Tag: ADHD

Categories : Obstetrics & Gynaecology PaediatricsTags :

Increased Odds of ADHD Symptoms in Children Born Before 39 Weeks

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Among children born at term (37–41 weeks), those born before 39 weeks are more likely to experience symptoms associated with attention-deficit/hyperactivity disorder (ADHD), according to a study published in the Journal of Pediatrics.

ADHD manifests early in childhood with symptoms of hyperactivity, impulsivity or inattention, and has known links to preterm birth (less than 37 weeks gestation). The present study is one of only a handful to investigate the associations between gestational age at term and a diagnosis or symptoms of ADHD. It is the first to include reports from teachers.

“Teachers’ reports, in conjunction with maternal reports and physician evaluations, provide valuable input for the diagnosis of ADHD,” said study author Nancy Reichman, author of the study and a professor of paediatrics at Rutgers Robert Wood Johnson Medical School. “Mother-reported symptoms generally reflect behaviours in the home or in small family or social groups, while teacher-reported symptoms reflect behaviours in a structured educational setting by professionals who work with a large number of children and observe the range of behaviours that students exhibit in classrooms.”

Prof Reichman and her team set out to estimate the link between gestational age at term and 9-year-old children’s teacher-reported ADHD symptoms.

The team analysed data on about 1400 children in a birth cohort study that randomly sampled births from large US hospitals 1998 to 2000 and re-interviewed mothers over nine years as well as teachers’ evaluations using the Conners’ Teacher Rating Scale-Revised Short Form.

The researchers found that children born early-term (37-38 weeks) had significantly higher scores on the teacher rating scales than children who were full-term (39-41 weeks) for hyperactivity, ADHD and cognitive problems or inattention, but that gestational age wasn’t significantly associated with oppositional behaviour.

Specifically, the researchers found that each week of gestational age at term was associated with 6% lower hyperactivity scores and 5% lower ADHD and cognitive problems or inattention scores, and that birth at 37 to 38 weeks was associated with 23% higher hyperactivity scores and 17% higher ADHD scores when compared with birth at 39 to 41 weeks.

“The findings add to growing evidence supporting current recommendations for delaying elective deliveries to at least 39 weeks and suggest that regular screenings for ADHD symptoms are important for children born at 37 to 38 weeks,” Prof Reichman said.

Preterm infants are at greater risk for ADHD because of immature brain development, she said. “Significant growth and development in various kinds of brain cells are observed between 34 and 40 weeks of gestation,” said Reichman. “Infants born at full-term likely benefit from the additional one to two weeks of brain growth in utero compared with those born early-term.”

Source: Rutgers University

Categories : PaediatricsTags :

A Prescription-only Video Game to Treat ADHD in Children

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Doctors in the US have been prescribing a unique new treatment for attention deficit hyperactivity disorder (ADHD) in children – a video game.

Designed in conjunction with neuroscientists, EndeavorRx, known in clinical trials as AKL-T01, is the first FDA-approved video game designed to treat ADHD in children. It is currently only available in the US by prescription but its creators are hoping to have it approved in other countries.

The game, which involves controlling a little alien racing across different environments to complete tasks, specifically trains users to concentrate on multitasking and to block out distractions – cognitive areas which often need a boost in ADHD.

In a randomised controlled trial published in The Lancet Digital Health, 348 patients, aged 8–12 years old and not receiving medication for ADHD, were randomised to receive the game intervention or a control.

For a control, the clinical trial made use of a different game specifically designed as a digital word game which did not target areas involved with ADHD.

Over four weeks, participants were instructed to play the intervention or placebo game for five minutes, five times a day, five days a week.

The trial found that compliance was high, with 83% of treatment session being played. Treatment-related adverse events were mild and included frustration (5 [3%] of 180) and headache (3 [2%] of 180).

ADHD was measured by Test of Variables of Attention (TOVA) Attention Performance Index (API). The mean change from baseline on the TOVA API was 0·93 in the AKL-T01 group and 0·03 in the control group.

An extension of the trial found that EndeavorRx also worked as an adjunct treatment in children with ADHD who were also receiving stimulant treatment for their condition. One hundred and thirty were enrolled in the On Stimulants cohort, and 76 in the No Stimulants cohort. Despite severe comorbidities being exclusionary, around 20% of the included participants still presented with at least one DSM-listed comorbidity. The trial involved a four week treatment period, a four week pause, and another four week treatment period. Improvements for both groups were found from the first treatment period, and continued into the pause and into the second treatment period, suggesting continuing and lasting gains.

Eddie Martucci, chief executive of Akili which produced the game, told the BBC that EandeavorRx offers something that pharmaceuticals currently cannot. “It is something that’s very difficult to get through molecular means, like taking a pill. But it turns out that sensory stimuli can actually directly stimulate parts of the brain controlling cognitive function.”

