The Global Market For ADHD Medications

Posted by on April 22nd, 2007 | Comments off

The Global Market For ADHD Medications

The University of California, Berkeley reports that ADHD has more than tripled worldwide since 1993. Researchers at UC, Berkeley found that the United States, Canada, and Australia “presented higher-than-expected rates of ADHD medication use between 1993 and 2003 – based on predictions from per-capita GDP indicators – a country-by-country analysis showed increases in ADHD drug consumption in countries ranging from France and Sweden, to Korea and Japan.” The US still leads the world in dollars spent on ADHD medication at $2.7 billion in 2006.

The University of California at Berkeley study was published in the journal, Health Affairs.  Researchers reviewed data on ADHD medication use among 5-19 year-olds in countries belonging to the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations.

The researchers stated that one in twenty-five children is taking medication for ADHD in the US. However, their research also suggests that the diagnosis of ADHD and subsequent use of medications to control it is now spreading worldwide.

Dr. Richard Scheffler, a UC Berkeley distinguished professor of health economics and public policy Overall thinks the study reflects global trends. “Given the global diffusion of ADHD medications, as well as the prevalence of this condition, ADHD could become the leading childhood disorder treated with medications across the globe,” Scheffler said. “We can expect that the already burgeoning global costs for medication treatment for ADHD will rise even more sharply over the next decade.”

The Berkeley researchers also cite that “Growth trends indicate that other countries are following in its tracks. For example, global spending on ADHD medications increased nine-fold among OECD countries during the time period studied. This increase is largely due to the advent and availability of more costly and long-acting medications such as Concerta™, Strattera™ and Adderral XR™”.

The use of medications outside of the US is still primarily short acting amphetamines. However, the pharmaceutical industry is well aware that they cannot reach the estimated $3.4bn by 2015, unless it is led by the launch of drugs with novel delivery mechanisms such as improved durations of action and anti-abuse profiles as media are raising the abuse flag significantly. These custom drugs will help differentiate these pipeline drugs from the current established ADHD therapies and increase market share.

It is important to note that although ADHD drugs have demonstrated efficacy in improving the three main symptoms of ADHD – inattention, hyperactivity and impulsivity – none have shown efficacy in treating the cognitive deficits of ADHD.

Drug makers are likely to increase the costs of these novelty release (e.g. long acting) drugs globally as they become more prevalent outside the U.S. in order to reach the estimated $3.4bn target in 2015.

Back to Berkeley, using the IMS Health MIDAS™, an international pharmaceutical database, researchers looked at data and found that between 1993 and 2003, “the number of countries using ADHD medications rose from 31 to 55, with the U.S. share of global market decreasing from 86.8 percent to 83.1 percent. Meanwhile, countries with traditionally low and moderate consumption of ADHD drugs were showing steady upswings.”

Stephen Hinshaw, who is frequently approached by the media to comment on ADHD, is chair of UC Berkeley’s Department of Psychology was a co-author of the study. Commenting on this study, Hinshaw states, “The results temper some key criticisms of ADHD. A common misconception is that ADHD only exists in the U.S. and that the pharmaceutical firms are getting bigger sales because of the ‘creation’ of the disorder in the U.S. Yet cross-cultural research has shown that ADHD exists in nearly any culture that has compulsory education. Clearly, ADHD–which has a substantial genetic liability–is not just a figment of American doctors’ imaginations.”

In a nutshell, here’s Hinshaw’s argument: The use of stimulant
medication in wealthy member nations of the OECD outside of the U.S. is
growing, therefore, “ADHD is not just a figment of American doctors’
imaginations.” I’m not arguing that ADHD is real or not real. I am
simply citing that pharmaceutical marketing dollars greatly contribute
to the rise in use of stimulant medications in these nations. For
example, when adult ADHD medication was marketed heavily in the U.S.,
sales of the drug skyrocketed. Did the number of diagnosed cases
increase? Yes. Did that mean more people had the disorder? No. If this
poor logic and poor research is the best Berkeley and Hinshaw can
produce, then the students that are graduated from Berkeley are doomed!
But, wait, that’s also a non causa pro causa!

Hinshaw has essentially committed a non causa pro causa (false cause). He’s co-authored a study of data from a pharmaceutical database and citing that the number of persons outside the U.S. in the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations. The pharmaceutical industry has spent many millions of dollars over the past few years to increase their profit in these nations in an effort to obtain their estimated goal of $3.4bn by 2015.

