Do they suffer injury more often?

Research reported in the September/October issue of Academic Pediatrics reveals that young ADHD adolescents face unintended injury at nearly twice the rate of their peers.

“Preventing injuries is probably not the primary reason to treat ADHD, but it is one of many positive consequences that should emerge if ADHD is properly treated,” first author David C. Schwebel, PhD, professor and vice chair, Department of Psychology, University of Alabama at Birmingham, told Medscape Medical News (http://www.medscape.com/viewarticle/750259). “Both psychotherapy and pharmacotherapy have evidence of efficacy,” he added.

Dr. Schwebel and colleagues found a significant association between ADHD symptoms and an increased risk for injury. In an ethnically diverse group of children with a median age of 11 years, Schwebel and his colleagues found that fourteen percent of study participants suffered 1 or more injuries requiring medical attention in the previous year. The most common injuries were broken bones (52%), joint injuries/sprains/strains (15%), and cuts/bruises (15%). The risk of injury increased with the increase of ADHD symptoms. Boys also presented higher risk of injury than girls.

Dr. Schwebel’s results resonate and make sense to parents of ADHD children. These children often have impulse control problems. Inattention to their environment is common which can result in greater chance of injury as well.

Dr. Schwebel said in addition to treatment of ADHD, “if clinicians have time and resources to focus especially on injury prevention in children with ADHD, considering ways to help children recognize potentially dangerous situations, perhaps through cognitive techniques, might be helpful to reduce injury risk.”

“Recognition of danger and invocation of executive function/self-inhibition skills might be helpful to children with ADHD if clinicians can successfully train or hone such skills,” Dr. Schwebel added.

Using Play Attention to help decrease inattention and control impulsivity is a great start. Our Motor Skills module teaches mind/body coordination to help reduce injury. We’re in development of a specific Play Attention game that will help teach valuable skills to identify dangerous situations. It will be available in the near future.

Is there a connection?

Teachers, parents, and ADHD exeprts almost expect to have a compounding issue along with an ADHD diagnosis. Reading disabilities, behavioral difficulties, dyslexia, etc. are very common among ADHD children.

A study in the September, 2011 issue of Pediatrics confirms this; ADHD children have a much higher risk of developing a written language disorder and especially a reading disability. Reading disabilites account for nearly 80% of all learning disabilities associated with an ADHD diagnosis.

To be specific, a written language disorder is an impaired ability to express oneself through the written word. Difficulties in organizing one’s thoughts, memory, distraction, and even poor motor skills contribute to written language disorders.

The study was performed by the Mayo Clinic’s department of health sciences research in Rochester, Minnesota. Co-author, Dr. Slavica K. Katusic, associate professor of epidemiology and pediatrics says,”So…the uniqueness of this study, [is] because this is population-based.And what we found is that, regardless of gender, there is a dramatic difference in the risk of written-language disorder. ADHD kids are at a five times greater risk for having writing problems compared to all others who do not have ADHD.”

To form their conclusions, the researchers performed meta-analysis of 5,718 children born between 1976 and 1982 in Rochester, Minnesota. The majority of the children were middle-class whites. All were tracked from birth until roughly the age of 19.

If the child had a reading diability, the risk of devloping a writing disorder vastly increased.

“When someone suspects that a child has ADHD, people are so impressed with concerns over dyslexia that they sometimes kind of forget about problems with writing. So, this should bring some needed attention to the need for equal testing and equal help for kids who also have writing problems,” warned Katusic.

Katusic’s research echoes previous research. ADHD is actually an impairment of a variety of skills. These skills are often fundamental to reading and writing. Remember that Play Attention teaches motor skills, auditory processing, memory and more.

Is there a connection?

Two distinct studies examined the role of PFC (Perfluorinated chemicals) and their possible connection to ADHD and hyperactive/impulsive behavior in children. The studies were published online last month.

Perfluorinated chemicals (PFC) have been used since the 1950s. Commonly used in industry, they can be found in a wide variety of consumer products including, food containers, waterproof fabrics, paints, non-stick cookware, and stain-proof coatings. PFC are actually a class of chemicals that include perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), perfluoroctanic acid (PFOA) and perfluorohexane sulfate (PFHxS).