Categories : PaediatricsTags :

ADHD Overdiagnosis Common and Racially Skewed, US Study Finds

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Children in classroom
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A study in the Journal of Learning Disabilities examining overdiagnosis of attention-deficit/hyperactivity disorder (ADHD) found that diagnoses are common in children who are functioning well, and that there is a racial bias.

ADHD overdiagnosis and subsequent overtreatment poses needless potential harm to children. It also contributes to scepticism toward those who do have moderate or severe symptoms and significant impairments, resulting in less supportive care.

Yet which sociodemographic groups of children are overdiagnosed and overtreated for ADHD is poorly understood. As a proxy for overdiagnosis, researchers selected elementary schoolchildren who had displayed above-average levels of independently assessed behavioural, academic, or executive functioning the year prior to their initial ADHD diagnoses and who did not have prior diagnostic histories. This suggested they were unlikely to have ADHD.

The researchers conducted descriptive and logistic regression analyses of a population-based subsample of 1070 elementary schoolchildren.

Among these children, (a) 27% of White children versus 19% of non-White children were later diagnosed with ADHD and (b) 20% of White children versus 14% of non-White children were later using medication. In adjusted analyses, White children are more likely to later be diagnosed (odds ratio [OR] range = 1.70–2.62) and using medication (OR range = 1.70–2.37) among those whose prior behavioural, academic, and executive functioning suggested that they were unlikely to have ADHD.

The findings also skewed toward older children, and differences in diagnoses according to race was not linked to socioeconomic status. The authors acknowledge limitations such as a small sample size as well as not being able to account for English-speaking versus non-English speaking families, but note that their results are significant for 9 out of the 10 tests used.

The researchers suggest that greater overdiagnosis in White children may be in part explained by greater access to better-resourced schools more likely to pick up (or attempt to pick up) ADHD in children. Non-White children may also need to display behaviours more consistent with ADHD to be referred for evaluation and treatment.

Cultural misconceptions about ADHD are less likely to be prevalent in non-White families, and there is evidence to suggest that ADHD overdiagnosis is being used to gain academic achievement.

They concluded: “Preventing or reducing ADHD overdiagnosis and overtreatment should contribute to more appropriate care, limit increasing ADHD prevalence, increase the academic and behavioural functioning of elementary schoolchildren being diagnosed with ADHD but who are displaying few or mild symptoms, reduce unnecessary exposure to adverse side effects of medication use, and better allocate limited mental health resources.”

Categories : Lab Tests and Imaging NeurologyTags :

Retinal Scans May be Able to Detect ASD and ADHD

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Eye
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By measuring the electrical activity of the retina in responses to a light stimulus, researchers found that they may be able to neurodevelopmental disorders such as ASD and ADHD, as reported in new research published in Frontiers in Neuroscience.

In this groundbreaking study, researchers found that recordings from the retina could identify distinct signals for both Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) providing a potential biomarker for each condition.

Using the ‘electroretinogram’ (ERG) – a diagnostic test that measures the electrical activity of the retina in response to a light stimulus – researchers found that children with ADHD showed higher overall ERG energy, whereas children with ASD showed less ERG energy.

Research optometrist at Flinders University, Dr Paul Constable, said the preliminary findings indicate promising results for improved diagnoses and treatments in the future.

“ASD and ADHD are the most common neurodevelopmental disorders diagnosed in childhood. But as they often share similar traits, making diagnoses for both conditions can be lengthy and complicated,” Dr Constable says.

“Our research aims to improve this. By exploring how signals in the retina react to light stimuli, we hope to develop more accurate and earlier diagnoses for different neurodevelopmental conditions.

“Retinal signals have specific nerves that generate them, so if we can identify these differences and localise them to specific pathways that use different chemical signals that are also used in the brain, then we can show distinct differences for children with ADHD and ASD and potentially other neurodevelopmental conditions.”

“This study delivers preliminary evidence for neurophysiological changes that not only differentiate both ADHD and ASD from typically developing children, but also evidence that they can be distinguished from each other based on ERG characteristics.”

According to the World Health Organization, one in 100 children has ASD, with 5–8% of children diagnosed with ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by being overly active, struggling to pay attention, and difficulty controlling impulsive behaviours. Autism spectrum disorder (ASD) is also a neurodevelopmental condition where children behave, communicate, interact, and learn in ways that are different from most other people.

Co-researcher and expert in human and artificial cognition at the University of South Australia, Dr Fernando Marmolejo-Ramos, says the research has potential to extend across other neurological conditions.

“Ultimately, we’re looking at how the eyes can help us understand the brain,” Dr Marmolejo-Ramos says.

“While further research is needed to establish abnormalities in retinal signals that are specific to these and other neurodevelopmental disorders, what we’ve observed so far shows that we are on the precipice of something amazing.