What can be clearly gleaned is that the Berkeley study is meaningless. It might have some teeth if the researchers actually correlated the marketing dollars spent by the pharmaceutical manufacturers to the numbers of persons using their medications in the OECD. It would be interesting to see the data on usage in third world countries who cannot afford it. I’d wager that they have far fewer cases of ADHD and use far less medication.

ADHD and Alcohol Abuse

Posted by on April 22nd, 2007 | Comments off

Two new studies confirm that ADHD children are more at-risk for alcohol and substance abuse as they grow older. Parental alcoholism and stressful family environments are additional risks. Results of the two studies were published in Alcoholism: Clinical & Experimental Research [April 2007].

Brooke Molina, associate professor of psychiatry and psychology at the University of Pittsburgh, and co-author for both studies says that, “Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems.”

To determine alcohol use, Molina interviewed 364 participants in the larger Pittsburgh ADHD Longitudinal Study and compared it with demographically age matched adolescents and adults as a comparison. “We found that the children with ADHD were more likely than the comparison group to drink heavily and to have enough problems related to their drinking that they were diagnosed with alcohol abuse or dependence,” said Molina. “This means that their drinking caused problems such as fights with their parents or friends, a drop in their grades at school, or difficulty with controlling the amount of alcohol that they drank.”

Drinking problems began around age 15, said Molina. “The 15-to-17-year olds with childhood ADHD reported being drunk an average of 14 times in the previous year, versus only 1.8 times for 15-to-17-year olds in the study who did not have childhood ADHD. Whereas 14 percent of the 15-to-17-year olds with childhood ADHD were diagnosed with alcohol abuse or dependence, none of the 15-to-17-year olds without childhood ADHD were.”

The study indicates that the ADHD-alcohol connection seems to begin in adolescence when children have greater access to alcohol and other substances.

“For example, 42 percent of those children with ADHD who also had serious, persistent behavior problems [later] had alcohol abuse or dependence by the age of 18 to 25,” said Molina.

Molina indicates that little is known about alcohol dependence beyond this age range for ADHD persons. “Most young adults drink less after they settle into jobs and family life,” she said. “We will be following the young adults in the Pittsburgh study to see if this happens or not.”

Molina’s research also indicated that parental alcoholism predicted heavy problem drinking among teenagers in her study. The ADHD/family link may cause increased family stress beginning in early childhood due to lack of parental coping skills and behavioral conflicts. The parent may begin drinking in response to the increased family stress. No genetic proclivity is identified by this study, however, this seems like an essential next step. The study reflects an issue that affects families whether they have and ADHD member or not: if a parent suffers from alcoholism, the child will have an increased risk as well. What is interesting about the research is the fact that stressors like ADHD may drive some parents to drink as a coping mechanism. This, in turn, may begin a similar cycle for the ADHD child.

Bottom line, Molina says, “We need to put these findings in perspective; it is important to recognize that not all children with ADHD will have problems with alcohol.”

For ADHD Children, Mother’s Depression, Early Parenting Predict Conduct Problems

Posted by on April 22nd, 2007 | Comments off

ADHD and
Behavioral Problems

According to a study published in the January 2007 issue of the American Psychological Association’s journal, Developmental Psychology, a mother’s depression predicts whether children with ADHD will develop behavioral problems.

Psychology professor Andrea Chronis, director of the University of Maryland ADHD Program and lead author on the paper said, “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

As I’ve discussed in many previous blogs, the brain is quite plastic almost to a flaw; negative stimulation, will affect the brain negatively while positive stimulation will affect the brain positively. This study seems to reflect that fact as well. The researchers found that positive parenting during preschool years predicted fewer behavioral problems as the children reached early adolescence. Children presented fewer conduct problems such as lying, fighting, bullying and stealing. Conversely, maternal depression predicted more conduct problems during adolescence.

The researchers estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says [see ADHD and Alcohol Abuse]. Chronis’ team has found in earlier research that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids. Focus was place on mothers as they are frequently the primary caregivers and are therefore subject to more stress and depression. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Chronis’ research is part of an ongoing longitudinal study funded by the NIH that follows ADHD children through their 18th birthdays. Collaborating with research teams at the Universities of Chicago and Pittsburgh, the study evaluated the behavior and development of 108 children whose ages ranged from four to seven at the study’s beginning. Parenting techniques were assessed by observation, and data on the mother’s mental health were analyzed annually.

