime by 32 percent in men and 41 percent in women.
The crimes were mostly burglaries or thefts. About 4,000 of more than 23,000 crimes committed were violent. ADHD medication use reduced all types of crime, Lichtenstein said.
Cooper called the results striking. "I was surprised by the magnitude of the effect of the medications and the fact that it was so consistent across all the analyses they did," such as the type of drug being used and the types of crimes committed, he said.
The Swedish Research Council, the U.S. National Institute of Child Health and Human Development, the Wellcome Trust and other agencies paid for the research.
ADHD medicines may help people organize their lives better and reduce impulsive behavior. They also bring a patient into counseling and health care, said Philip Asherson, a professor at the Institute of Psychiatry at King's College London.
"It's not necessarily just the medication" that is reducing the likelihood of crime, he said.
Still, Asherson said the study should lead to wider use of the drugs: "It firmly establishes the link between ADHD and criminality and establishes that medication has an impact on that criminality."Read article >>
The youngest kids in the class may have a tougher time with academics and behavior, researchers found in a population-based study.
Icelandic elementary school students in the bottom third of their fourth-grade class for age were almost twice as likely to score low on math and language arts standardized tests, Helga Zoëga, PhD, of Mount Sinai School of Medicine in New York City, and colleagues found.
They were also 50% more likely to be prescribed stimulants for attention-deficit hyperactivity disorder (ADHD) by seventh grade than the oldest kids in their class (95% CI 28% to 80%), the group reported in the December issue of Pediatrics.
"Birthday cutoffs for school entry necessarily lead to an age span of at least 12 months within a classroom," they noted. "At age 5, this span accounts for 20% of the child's age and presents a difference in maturity and performance between the youngest and the oldest child in class."
Since the gap appeared to persist through age 14 in the study, "this should be taken into account when evaluating children's performance and behavior in school to prevent unnecessary stimulant treatment," to make sure kids aren't getting a lifelong label merely because of their immaturity relative to older peers, Zoëga's group argued.
Parents also might want to consider these results in deciding when to start their kids in school, they suggested.
Given controversy on the subject, the investigators used national databases from Iceland to pull together the evidence on standardized test results and filled psychotropic drug prescriptions among all 11,785 children tested at age 9 to 12 there.
The youngest students in fourth grade, born in September to December, came in 10 percentiles lower on average on standardized tests in both math and language arts than the oldest third, born in January to April.
By seventh grade, the difference was smaller but still substantial. Averages were seven percentiles lower for the youngest third versus the oldest third in both areas.
The relative risk of a low test score in the bottom 10th percentile was:
-In fourth grade, 1.9-fold for mathematics (95% CI 1.6 to 2.2) and 1.8-fold for language arts (95% CI 1.6 to 2.1)
-In seventh grade, 1.6-fold for both subjects (95% CI 1.4 to 1.9 and 1.4 to 1.8, respectively)
Prescription of stimulant medication for ADHD as a measure of behavioral difficulties showed higher rates for younger kids. The rates rose from 5.3% in the oldest third to 5.6% in the middle group born in May to August to 8% for the youngest third.
Both standardized test scores and ADHD prescriptions showed significant effects of age strata for girls as well as boys.
The researchers cautioned that these measures may only partially predict long-term academic and psychiatric outcomes.
Nor could the study rule out possible undertreatment of ADHD in the oldest kids as the mechanism rather than overtreatment in the youngest, the investigators noted.
Generalizability may also be an issue, as Iceland's universal healthcare as well as other local educational, structural, and cultural factors may have influenced the results, they acknowledged.
They pointed to a large U.S. study showing double the risk of diagnosis or treatment for ADHD in children born in the 4 months prior to the school eligibility age cutoff.Read article >>
The findings are part of a study on the effects of distractors on children with ADHD. A team of researchers, led by FIU Center for Children and Families Director William E. Pelham Jr., set out to examine how distractions – such as music and television – affect children with ADHD.
Traditionally, Pelham said, parents and teachers believe distractors only have negative effects. Pelham set out to discover how music and videos actually impact the abilities of children with ADHD to focus in the classroom. Leading into the study, Pelham believed the music would have negative effects in many cases, and would have no effects at best. But even a world-renowned psychologist and leading authority on ADHD can be surprised by his own research findings.
"If a kid says he can watch TV and focus, it's just not true. With television, we found out what we needed to know," said Pelham, who also serves as chairman of FIU's Department of Psychology. "But with music we actually discovered, in most cases, it didn't really affect the children."
While a few were distracted by music, the majority were not.
"And in some cases," Pelham noted, "we found listening to music helped the kids with ADHD to complete their work. Actually for this subgroup, the effect of music on them was nearly as effective as medication."
The research studied both medicated and non-medicated male students with ADHD, as well as a control group of male students who were not diagnosed with ADHD. The students were given the opportunity to weigh in on the music and video selections. The radio stations selected for the music portion of the study featured contemporary music including rock and rap.
"Rather than just assuming it's better for a child with ADHD to do their homework in complete silence, it may help their concentration to let them listen to music," Pelham said.
"If parents want to know if listening to music will help their child's performance in school, they should try it. In psychology, we have what we call single-subject-design studies.