“It is truly a case of watching this space; as it happens, the eyes could reveal all.”

Source: Flinders University

Categories : Mental HealthTags :

For Some, It may be Daydreaming – not ADHD

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Maladaptive daydreaming (MD) may be a better diagnosis for some people than ADHD, researchers argue in a paper in the Journal of Clinical Psychology. MD is a condition whereby people slip into involved highly detailed and realistic daydreams that can last hours at the cost of normal functioning – but it is not yet recognised as a psychiatric disorder.

Dr Nirit Soffer-Dudek of the Consciousness and Psychopathology Laboratory in the Department of Psychology at BGU is one of the leadings experts on the condition and wants to have MD added to the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM VI), by promoting rigorous research into this condition.

Explaining the concept of MD, Dr Soffer-Dudek said: “Some individuals who become addicted to their fanciful daydreams experience great difficulty in concentrating and focusing their attention on academic and vocational tasks, yet they find that an ADHD diagnosis and the subsequent treatment plan does not necessarily help them. Formally classifying MD as a mental disorder would enable psychological practitioners to better assist many of their patients.”

Previous studies had found high levels of ADHD in those also presenting with MD, thereby raising the question of whether MD was separate from ADHD. In the current study, the investigators assessed 83 adults diagnosed with ADHD for inattention symptoms, MD, depression, loneliness, and self-esteem. Of those, about 20% met the proposed diagnostic criteria for MD, with significantly higher rates of depression, loneliness, and lowered self-esteem, compared to those with ADHD that did not meet criteria for MD.

“Our findings suggest that there is a subgroup of those diagnosed with ADHD who would benefit more from a diagnosis of MD,” concluded Dr Soffer-Dudek.

Source: Ben-Gurion University of the Negev

Categories : Diseases, Syndromes and ConditionsTags :

Caffeine May Help with Cognitive Symptoms of ADHD

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Coffee cup and beans
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Researchers in Spain have found that caffeine may be beneficial in alleviating cognitive symptoms of ADHD, such as improving attention span and retention capacity. Their findings, published in Nutrients, may provide a less controversial addition to the therapeutic arsenal for this disorder.

Attention deficit hyperactivity disorder (ADHD) diagnoses have increased exponentially over the last 20 years. It is currently estimated that this disorder affects between 2% and 5% of children in Spain, an average of one or two children per classroom, and up to 4% of the adult population.

Despite these high incidence rates, controversy surrounds the treatment of this pathology and the therapeutic approach to it. This varies widely depending on each patient, the symptoms they present and their intensity. For this reason, experts are continuing to investigate different components and substances that may be capable of providing new treatment opportunities for patients diagnosed with ADHD.

A team of experts at the Universitat Oberta de Catalunya (UOC) has investigated caffeine to alleviate some of the symptoms of ADHD, given the controversy surrounding the use of some medicines derived from methylphenidate, among others. Their systematic review of animal studies concludes that a prescribed consumption of caffeine can increase attention and retention capacity in adolescents and adults with ADHD.

“The therapeutic arsenal for alleviating ADHD is limited, and there is a certain degree of controversy around the use of some types of medications and stimulants, especially during childhood and adolescence. That’s why it’s useful to study the efficacy of other substances, such as caffeine,” explained Javier Vázquez, one of the paper’s main authors.

This is the first systematic review with results linking caffeine consumption in different animal models of ADHD with an increased attention span, improved concentration, learning benefits, and improvements in some types of memory.

“This substance improves these types of cognitive procedures, and increases capacity and flexibility in both spatial attention and selective attention, as well as in working memory and short-term memory,” emphasised Vazquez, who added that controlled treatment with this substance “doesn’t alter blood pressure, and doesn’t lead to an increase or reduction in body weight.”

The researchers point out that while possibly effective for cognitive symptoms, the results are unclear for other characteristic symptoms of ADHD, such as hyperactivity and impulsivity. “The results are very positive, but we must be much more careful when prescribing a caffeine-based medical treatment for these symptoms. In diagnoses in which the problem is purely attentional, caffeine may be an appropriate therapy, but if there’s a symptomatological presence of hyperactivity or impulsivity, we must be more cautious,” said Vasquez.

However, the results show that caffeine has a clear benefit in ADHD’s cognitive symptoms. “Our results reinforce the hypothesis that the cognitive effects of caffeine found in animal models can be translated and applied in the treatment of ADHD in people, especially at young ages such as adolescence,” the authors concluded.

“We want to emphasise that we aren’t against medication for ADHD, but we’re open to investigating all possible alternatives for improving this type of disorder, and for being able to use caffeine from a therapeutic point of view with all the appropriate medical supervision, a prescribed treatment and follow-up,” said Vázquez.

