Is It More Than Just ADHD?

Posted by on April 26th, 2013 | No Comments

New study sheds some light
Reported in the journal Science
Study author: Brian Butterworth. Butterworth is a professor at the Institute of Cognitive Neuroscience of the University College London

Research in the journal Science reports that up to 10 percent of all children are thought to have learning disabilities. This would amount to two or three kids per classroom.The researchers found that the disabilities have complex causes.

It’s estimated that nearly 10% of all children have ADHD, but it usually doesn’t occur by itself according to the researchers. They cited that 33 percent to 45 percent of children with ADHD also have dyslexia and 11 percent also have dyscalculia.

Dyslexia is a reading, writing and spelling disability frequently associated with auditory processing issues. Dyscalculia is a math learning disability.

The researchers stated that learning disabilities are the result of abnormal brain development caused by complicated genetic and environmental factors.

“We now know that there are many disorders of neurological development that can give rise to learning disabilities, even in children of normal or even high intelligence, and that crucially these disabilities can also co-occur far more often that you’d expect based on their prevalence,” said study author Brian Butterworth in a university news release. Butterworth is a professor at the Institute of Cognitive Neuroscience of the University College London

Butterworth’s team noted that if a child has multiple learning disabilities, they may be overlooked when one gets an ADHD diagnosis. The diagnosis may overlook dyslexia for example. Not knowing may lead to frustration by both student and teache as well as inadequate instructionr. Knowing a student has both learning disabilities would allow the teacher to properly accommodate the student’s needs.

The study reinforces the fact that one needs to get a good evaluation form a specialist, not just a short 20 minute visit to one’s pediatrician. Proper instruction can come only when one has full knowledge of student needs.

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ADHD Rates Are Skyrocketing

Posted by on April 4th, 2013 | No Comments
What’s behind the 53% increase?
Reported By: healthland.time.com
For the last few years the rate of ADHD was calculated to be between 4% to 6% of all school age children. New Center for Disease Control (CDC) data report that 11% of all school age children are now diagnosed with ADHD as well as nearly one in five high school age boys in the United States. The new data reflect a 53% rise over the last decade.This has alarmed man of the experts.“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.”Read the full article: http://healthland.time.com/2013/04/02/understanding-the-rise-in-adhd-diagnoses-11-of-u-s-children-are-affected/?iid=tsmodule

Understanding the Rise in ADHD Diagnoses: 11% of U.S. Children Are Affected | TIME.com
healthland.time.com
The rates of U.S. children affected by attention deficit-hyperactivity disorder
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Who’s Getting Diagnosed the Most?

Posted by on February 6th, 2013 | No Comments

As mentioned last week, an epidemic leap in ADHD diagnoses was revealed in a study published in the January online edition of JAMA Pediatrics. Diagnoses increased 24% over the 10-year period from January 1, 2001 through December 31, 2010.

Who? Caucasian children consistently had the highest rates of ADHD diagnosis over the term of the study (4.7% to 5.6% increase). However, the largest increases in diagnosis rates were seen in black children (2.6% to 4.1% increase) and Hispanic children (1.7% to 2.5% increase). Roughly, this translates into a 30% increase in Caucasian children, 67% in black children, and 60% in Hispanic children. Interestingly, ADHD diagnosis rates for Asians/Pacific Islanders remained unchanged at around 1%. This very low rate was not explained.

The researchers attributed the increase in diagnosis in black children to an increasing likelihood of diagnoses in black girls that heretofore had not been identified.

According to the study, children diagnosed with ADHD were more likely to be from higher income families.

The fact that Asian/Pacific Islanders had vastly lower rates is quite interesting. Could it be related to different parenting and expectations? Or is it related to cultural differences that circumvent western medicine? We cannot derive an answer from this study.

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ADHD medication no substitute for effective parenting

Posted by on January 1st, 2013 | No Comments

The Journal Gazette posted an article by Dr. Rama Cousik. Cousik is an assistant professor of special education at IPFW (Indiana University–Purdue University Fort Wayne). The article  is relevant and provocative.

www.journalgazette.net/article/20121223/EDIT05/312239978/1147/EDIT07

As I was preparing for a lecture on ADHD, one sentence in a 2009 UNESCO report caught my eye:

“A single ‘good’ quality study of methylphenidate (MPH) with 114 preschool children provided low SOE for improving child behavior. …Adverse effects were present for preschool children treated with MPH; adverse effects were not mentioned for PBT.”