Neuroplasticity at work: the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time while children of previously depressed mothers had significantly higher levels of conduct problems over time.

As I mentioned in ADHD and Alcohol Abuse, the problems of depression and alcohol abuse may be parental coping mechanisms in response to an ADHD child. They are also quite likely cyclic; the child is more likely to be depressed or abuse alcohol later in life.

This does give us a background to develop a methodology to prevent the cycle from recurring.

For ADHD Children, Mother’s Depression, Early Parenting Predict Conduct Problems

COLLEGE PARK, Md., March 22 (AScribe Newswire) – A mother’s depression predicts whether children with ADHD (Attention Deficit Hyperactivity Disorder) will develop conduct problems such as lying, fighting, bullying and stealing, according to a new study from a University of Maryland researcher.

The study, published in the January 2007 issue of the American Psychological Association’s journal, “Developmental Psychology,” also found that early positive parenting during the preschool years predicted fewer conduct problems as the children grew to early adolescence. The strength of the findings led the researchers to conclude that maternal depression may be a risk factor, whereas positive parenting may be a protective factor.

“This research gives us clear targets for early intervention to prevent conduct problems in children with ADHD,” says Andrea Chronis, director of the University of Maryland ADHD Program and professor of psychology who served as lead author on the paper. “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

The researchers say their study is the first to focus directly on the role of parent mental health and early parenting in the development of conduct problems among children with ADHD. Moreover, they point to previous research that shows the development of conduct problems to be quite common in children with ADHD. By one estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Findings and Method

Specifically, the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time, when other possible contributing factors were controlled. Also, children of previously depressed mothers had significantly higher levels of conduct problems over time compared to children whose mothers had never been depressed.

This research is part of an ongoing longitudinal study funded by the National Institutes of Health that follows ADHD children through their 18th birthday. Conducted by members of the research team at the Universities of Chicago and Pittsburgh, it consisted of a series of annual assessments of 108 children’s behavior and development. Children ranged in age from four to seven at the start of the research. The parenting techniques were assessed using observational methodology during the first year of the study. Information on the mother’s mental health was also collected annually.

The study focused on the mothers’ health and parenting since they are most often the primary caretakers and are more likely to be depressed than men. Also, an earlier study by Chronis and the research team found that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids.

With a grant from the National Institute of Mental Health, Chronis and her research team at the University of Maryland are now developing and evaluating a 14-week behavioral intervention for depressed mothers of children with ADHD that targets effective parenting and reducing maternal depression.

An electronic copy of the research paper is available to journalists. Please email Neil Tickner: ntickner@umd.edu.

The Maryland ADHD Program is a clinical research program with a strong commitment to conducting clinical research that advances knowledge of the assessment and treatment of ADHD, provides comprehensive, empirically-based assessment and treatment of ADHD and associated behavior problems, trains the next generation of child clinical psychologists in these practices and educates parents and schools in this form of assessment and treatment. More information is available online: http://www.bsos.umd.edu/psyc/clinicalpsyc/training/adhd.htm.

Max Gail and ADHD

Posted by on April 22nd, 2007 | Comments off

I sat down with veteran actor, Max Gail a short time ago to discuss Max’s attention problems and how they relate to his family and acting career.

Q: Do people still recognize you from Barney Miller?

A: Probably most people would connect me up as an actor or I get recognized for the work I’ve done as an actor because it’s a real visible kind of work. People say where do I know you from, which I hear a lot, or gee you look familiar to me or something or haven’t I seen you in the movies or something. I start with Barney Miller because it’s a TV show that was on for, we shot for seven and a half seasons and then went immediately into reruns and were on twice a night for another 8 years in most cities and it’s still playing some places.

We had critical success and we had a lot of fun doing it. I did a show, and we did half a season, and they showed it on ABC called Sons and Daughters.

Q: You told me that your son, Max, Jr. has attention problems. How have the two of you coped with them?