Source: Universitat Oberta de Catalunya (UOC)

Categories : PaediatricsTags :

Only 10% of Children Completely ‘Outgrow’ ADHD

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In contrast to popular belief, most children diagnosed with attention deficit hyperactive disorder (ADHD) do not in fact outgrow the disorder according to a new study in the American Journal of Psychiatry. Instead, it manifests itself in adulthood in different ways over a lifetime, increasing and decreasing.

“It’s important for people diagnosed with ADHD to understand that it’s normal to have times in your life where things maybe more unmanageable and other times when things feel more under control,” said lead researcher Margaret Sibley, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a researcher at Seattle Children’s Research Institute.

Decades of research characterise ADHD as a neurobiological disorder typically first detected in childhood that persists into adulthood in approximately 50% of cases, but this study found that only 10% of children completely outgrow it.

“Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in the Multimodal Treatment Study of ADHD continued to experience residual symptoms into young adulthood,” they wrote.

ADHD is characterised by two main clusters of symptoms: inattentive symptoms which look like disorganisation and forgetfulness, and also the hyperactive, impulsive symptoms. In children, those symptoms look like having a lot of energy, such as running around and climbing on things. In adults, it manifests more as verbal impulsivity, difficulty with decision-making, and not thinking before acting. The disorder affects people differently and looks different depending on the phase of life.

Some people with ADHD also report a unique ability to hyper-focus, as in some Olympic athletes. While many people may experience symptoms similar to ADHD, it is estimated the disorder roughly affects 5% to 10% of the population, said Sibley.

This study followed a group of 558 children with ADHD from 8-years old to 25 years-old. Every two years, the cohort had assessments to determine whether they had symptoms of ADHD. Family members and teachers were also asked about their symptoms.

According to Prof Sibley, the belief that 50% of children outgrow ADHD was first put forward in the mid-1990s. Most studies, she said, only re-connected once when the kids reached adulthood and weren’t able to see if the ADHD had really gone away.

Coping with ADHD
Researchers have yet to find what causes ADHD to flare. Prof Sibley said it could be stress, the wrong environment, and not having a healthy lifestyle of proper sleep, healthy eating, and regular exercise. Also, if a person is not taking the time to manage symptoms and really understand what works best for them, then the symptoms are probably going to get more out of control, she said.

The two main treatments for ADHD are medication and therapy, though people can pursue their own healthy coping skills as well, said Prof Sibley.

Researchers found that most people who technically no longer meet criteria for ADHD in adulthood still retained traces though they were coping well.

“The key is finding a job or a life passion that ADHD does not interfere with,” Prof Sibley said. “You are going to see a lot of creative people have ADHD because they’re able to be successful in their creative endeavors despite having ADHD, whereas people who might be required to do very detail-oriented work at a computer all day—that could be a really hard combination for a person with ADHD.”

Prof Sibley said the time to seek professional help is when the symptoms cause problems in life, including not performing at one’s best, interpersonal problems, and inability to complete basic daily tasks.

Source: Medical Xpress

Categories : PaediatricsTags :

New ADHD Drug Gets FDA Approval for Children

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US regulators have approved the first new ADHD drug for children in over a decade.

The Food and Drug Administration last week approved  viloxazine (Qelbree) for the treatment of attention deficit hyperactivity disorder in children ages 6 to 17. It was developed by  Supernus Pharmaceuticals. The drug’s price was undisclosed but is likely to be higher than the generic ADHD pills.

In Europe, viloxazine was sold as an antidepressant for several decades, but never received FDA approval. It was discontinued nearly two decades ago, due to competition from popular pills like Zoloft and Prozac.

ADHD affects about 6 million American children and adolescents. For many, problems include trouble paying attention and completing tasks, fidgeting and impulsiveness.  

Earlier ADHD treatments like Ritalin, nearly all of which contain the stimulants amphetamine or methylphenidate, which create the potential for abuse. Viloxazine however is not a stimulant or a controlled substance. It carries a warning of potential for suicidal thoughts and behaviour, which occurred in fewer than 1% of volunteers in studies of the drug.

Qelbree could be an option for children with substance use disorders, who do not cope well with stimulant side effects or who need more therapy, said Dr David W. Goodman, director of Suburban Psychiatric Associates near Baltimore and an assistant professor of psychiatry at Johns Hopkins School of Medicine.

Goodman said that long-acting stimulants prescribed to ADHD patients currently are harder to abuse to get a high than the older fast-acting versions.

In a late-stage study, 477 children ages 6 to 11 took viloxazine for six weeks. Compared to placebo, Inattention and hyperactivity symptoms were reduced by about 50%. Symptom reduction was seen within a week in some participants. Its common side effects include sleepiness, lethargy, decreased appetite and headache.

Supernus is in late-stage testing for adults with ADHD, who represent a small but growing market as adult treatment of the condition expands.

Source: Medical Xpress