We in academia are so fond of acronyms. Luckily, we are required to decode them: SOE means strength of evidence, and PBT means parent behavior training.

This quote is from a research report on treatments for children who are at risk for ADHD (attention deficit hyperactivity disorder). At risk means they are highly likely to be diagnosed with the disorder when they are older.

Methylphenidate is a prescription drug sold as Concerta, Metadate, Methylin and Ritalin – a drug as popular and as widely consumed as popcorn.

The researchers compared the effect of two treatment methods on children’s behavior: 1.) Prescribing methylphenidate to children and 2.) Training parents to manage their children’s behavior without medication.

Children with ADHD have problems paying attention, are impulsive and hyperactive. A diagnosis usually occurs at or after 7 years of age. Children who are younger than 7 years, at risk for ADHD, may be diagnosed with oppositional defiant disorder.

According to the Centers for Disease Control, “Parents report that approximately 9.5 percent or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.” And the number is increasing.

Having grown up in a world without ADHD, I struggle with the idea that many young children are increasingly being considered at risk for ADHD. I also struggle with the fact that medication is a part of the treatment package for many preschool children.

Like all drugs, methylphenidate has many side effects. According to PubMed, “Methylphenidate may cause side effects … nervousness, difficulty falling asleep or staying asleep, dizziness, nausea, vomiting, loss of appetite, stomach pain, diarrhea, heartburn, dry mouth, headache, muscle tightness, uncontrollable movement of a part of the body, restlessness, numbness, burning, or tingling in the hands or feet…”

While I am grateful that drug manufacturers are required by law to publish the side effects of all drugs in the market, one thing bothers me. How does one expect a preschooler to even begin to comprehend what symptoms she is experiencing, let alone communicate them to parents?

And as if these side effects are not serious enough, they warn you about serious side effects, including “…irregular heartbeat, difficulty swallowing, fainting, seizures, hallucinations and tics.”

Two statements at the end of the PubMed webpage were foreboding: “Methylphenidate may cause sudden death in children … (and) may slow children’s growth or weight gain.”

Naturally, the UNESCO study found that medication had adverse effects and hardly improved children’s behavior, whereas parent training programs improved children’s behavior and, most importantly, had no harmful effects.

Now what does that tell us about parenting? It is in our hands to prevent our children from being diagnosed with ADHD and protect them from harmful side effects of medication, unless extremely necessary.

As parents, we want the best for our children. However, their best will not evolve if we don’t do our best to raise them. And doing our best includes learning about the harmful effects of drugs before we force them on our children.

If your doctor has told you that your child has ODD, learn everything about the condition and treatment options before you agree to medicate him.

Learning how to manage your child’s behavior without medication is the most effective first option of treatment and causes no harm to your child. Ask your health care provider to give you information about parent behavior training program in your area. If there is none, get together with other parents who are concerned about their preschoolers’ behavior and demand that such a program be initiated in your community.

Let us make a concerted effort and learn to manage children’s behavior without resorting to Concerta.

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Do We Outgrow ADHD?

Posted by on August 20th, 2012 | No Comments

Does ADHD Affect People Over Age 60?
Surprising results of Dutch research

It’s estimated that ADHD affects 5 to 10 percent of the child population in the US. Recent studies suggest that it may be a simple developmental delay. However, a new Dutch study finds ADHD does not disappear with age; it follows us from childhood to adulthood.

According to the first study of its kind, ADHD also affects around 3% of people over age 60. This casts significant doubt on the popular belief that many children grow out of the condition. The Dutch study was published in the British Journal of Psychiatry and examined 231 Dutch adults aged 60 to 94.

Lead researcher of the Dutch study, Marieke Michielsen said in a press  release:  “ADHD affects 3-7% of school-aged children, and about 4.4% of  adults. However, little is known about ADHD in old age and this is the first epidemiological study on ADHD in older people.”

The study reveals what most adults with ADHD already know — they work below their intellectual level, cannot maintain relationships, often express anti-social behavior, lack organizational skills, and have higher rates of accidents than adults without ADHD.

The Longitudinal Aging Study Amsterdam had 1,494 participants between the ages of 60 and 94. All completed a questionnaire to screen for ADHD. The number that showed the greatest symptoms was 231. They participated in a longer, structured diagnostic interview.

What could account for the discrepancy between the higher diagnosis of children and the lower incidence in adults? Several explanations are possible:

  • It is possible that symptoms diminish with increasing age.
  • ADHD may be over-diagnosed in children.
  • ADHD adults may learn coping skills that mitigate their symptoms.
  • Most diagnostic tools were developed for children and may not be sensitive enough to detect ADHD in older people.