A: My son Max, really really bright kid was having some difficulties with certain aspects of school and I saw that they were the same difficulties I had although when I was in school it was easier to slide around those things and most of the solution that were being offered had to do with drugs and I had some intuitive issues with that. At a different time if they would have been diagnosed with ADD or ADHD or maybe Asperger’s [syndrome] or any of these things, you know, I could have made the cut. I have to say [I’m] a person who resonates with this, personally, both in what my life has been, where my strengths and weaknesses have been, in everything I’ve tried to do.

Q: Is that what spurred your interest in finding a solution?

A: I met you, Peter, at the disabilities conference in Los Angeles. I’m concerned about helping my son and spreading what I find into the community at large. Watching my son in particular but really all my kids in some ways struggle with these things and then to see that there really is a way to use some technology and some understandings and some relationships to deal with those issues in a way to create a since of having some kind of powerless confused sort of feeling that makes you want to deny it or run away from it or get angry about it or blame somebody. It’s just a really wonderful thing

Q. What do you think about Play Attention?

A: I love the name Play Attention. I love that there’s something behind it very meaningful that comes from people who have worked with kids and care about kids and care about these kinds of problems and identifying that there are solutions.

Play Attention with the technology and the coaching components of it really creates a way that there can be that guide in a practice of working to develop those kinds of skills and strengths that are missing. Play Attention puts that focus on play state which is really how we learn. Play Attention provides a practice that’s meaningful and can be fun to do and this is kind of special technology even though it’s made up of stuff that’s around.

It’s kind of new to get it out to people. It’s new for people to hear about it so that process is mostly families or people that are at their wits end that finally find out about Play Attention and they call and get connected and try it and it works and then they’re really thankful. They’re having a lot of recurring pain and lack of success or confusion or just problems in their lives that can really be helped or something that can be done about it.

Brain Study May Shed Light on Attention Disorders

Posted by on April 16th, 2007 | Comments off

New research shows it takes one part of the brain to start concentrating and another to be distracted.

This discovery could help scientists develop better treatments for attention deficit disorder .

The study, Top-down versus bottom-up control of attention in the prefrontal and posterior parietal cortices, performed at Massachusetts Institute of Technology (MIT) and published in of the journal Science, reveals that attention may have two forms: willful and reflexive. While this information is not new – cognitive psychologists have written about this for many years – the study finds that these two types of attention are controlled by distinct areas of the brain. Willful attention seems to be controlled by the frontal region of the brain in the prefrontal cortex while reflexive attention seems to be activated by the parietal cortex toward the back of the brain.

Put simply, if one is reading a book, then likely the prefrontal cortex is engaged in commanding attention like the conductor of an orchestra. If, while reading, a firecracker explodes nearby, your reflexive attention will activate from the parietal cortex command center shifting control away from the prefrontal cortex.

“This ability to willfully focus your attention is physically separate in the brain from distracting things grabbing your attention,” said Earl Miller, a neuroscientist at the Massachusetts Institute of Technology. “Now we know these two things are separate, it raises the possibility that we can fix them independently,” Miller said.

RESEARCH

MIT’s research sheds a little more light on the subject of attention because until now researchers have examined only one region at a time. Studying both regions allows us to examine their collaborative interactions, functions, and purposes.

Miller used EEG electrodes connected to the heads of monkeys to examine the complex interplay between the prefrontal cortex and parietal regions during tests of attention and bursts of reflexive attention.

When the monkeys voluntarily concentrated, the so-called executive center in the front of the brain – the prefrontal cortex – was in charge. But when something distracting grabbed the monkeys’ attention, that signal originated in the parietal cortex, toward the back of the brain.

ADHD IMPLICATIONS

Miller concluded that once the prefrontal and parietal regions signaled each other (see my blogs on neural networks), the electrical activity in these two areas began vibrating in synchrony. However, as EEG specialists have known for quite some time, willful concentration involved lower-frequency neuron activity. Distraction occurred at higher frequencies. This again lends credence to EEG training to produce better attention.

While the study sheds a little more light on the subject of concentration, it examined only two portions of the brain. I contend that the entire brain is involved in concentration. The brain seems to work as an orchestra works. While the conductor is not in command, the players tune and rehearse each of their own will. When the conductor steps to the stage, taps his baton, all the individual players each snap to attention and begin to play in synchrony. It is a metaphor for brain function – our brains are formed of many different parts that perform jobs independently of each other. When necessary, a conductor taps his baton and attention is achieved as the individual parts work in synchrony.