In the first study, Brooks Gump of SUNY, Oswego, and colleagues assessed impulsive behavior using a computerized test. They compared the test results with PFC in the children’s blood samples. They used a sample of 83 children from Oswego County, N.Y. The children ranged in age from nine to 11 years old.

Gump found that higher concentrations of PFHxS were associated with increased odds of ADHD. Children with the highest exposure to PFHxS were 60 percent more likely to have ADHD and take ADHD medication. Gump could not find a strong correlation with the other PFC and ADHD.

Researchers Cheryl Stein from the Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, and David Savitz, Departments of Community Health and Obstetrics and Gynecology, Brown University, Providence, Rhode Island, are authors of a second study published online in Environmental Health Perspectives.

They reviewed data from the C8 Health Project survey conducted between 2005 and 2006. The project examined more than 10,000 parents and their children aged 5- to 18. These families lived in West Virginia and Ohio near a DuPont plant that manufactures PFOA. Commonly, PFC are transferred in food, but the plant seems to have exposed the families to PFOA through groundwater contamination and airborne plant emissions.

Stein and Savitz’s findings from the C8 Study echo results from a previous study done in 2010; higher levels of PFOA were highly associated with ADHD.

Neither of the studies can prove that PFC cause ADHD, only that there is a high degree of association between PFC levels and ADHD. It would be wise to limit exposure to PFC whenever possible. Further studies will have to be performed to determine if health outcomes are affected later in life.

Another environmental contributor to ADHD may be secondhand smoke. A recent study confirms a study done in 2007 by Richard D. Todd, M.D., Ph.D., the Blanche F. Ittleson Professor and director of the Division of Child Psychiatry at Washington University — secondhand smoke may be linked to a greater risk of ADHD and learning disabilities in children.

The current study was funded by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics. The researchers found an amazing correlation between secondhand smoke and ADHD: children exposed to secondhand smoke in the home are twice as likely to develop either ADHD or a learning disability.

Data were collected from parents and guardians of over 50,000 children ages 11 and younger in the US. The researchers found that children exposed to secondhand smoke had a learning disability 8.2 percent of the time, ADHD nearly 6 percent of the time, or another conduct disorder 3.6 percent of the time.

Obviously, the cost of treatment via medical and educational interventions is in the billions of dollars. Environmental factors are something we can control, if we place emphasis on the need to control them. I’m quite certain that as we study the relationship between our environment and our health, greater causal relationships will be revealed.

Are underlying problems like ADHD involved?

The July issue of Archives of General Psychiatry reports a study that finds teens who “cyberbully” others via the Internet or cell phones are more likely to suffer from both physical and psychiatric troubles. Additionally, their victims are at heightened risk from both physical and psychiatric troubles.

The research team was led by Dr. Andre Sourander, from Turku University, Finland, defines cyberbullying as aggressive, intentional, repeated acts using mobile phones, computers (including e-mails and Facebook) or other electronic media against victims who cannot easily defend themselves.

The study is relevant to current trends in the use of electronic media by teens. Researchers at the JFK Medical Center say that the average teenager sends a total of over 3,400 electronic [text] messages every month or surfs the Internet at bedtime. In January of 2011, national media focused on the death of 15-year-old Phoebe Prince. Prince, a Massachusetts teen, committed suicide after months of relentless cyberbullying.

The online Healthgrades.com site reports a recent U.S. survey of children aged 10 to 17 found that 12 percent were “aggressive” to someone else while online, 4 percent were victims of this type of online aggression, while 3 percent reported being both aggressors and targets.

The national spotlight on these trends has caused many parents to become increasingly concerned about both cyberbullying and their children’s Internet safety.

To evaluate cyberbullying, Sourander and team surveyed almost 2,500 teens. More than 7 percent of teens reported that they bullied other teens online. Almost 5 percent said they were targets of cyberbullies while 5.4 percent said they were both bullies and bullied.

The researchers’ data were quite compelling; teens who were victims of cyberbullying were more likely to come from broken homes and felt unsafe at school. Furthermore, they also had problems with concentration (ADHD), emotional problems, sleeping problems, and behavioral problems. The teens reported that they found it difficult to associate with their peers and were often prone to headaches and abdominal discomfort. It was quite apparent that psychological trauma was induced by cyberbullying.