ADHD is often diagnosed 4 to 1 boys to girls in the US. Previous studies confirm that it’s more prevalent in boys than girls. However, this study reveals that both men and women reported similar amounts of ADHD symptoms.

Regardless, it’s evident from this study that many people don’t outgrow ADHD and it’s necessary to develop the skills to make us happy and successful. Call 800-788-6786 to find out how.

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Is It ADHD or Typical Toddler Behavior?

Posted by on July 16th, 2012 | No Comments

A great article from Psychology Today (http://www.psychologytoday.com/blog/brain-sense/201207/is-it-adhd-or-typical-toddler-behavior).

10 Early signs of ADHD risk in young children.

Young children often have problems paying attention or concentrating, but when are these problems serious enough for parents and teachers to be concerned? According to estimates from the Centers for Disease Control, one in 11 school-aged children are diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), but research suggests that the warning signs often appear before a child first goes to school. Some experts estimate that as many as 40 percent of children have significant problems with attention by age four.

Why should parents be concerned about ADHD in their preschoool chidlren? “We want to catch ADHD early because it has such a profound effect on learning and academic development. Children whose symptoms begin in early childhood are at the highest risk for academic failure and grade repetition.” says Dr. Mark Mahone, director of the Department of Neuropsychology at the Kennedy Krieger Institute in Baltimore, MD.

In children ages three to four years, Dr. Mahone recommends looking for the following signs that are associated with an ADHD diagnosis at school age:

1. Dislikes or avoids activities that require paying attention for more than one or two minutes

2. Loses interest and starts doing something else after engaging in an activity for a few moments

3. Talks a lot more and makes more noise than other children of the same age

4. Climbs on things when instructed not to do so

5. Cannot hop on one foot by age four

6. Is nearly always restless — wants to constantly kick or jiggle feet or twist around in his/her seat. Insists that he/she “must” get up after being seated for more than a few minutes.

7. Gets into dangerous situations because of fearlessness

8. Warms up too quickly to strangers

9. Is frequently aggressive with playmates; has been removed from preschool/daycare for aggression

10. Has been injured (e.g., received stitches) because of moving too fast or running when instructed not to do so

“If parents observe these symptoms and have concerns about their child’s development, they should consult with their pediatrician or another developmental expert,” says Dr. Mahone. “There are safe and effective treatments that can help manage symptoms, increase coping skills, and change negative behaviors to improve academic and social success.”

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ADHD’s Genetic Link

Posted by on October 11th, 2010 | Comments off

What causes attention-deficit hyperactivity disorder – ADHD? Research in the English medical journal, The Lancet, says it’s not too much sugar, bad diet, or poor parenting. Professor Anita Thapar, lead author of the study, says it’s likely genetic.

Thapar and her group of scientists at Cardiff University in Wales compared 366 children with ADHD to 1,047 kids without ADHD. In particular, the researchers examined differences in the children’s DNA. They found that kids with ADHD were more likely to have small segments of DNA that were duplicates or missing (copy number variants or CNVs — either a deletion or duplication of genetic material).

“We hope that these findings will help overcome the stigma associated with ADHD,” Professor Anita Thapar, the study’s lead author, said in a written statement. “Too often, people dismiss ADHD as being down to bad parenting or poor diet. As a clinician, it was clear to me that this was unlikely to be the case. Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children.”

While being media friendly, Thapar’s last statement is a stretch in relation to her research. People and the media love statements that provide seemingly conclusive answers.

Let’s go beyond the media hype that says this research concludes there is a definite genetic link. The researchers really only say there seems to be a possible “genetic link.”  However, their research did not conclude that it is purely or even primarily genetic. What they truly are saying is that this study is evidence that ADHD is not purely social.

The authors conclude:

“Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct.”

This is logical because only 15% of the research subjects with ADHD demonstrated increased CNVs. So is it safe to conclude that genetic makeup may contribute, at least in some particular cases, to ADHD? Yes, but to be clear,  this research did not conclude that it is entirely genetically based and was only partially genetically based in a small segment of their study population. This is very similar to other genetic research.

Why is it, if ADHD is genetically based, at least in part, that 30% don’t have it as adults when diagnosed as a child? What happened? Where did it go? This is what is most  important to parents and professionals.

Epigenetic theory, now being widely embraced by the scientific community, maintains that human development  includes both genetic origins of behavior and the direct influence that environmental forces have on the expression of those genes (nature/nurture). Epigenetic theory regards human development as a dynamic interaction between these two influences.

