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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The ADHD link to social dynamics

Posted by on June 21st, 2010 | Comments off

If I told you that women who received only basic education were 130 % more likely to have a child on ADHD medication than women with university degrees, you’d see a link, wouldn’t you? 

Well, that’s what a  study published this month in Acta Paediatrica found.  That implies that nearly half of the serious cases of ADHD  in children are closely tied to social factors. The study reveals that factors like single parenting and poor maternal education were directly tied to ADHD medication use.

While we know that a genetic propensity likely exists, the human brain develops based on a complex interplay between nature and nurture; between genetic endowment (nature) and environment/social factors (nurture). Epigenetic theory tries to explain this relationship.

Curiously, few large-scale studies have tried to determine the impact of social and family influences on ADHD. Researchers at the Karolinska Institute in Stockholm, Sweden assessed data on 1.16 million school children and examined the health histories of nearly 8,000 Swedish-born kids, aged six to 19, who had taken ADHD medication.

"We tracked their record through other registers … to determine a number of other factors," said lead author Anders Hjern.

Here’s what the researchers found:

  • Living in a single parent family increased the chances of being on ADHD medication by more than 50 percent.
  • A family on welfare upped the odds of medication use by 135%.
  • Boys were three times more likely to be on medication than girls.
  • Social dynamics affected both sexes equally.

"Almost half of the cases could be explained by the socioeconomic factors included in our analysis, clearly demonstrating that these are potent predictors of ADHD-medication in Swedish school children," Hjern said.

It’s clear that this study found a link between socioeconomic factors and ADHD medication use/diagnosis. Other US studies have found that minority children and children of low socioeconomic status were more likely to receive ADHD medication.

Factors like low income and diminished quality time are more common in single-parent families. These typically lead to stressors like family conflict and a lack of social support, Hjern said.

While more research must be done, one has to ask, is medication the answer to social stressors like lack of time and money? Sounds too silly to ask, but it seems that our answer, ridiculously, is a resounding, YES!

We are the masters of our lives. We can make significant personal changes, but we must have the tools to do so. That’s why I began Play Attention (www.playattention.com) years ago.

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Tobacco Smoke, Lead & ADHD

Posted by on December 30th, 2009 | Comments off

The November issue of the medical journal Pediatrics published research from Dr. Robert Kahn et al regarding the relationship between tobacco smoke, lead concentrations, and ADHD.

Kahn, a physician and researcher at Cincinnati Children’s Hospital Medical Center, Ohio, found that two risk factors: 1) exposure to tobacco in the womb and 2) exposure to lead in childhood significantly increased the likelihood of ADHD developing  in children.

The researchers used data from the National Health and Nutrition Examination Survey. Tobacco exposure in the womb was measured by reports of cigarette use during pregnancy, and childhood lead exposure was assessed by blood levels. Of the 2588 cases they reviewed, the researchers determined that children aged 8 – 15 who were exposed to tobacco smoke in the womb were 2.4 times more likely to have ADHD. Children with lead blood levels in the top third of the population had a 2.3-fold increased likelihood of ADHD diagnosis.

Lead researcher, Tanya E. Froehlich, MD, cited that the combination from both lead and tobacco smoke created a synergistic effect, an even greater effect than smoke or lead alone. Children who were exposed to  both tobacco smoke in the womb and higher lead levels had a more than eightfold increased chance of having ADHD compared to children who weren’t exposed to either.

The study does have limitations; the researchers analyzed data on smoking that was derived from the mothers’ answers on a questionnaire. The data did not include the number of cigarettes smoked. And while the researchers found a link between tobacco, lead and ADHD, they did not prove that these factors actually caused the disorder. This is similar to previously published research on prenatal tobacco smoke and lead levels.

Curiously, smoking tobacco is twice as popular in the adult ADHD population compared to the non-ADHD adult population.  Columbia University researchers established a study to determine if smoking ameliorated ADHD symptoms in adults back in 2006.  If tobacco smoke truly increases the risk of developing ADHD, the popularity of smoking among ADHD adults may create a cycle of producing more ADHD children if smoking is done prenatally.

While a strong genetic link is still the likely cause of ADHD, environment still plays a significant role in brain development. The researchers assert that perhaps up to 35 per cent of cases of ADHD in youngsters aged between 8 and 15 could be reduced by getting rid of both prenatal exposure to tobacco and childhood exposure to lead.

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Is ADHD Simply a Developmental Delay?

Posted by on December 8th, 2009 | Comments off

Attention-deficit hyperactivity disorder (ADHD) is conservatively estimated to affect anywhere between 5-7% of the world’s school-children. Is it possible that ADHD is the result of a brain that just develops slower than the brain of a child that doesn’t have ADHD?