For a person with an attention problem or AD/HD, the conductor is not controllable at-will unless the object of attention is highly stimulating like a three ring circus. A little attention may be sustained if the object of attention is only moderately stimulating, but the other conductor responsible for reflexive attention quickly takes command and distraction ensues.

ADHD persons don’t have at-will command over either conductor responsible for willful attention or reflexive attention. Do we know why this is so? No, it may be caused by a variety of factors. Can they be taught to control these conductors? Absolutely. The brain is very flexible and can compensate. All educational systems are built upon this foundation. So, let’s take this out of the realm of medical mystery and dysfunction. Let’s place it back in the realm where it is a skill that can be improved like any other.

ADHD and Social Distancing

Posted by on April 16th, 2007 | Comments off

As I’ve discussed in previous blogs, ADHD children and adults have difficulty recognizing social cues or regulating impulse control and therefore frequently cannot maintain friendships or adapt well socially.

A recent study published in the Journal of Health and Social Behavior, (48, 50-67) examines the other side of this issue; it examines the attitudes of adults toward persons with depression or AD/HD. The study indicates that many adults would personally prefer not to interact or have their child not interact (social distancing) with an AD/HD child. The study also reveals factors that contribute to the desire for social distancing. Participants in the study consisted of 1393 adults from across the US.

Participants were read a randomly selected vignette that provided a brief behavioral description of 1 of 4 different children. While no diagnoses were provided, the vignettes depicted behaviors characteristic of a child with a medical condition (asthma), a child with depression, a child with ADHD, and a child that presented what the authors described as “normal troubles.”

After listening to the vignette, researchers asked a series of questions to learn about the participants’ thoughts and emotions regarding the child depicted in the vignette. To more deeply delve into the reasoning behind social distancing, the researchers also examined participants’ beliefs about the suspected causes of behavior displayed by the child in the vignette. These included whether the participants believed the child had a mental illness, “bad character”, or “chemical imbalance in the brain.” Participants were also queried whether they believed the child depicted was a danger to self or others.

CONCLUSIONS

Interestingly, percentages of adults who were more likely to not engage with a child or child’s family, if that family was described as having symptoms characteristic of AD/HD or depression, were 2-3 times higher than when a child with “normal troubles” or asthma was depicted.

Some clear trends were also established: male participants were more likely to desire distance than females and older children desired distancing more frequently than younger (8 yrs.) children.

Furthermore, preference for distance increased if participants believed that the depicted child’s problems were caused by poor parental discipline.

When participants believed the depicted child’s problems were caused naturally, e.g. from food allergies or “normal ups and downs” their preference for distance decreased.

Attributing the child’s problems to a mental illness increased the preference for distance. Related to this, believing that the child posed a danger to himself or to others increased the preference for distance.

SUMMARY

The researchers cite that “… a substantial minority of American adults are reluctant to interact, or to have their children interact, with children described in ways consistent with ADHD and depression. Specifically, about 1 in 5 adults was unwilling to have these children living next door, in his or her child’s class, or as his or her child’s friend.”

It is a myth that poor parenting causes AD/HD. However it is evident that social distancing is desired if parents deem the offending child’s behavior to be caused by poor parenting.

By middle school, I would suggest a majority of AD/HD children feel socially outcast. Social acceptance of AD/HD children by their peers may be influenced by the parental attitudes either explicitly conveyed or indirectly communicated. Regardless, it’s evident that despite continued public education, barriers toward social acceptance exist albeit on a minor scale as about 4 out of 5 adults did not report these biases.

I think the greatly varying attitudes toward AD/HD reflect a general confusion regarding the subject. It’s regarded a brain disorder, not as a learning disability which is where I would prefer to see it. The brain disorder lends a certain stigma to AD/HD which is unfortunate. If it were considered a simple lack of certain skills (which is what it actually is) then not only could it be better understood by the general populace, but it would force the medical community to broaden their utterly narrow perspective on treatment benefiting all concerned.

Kids with mental illness often rejected socially

March 19, 2007

NEW YORK (Reuters Health) – Research suggests that a “substantial minority” of American adults are reluctant to let their children interact with children who suffer from depression or attention deficit hyperactivity disorder.