Oddly, the cyberbullies had their own problems; they too were also more prone to suffer from problems with concentration (ADHD), emotional problems, sleeping problems, and behavioral problems. They too, found it difficult to associate with their peers. Cyberbullies also frequently smoked or got drunk, reported headaches, and were more prone to not feeling safe at school.

The researchers noted that cyberbullying was different than physical bullying. Physical bullying typically remains confined to school grounds or public places like the mall. Cyberbullies have an increased power and effect as they can bully 24 hours a day, seven days a week if so compelled. This relentless attack seems to affect both the cyberbully as well as the victim.

It is important to discuss this behavior with your child. That discussion should set stric

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ADHD is a hot topic. You’re likely reading this because you’re interested in ADHD. It’s such a hot topic that many claim ADHD is a growing epidemic. It’s estimated that about 4 percent of the adult population has ADHD. That’s approximately 8 million people. However, a study published in the journal The Clinical Neuropsychologist finds that almost one in four adults who show up in doctors’ offices seeking treatment may be exaggerating or possibly faking their symptoms. That means that approximately 2 million adults may be faking ADHD symptoms.

Paul Marshall, a clinical neuropsychologist with Hennepin Faculty Associates, a medical group that provides services at Hennepin County Medical Center in Minneapolis, Minnesota found that twenty-two percent of adults in the study tried to skew test results to make their symptoms look worse. Dr. Marshall and his colleagues examined the medical records of 268 patients. They carefully scrutinized patient interviews and questionnaires. The questionnaires were cleverly designed with mini-tests embedded that would expose people who might exaggerate their symptoms. Marshall noted that people in the survey who exaggerated their symptoms also scored much more poorly on the embedded tests than people with actual ADHD symptoms.

“Some of those who exaggerated their symptoms actually had ADHD, but embellished their reports to ensure they got diagnosed”, said Dr. Marshall. “Others didn’t have the disorder at all, but were having a tough time dealing with their workloads and lives. A lot of people think they have it because they are struggling, but it’s not because of ADHD,” Marshall said. “Often times, it’s simply depression, anxiety or lack of sleep.”

As I’ve written many times before, there is no pathology to ADHD; there is no place that it exists in the brain like a tumor or scar tissue. There’s also no definitive test for it. Therefore, it’s a highly subjective diagnosis. Most people are prescribed medication after a simple 20 minute visit with their family practitioner. So, for adults, the practitioner must simply rely upon the patient’s word.

Other patients may have been faking symptoms to get access to stimulant medications, Marshall said. In some cases, college and graduate school students want to be diagnosed with ADHD in hopes of gaining access to medications that boost concentration and focus, as well as accommodations such as longer times for tests. And some just want the meds for an inexpensive high, he added.

Marshall’s observations echo many previous studies (Journal of American College Health. Issue: Volume 57, Number 3 / November – December 2008 Pages:315 – 324) that found 34% of university students reported the illegal use of ADHD stimulants. Most illegal users reported using ADHD stimulants primarily in periods of high academic stress and found them to reduce fatigue while increasing reading comprehension, interest, cognition, and memory.

What benefits do ADHD drugs produce for the non-ADHD person? They are considered Schedule II substances in the same class as cocaine and amphetamines.

It may surprise you that ADHD drugs work for everyone. Stimulant medications can temporarily increase brain function making it easier for a high-school or university student to study for a test. These students are well aware of this and often use the drugs for this purpose.

This fact also exposes a major flaw in our medical system: many doctors use a reverse logic or rationale for diagnosing ADHD. When a patient is seen and describes their symptoms, the doctor will often prescribe ADHD medication first and see if the symptoms improve. The rationale is: if the symptoms improve using ADHD medications, then the problem was ADHD. This is known as a false conclusion because the symptoms will improve for just about everyone — at least temporarily.

Medications do have their place. Must we have a true evaluation from a professional to obtain a correct diagnosis? Yes. Does this take longer than 20 minutes? Yes. Should we do more than just medicate? Yes. The NIH has concluded that a multi-modal approach is best. This includes behavior shaping and cognitive skills training. Sound familiar? Yes, that’s Play Attention.