Research has shown that the ADHD brain may develop differently than one without ADHD. However, no conclusive pathology (diseased or damaged location in the brain) exists; we don’t know what causes it.

What we do know: As a child’s brain develops, his experiences and environment help shape the connections in the brain. This development is also connected to genetic endowment. Thus, the brain develops dependent upon a complex interplay between nature (genetic endowment) and nurture (experience/environment). These connections form networks which help us process language, calculate math, feel, see, smell, think, and all else the brain is responsible to perform.

The part of the brain that is crucial to a child’s development is the cerebral cortex, the brain’s outer layer. The brain’s most complex functions like attention, consciousness, memory, and language are believed to be regulated in the cerebral cortex. As a child develops, gains experiences, and is subjected to his/her environment, the connections between the neurons (nerve cells in the brain) increase causing the cortex to thicken. The brain acts much like a muscle during adolescence; it’s a use it or lose it proposition. Connections which are frequently used are strengthened while unused connections are pruned away.

Researchers Philip Shaw, Judith Rapaport and others from the National Institute of Mental Health have proposed that ADHD may be the result of  lagging brain development resulting in an average 3 year delay. This theory is supported by earlier studies which found that children with ADHD have similar brain activity to slightly younger children without the condition. 

Shaw and Rapaport used MRI (magnetic resonance imaging) to measure the brains of 447 children of different ages. They frequently noticed that the volume of the brain in the prefrontal cortex was thinner in ADHD children than other children of the same age. The cortex developed correctly over time, but the ADHD brain’s  development lagged behind about 3 years before it reached maturity. Among other things, the prefrontal cortex has the responsibility of governing attention, short-term memory,  and controlling inappropriate thoughts and actions. The researchers theorized that ADHD is a lack of control over these tasks, so it was logical to suggest that ADHD is a matter of developmental delay.

Significantly, Shaw and Rapaport found that the primary motor cortex developed faster in ADHD children. As its name implies, the motor cortex helps to plan and control movements. Shaw theorized that this might explain the restlessness, fidgeting and uncontrolled hyperactivity found in ADHD children.

This research raises more questions than it answers. Currently, the cause of the delay is unknown.  If ADHD is just a developmental delay, why do approximately 70% to 80% of children carry their ADHD traits into adulthood? This fact does not rule out Shaw’s conclusions, just that developmental delay may only be present in a minority of children labeled ADHD. Other children, the 70% to 80% previously mentioned, do carry their brain differences into adulthood.

Other research points to a set of genes responsible for the ADHD trait. If either genes and/or developmental delay are the cause, then what is one to do? The brain is an incredibly flexible organ. It is shaped by a variety of factors which means that parents, teachers, and other professionals can influence outcomes. Finding a program that addresses the needs of an ADHD child, helps shape behavior, and optimizes their potential is still the best practice.

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Sleep Disorders & ADHD

Posted by on November 17th, 2009 | Comments off

It’s suspected that nearly 25% of all cases identified as attention deficit hyperactivity disorder (ADHD) are not really ADHD at all, but are symptoms related to sleep disorders.

One of the leaders in this research is University of Michigan professor Ronald Chervin.  Chervin theorizes that very important brain development is done during sleep. Among other things, this includes the ability to regulate emotion and processing. So, if a child has chronic sleep problems, brain development may be impaired. Chervin also suspects that the brain does not receive enough oxygen if the child snores which further inhibits development.  According to Chervin’s research, children who snore are more likely to have ADHD.

He likens the ADHD-sleep connection to a child who doesn’t get a nap; he becomes restless, irritable, and acts out.

Chervin developed his theory based on a sleep/behavior survey of the parents of 866 children.  Chervin’s data exposed a sleep disorder -behavior relationship.  It was only logical to conclude that if the sleep disorder could be corrected, the ADHD symptoms would be extinguished. 

According to Newsweek: “To test this theory, Chervin then studied 79 kids (5 to13 years old) who were about to have an adenotonsillectomy. Prior to the surgery, 22 of the 79 were categorized as having ADHD, based on standard measures for such a diagnosis. One year later,  Chervin’s team tracked down the kids for a follow-up. Of the 22 identified as having ADHD, 11 kids no longer qualified as having the disorder.”

Two problems lingered: 1) New cases of ADHD cropped up and 2) 50% of the surgical patients received no benefit at all.

Before you go and get your child’s tonsils and adenoids out, let’s discuss the distinct problems in the logic associated with this research.

First, we have a problem of antecedence; does ADHD exist because of sleep problems? or does the sleep problem exist because of  ADHD? That relationship cannot be clearly identified and is a confounding problem.