About one out of five parents would not want these children as neighbors, in their child’s classroom, or as their child’s friend, report Jack K. Martin and colleagues from Indiana University in the Journal of Health and Social Behavior.

Older children and boys with mental conditions are most likely to be rejected.

This troubling pattern, the investigators report, appears to result from perceptions that a mentally ill child may be “dangerous.”

“If, as it seems, the ‘mental illness’ of either children or adults signals danger to the public, this barrier must be addressed by future political, legal, and research agendas,” according to Martin and colleagues.

The research stems from interviews with more than 1,100 adults as part of the General Social Survey administered by the National Opinion Research Center. The interviewees were given descriptions of children of various ages with asthma, attention deficit hyperactivity disorder, depression or “normal” ups and downs of childhood.

Levels of rejection for children with depression and ADHD were two to three times higher than those reported for children with asthma or “normal” childhood troubles.

The results showed that almost 30 percent of parents said they would not like their child to become friends with a child who was depressed and more than 18 percent wouldn’t want to live next door to a family with a depressed child.

Roughly 23 percent of parents said they preferred that their child not make friends with a child with behaviors consistent with ADHD and 22 percent wouldn’t want to live next door to a family with a child with ADHD.

“In line with the 1999 Surgeon General’s report on mental illness, our analyses point to continuing barriers to public acceptance,” note the report’s authors. “While not as significant an obstacle as the rejection of adults, social distance does reflect stigma surrounding children’s mental health problems.”

They hope a greater understanding of the roots of this stigma will lead to effective efforts to confront the persistent lack of social acceptance of the mentally ill.

SOURCE: Journal of Health and Social Behavior, March 2007.

Brain Volume and ADHD

Posted by on April 16th, 2007 | Comments off

I’ve briefly mentioned research studies in the past that find ADHD children have decreased brain volumes (essentially smaller brains) than their peers. Recently, another of these studies was published in the American Journal of Psychiatry (April 2007). Using MRI, the study followed 36 children over two years. How research like this gets published is beyond speculation, but in the publish or perish world of academia, it’s fairly standard trash.

The journal reports that the researchers (a group of MDs and PhDs) “…compared the volumes of each lobe of the cerebellar hemispheres and vermis in children with ADHD and comparison subjects and used a new regional cerebellar volume measurement to characterize the developmental trajectory of these differences.”

Just an anatomical note, the cerebellar vermis is a part of the structure of animal brains. It’s a thin wormlike structure between the hemispheres of the cerebellum. It would take far too long to fully detail the brain structures the researchers have noted as being reduced in volume, but the anatomy is easily available for review on the web.

According to the researchers, the “36 children with ADHD were divided into a group of 18 with better outcomes and a group of 18 with worse outcomes and were compared with 36 matched healthy comparison subjects. The volumes of six cerebellar hemispheric lobes, the central white matter, and three vermal subdivisions were determined from MR images acquired at baseline and two or more follow-up scans conducted at 2-year intervals.”

I’m not bothered by the low number of children in the study. However, we cannot forget that ADHD is a subjective diagnosis. This study, like many others before it, seeks to find some biological marker that might reveal the nature of ADHD. Unfortunately, we have several problems: one, go to any search engine you wish, type in ADHD and then any structure in the brain that you wish, e.g. cerebellum, frontal cortex, basal ganglia, putamen, etc. You’ll find a controlled study indicating that that structure of the brain is diminished in volume, not functioning normally, etc. Apparently, if one takes these studies seriously, the brains of ADHD persons are extraordinarily damaged. Not likely.

The Holy Grail of ADHD is to find a correlation between brain structure and specific dysfunction which would cause ADHD. This is a foolhardy endeavor. Since ADHD is diagnosed through a checklist of symptoms presented over time, it is very likely it is caused by a variety of factors including environment, heredity, etc.

Furthermore, brain structures that are smaller in volume (if this rot could be proven), or function differently, may be related to the manner in which they ADHD person engages with his environment, i.e. the different structures may not have been congenital, but are the direct effect the person’s interaction with their environment. This is a problem of antecedence (chicken and egg). Secondly, until we study several million brains to find out what the ‘normal’ brain looks like among the full spectrum of human traits and personality characteristics, studies of the sort mentioned are simply a house of cards ready to fall.