Simply put, how our genes express themselves is greatly impacted by environment. This is likely why, over time, 30% of children don’t display symptoms as adults. The brain changes, rewires, or (a radical version of epigenetic theory) their genes change.

Do tools exist to do this? Yes. See www.playattention.com.

If I may quote Dr. Theodore Dalrymple, “What seems to have happened is that parents have lost the awareness that they had for decades – if not for centuries – that concentration and self-discipline do not come naturally to children, and have to be taught (as well, sometimes, as enforced).”

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Training the ADHD Brain

Posted by on September 27th, 2010 | Comments off

For years, we at Play Attention, have trained thousands and thousands of people to better pay attention, learn the cognitive skills they need to succeed, and change their behavior. Our results have spoken clearly for us since 1994. Now science is catching up.

Two recent distinct studies validate the brain’s ability to change. While a vast plethora of research confirms these studies’ findings, they are noteworthy. The first study demonstrates the efficacy of skill training, and the second demonstrates how teaching skills rewires the living brain.

The first study, published in the August 25 Journal of the American Medical Association, was performed by researchers from Massachusetts General Hospital (MGH). They utilized cognitive behavioral therapy as a direct intervention for ADHD adults. Cognitive therapy teaches skills for managing life challenges.

The researchers at  MGH found that while medications were the first line of treatment, many patients still persist with underlying symptoms.  While previous studies on cognitive behavioral therapy for ADHD were small and short term, the researchers at MGH claim their study to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

Like Play Attention has been doing since 1994, the researchers provided training sessions mainly that included skills training in filtering of distractions, organization, problem solving, and planning.

Safren’s group receiving cognitive and behavioral training demonstrated advanced control of their symptoms over their control group.  This benefit had persisted when measured three and nine months after the training.

The second study, published in The Journal of Neuroscience (August 25, 2010, 30 34 11493-11500 doi 10.1523 JNEUROSCI.1550-10.2010), examined the brains of rats when they learned to control their impulses.  The researchers documented synaptic changes in the medial prefrontal cortex. They concluded that the rat’s brains rewired themselves to produce the impulse controls necessary to be successful in the tasks the scientists had established for them.

Other past studies have confirmed that the brain will rewire to make changes for skills, impulse control, organization, etc. We’re glad that science is catching up to an learning process that we’ve done at Play Attention for sixteen years now.  That’s beyond cutting edge; it’s leading the way for others.

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Misdiagnosing ADHD

Posted by on September 13th, 2010 | Comments off

According to a study released by the University of Michigan, nearly 1 million children in the United States are potentially misdiagnosed with ADHD.

The research was conducted, not by a medical group, but by economist Todd Elder  in the Journal of Health Economics (Elder et al. The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Journal of Health Economics, 2010; DOI: 10.1016/j.jhealeco.2010.06.003).

Elder found that the youngest or often the most immature children are misdiagnosed with the ADHD label simply because of their age and exhibited maturity. Elder also found that these children are significantly more likely than their older classmates to be prescribed medications like Ritalin to control their behavior. Using a sample of 12,000 children, Elder examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. He found that the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest kindergarten children. Elder followed that group of children and found that they were more than twice as likely to be prescribed stimulant medication by the time they reached the fifth and eighth grades.

Currently, about  4.5 million children are diagnosed with ADHD. Elder concludes that about 20 percent  or about 900,000 children have likely been misdiagnosed.

In a press release from the University of Michigan, Elder said that such inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant use on children’s health. Elder is also concerned that misdiagnosis wastes an estimated $320 million-$500 million a year on unnecessary medication. He estimates that between $80 million-$90 million of it is paid by Medicaid.

“If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6,” said Elder. “There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD.”

ADHD has no pathology, no biological marker in the brain that clearly demonstrates its existence. Thus, its diagnosis is always subjective. While teachers are not permitted to make this diagnosis, their perceptions and opinions serve as the initial step to a diagnosis made by a doctor.

“Many ADHD diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a kindergarten classroom,” he said. “But these ‘symptoms’ may merely reflect emotional or intellectual immaturity among the youngest students.”

According to Science Daily, Elder’s paper will be published in the Journal of Health Economics in conjunction with a related paper by researchers at North Carolina State University, Notre Dame and the University of Minnesota that arrives at similar conclusions as the result of a separate study.

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Is ADHD all in your head?

Posted by on July 19th, 2010 | Comments off

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina.  The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo --  A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing.  Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

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