Basically, it's trial and error. If a child's performance improves after trying the music for a period of time, then that's a pretty good indicator that the child falls into the subgroup of children that benefit from music."
While the research indicates music may help some, Pelham said there is opportunity to explore why and to what degree.
"There's actually a lot of different directions you could take this research," Pelham said. "But I'm an applied person. I like to find out what I can do to help people."Read article >>
A few minutes of exercise can help children with attention deficit hyperactivity disorder perform better academically, according to a new study led by a Michigan State University researcher.
The study, published in the current issue of the Journal of Pediatrics, shows for the first time that kids with ADHD can better drown out distractions and focus on a task after a single bout of exercise. Scientists say such "inhibitory control" is the main challenge faced by people with the disorder.
"This provides some very early evidence that exercise might be a tool in our nonpharmaceutical treatment of ADHD," said Matthew Pontifex, MSU assistant professor of kinesiology, who led the study. "Maybe our first course of action that we would recommend to developmental psychologists would be to increase children's physical activity."
While drugs have proven largely effective in treating many of the 2.5 million school-aged American children with ADHD, a growing number of parents and physicians worry about the side effects and costs of medication.
In the study, Pontifex and colleagues asked 40 children aged 8 to 10, half of whom had ADHD, to spend 20 minutes either walking briskly on a treadmill or reading while seated. The children then took a brief reading comprehension and math exam similar to longer standardized tests. They also played a simple computer game in which they had to ignore visual stimuli to quickly determine which direction a cartoon fish was swimming.
The results showed all of the children performed better on both tests after exercising. In the computer game, those with ADHD also were better able to slow down after making an error to avoid repeat mistakes -- a particular challenge for those with the disorder.
Pontifex said the findings support calls for more physical activity during the school day. Other researchers have found that children with ADHD are less likely to be physically active or play organized sports. Meanwhile, many schools have cut recess and physical education programs in response to shrinking budgets.
"To date there really isn't a whole lot of evidence that schools can pull from to justify why these physical education programs should be in existence," he said. "So what we're trying to do is target our research to provide that type of evidence."
Pontifex conducted the study for his doctoral dissertation at the University of Illinois before joining the MSU faculty. His co-investigators included his adviser, kinesiology professor Charles Hillman, and Daniel Picchietti, a pediatrician at the Carle Foundation Hospital in Champaign, Ill. The research was funded by the National Institute of Child Health and Human Development.Read article >>
Children taking medication for ADHD don’t have an increased risk of serious heart problems during treatment, experts report.
Published in the British Medical Journal, the study contributes to a decade-long clinical and policy debate surrounding treatment risks for children with attention deficit hyperactivity disorder, or ADHD. The study also confirms findings reported last year.
Stimulant drugs such as Adderall and Ritalin are one of the most commonly prescribed medications for children—after antibiotics and antidepressants.
“This is a question that has been lingering for about 10 years,” says Almut Winterstein, a pharmacoepidemiologist and professor in pharmaceutical outcomes and policy at the University Of Florida College Of Pharmacy.
Every year, children have an approximately one in 30,000 risk of suffering a severe cardiac event, including sudden cardiac death, heart attack, or stroke, that is typically caused by underlying heart disease.
The new results confirm previous study conclusions that there are no serious cardiac events resulting from short-term use of central nervous system stimulant drugs by children and young adults.
In 2007, Winterstein conducted the first large population study to investigate the risk associated with the use of these drugs in children and young adults between ages 3 and 20. Published in the journal Pediatrics, the study showed a 20 percent increase in emergency clinic or doctor’s office visits with cardiac-related symptoms, but no increase in death or hospital admission for serious heart conditions.
In that study, she analyzed records from 55,000 children under Medicaid who had ADHD and were undergoing treatment between 1994 to 2004. But the population was still not large enough to determine if these drugs were indeed safe for children.
The new study examines a larger US population of 1.2 million youths eligible for Medicaid programs in 28 states. It follows a similarly large investigation published in December 2011 in The New England Journal of Medicine by William O. Cooper, who looked primarily at privately insured patients.
“We complemented Dr. Cooper’s study by utilizing Medicaid patients who are typically more vulnerable and at higher risk for serious adverse events,” Winterstein says. “This allowed us to examine patients with severe underlying heart conditions who received stimulants.”
Although the study confirms there are no short-term effects from central nervous system stimulants, it didn’t reveal how the drugs affect patients in the long term.
“Neither of the studies was able to answer what happens in the long term,” Winterstein says. “It’s an important issue to address, but we won’t be able to answer the question until this generation of ADHD children, who began using stimulant drugs in the 1990s, reaches adulthood into their 50s, 60s, and 70s.”
Another concern the study raised is related to children who were on continuous stimulant medication for more than 10 years into their adulthood. The effects of even minor increases in blood pressure and heart rate over a sustained period of time are unknown, Winterstein says.
Recommended evaluation practices should continue for young patients, says Regina Bussing, professor of medicine in the division of child and adolescent psychiatry, including cardiovascular monitoring.
Parents will still be advised to stop medication and take the child to the emergency room should he or she develop sudden onset of chest pain or shortness of breath, but the study should alleviate doctor and parent concerns for the most serious cardiovascular events.
The study was funded by the Agency for Healthcare Research and Quality and in part by the National Center for Advancing Translational Sciences.Read article >>