Secondly, new cases of ADHD appeared and others did not benefit at all from the surgery. This would lead one to think that the outcomes may not be related at all to the procedure.

I’m reminded of an old story about researchers who taught a frog to jump upon saying, “Jump!” Many weeks were spent training the frog.  The researchers were quite happy that they had proved the frog could hear and could respond to the human voice. One of the researchers  decided they should amputate the frogs hind legs. After carefully surgically removing the frog’s legs and rehabilitating the poor frog, the researchers stood in front of the frog and yelled, “Jump!” When the frog did not respond, they all heartily nodded in agreement that the frog’s hearing was severely impaired by the removal of his hind legs.

There is little doubt that sleep problems affect brain development. Past studies have demonstrated that preschoolers with a sleep disorder are twice as prone to substance abuse by early adolescence and more likely to suffer from anxiety in their 20s. Even the American Academy of Pediatrics concurs that sleep problems are not benign.

However, before we undertake invasive, painful surgery as an option, far more research should be performed to absolutely indicate a direct correlation. One currently does not exist and other options should be explored. playing241

It has become obvious that adequate, restful, uninterrupted sleep is essential to our personal well being. Abnormal sleep patterns may result in behaviors that can be easily confused with ADHD.

If your child has a sleep problem, taking them to a sleep specialist may help. Getting adequate exercise, providing a consistent sleep routine/schedule, reducing stress,  and eating a proper diet may also assist in getting better sleep and better behavior. 

  • Chervin RD, Arcbold KH, Dillon JE, et al. Inattention, hyperactivity and symptoms of sleep disordered breathing. Pediatrics. 2002;109:449-456
  • Chervin RD, Dillon JE, Bassett C, et al. Symptoms of sleep disorders, inattention and hyperactivity in children. Sleep. 1997;20:1185-1192
  • Chervin, RD, Rusicka DL, Giordani BJ, et al. Sleep disordered breathing, behavior and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769-e778
  • Cortese S, Konofal E, Lecendreux M, et al. Restless leg syndrome and attention deficit/hyperactivity disorder: a review of the literature. Sleep. 2005;28:1007-1013
  • Cortese S, Konofal E, Yateman N,et al. Sleep and alertness in children with attention deficit hyperactivity disorder: a systematic review of the literature. Sleep. 2006;29:504-511
  • Harnish MJ, Boyer S, Kukas L, Bowles AM, et al. The relationship between sleep disorders and attention deficit hyperactivity disorder (ADHD): objective findings. Sleep. 2001;24:A14.
  • Owens JA. The ADHD and sleep conundrum: a review. Journal of Developmental and Behavioral Pediatrics. 2005;26:312-322.

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    Omega 3 Fatty Acids (Fish Oils) and ADHD

    Posted by on August 14th, 2009 | Comments off

    While the topic of nutrition & ADHD is contentious, omega 3s have gained ground in the relief of ADHD symptoms.  

    Respectable studies from Goteborg University in Sweden, University of South Australia, and Oxford University in the United Kingdom have shown that omega 3 fatty acids have reduced symptoms by as much as 50%. A more recent Norwegian study produced similar results. 

    In the study performed at the University of South Australia, children were divided randomly into three groups for the first 15 weeks of the study. One group was given a fish oil & primrose oil combination; the second took the same combination plus a multivitamin/mineral supplement, and the third group took a placebo. During the second 15 weeks, the kids on the placebo were given the fish oil & primrose oil combination plus the multivitamin/mineral as well.

    While the studies received little press, the results were quite good for the two 30-week fish-oil groups. They demonstrated 40%- 50% improvement in behavior while the 15-week group showed a 30% – 40% percent improvement.  

    Ritalin and Concerta are the drugs most often prescribed for ADHD. The results actually were far better for fish oil when compared with results of studies of Ritalin and Concerta. Fish oils were more effective.

    Let me make it clear that fish oil will not cure ADHD. Could it possibly mitigate symptoms for you? Possibly. According to Dr. Andrew Weil  “Levels of omega-3s in the plasma and red blood cells of children with ADHD are lower than in kids who don’t have the disorder.”

    As attention issues are only the tip of the ADHD iceberg, it’s not a good idea to use fish oils as your only intervention. I strongly recommend using Play Attention; a cognitive program to improve attention, memory, visual tracking, time on-task, motor skills, and discriminatory processing.

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    Pediatricians on ADHD Drug Heart Risk

    Posted by on December 4th, 2008 | Comments off

    The American Academy of Pediatrics has issued a new policy contradicting the American Heart Association’s: stance that children prescribed stimulant medication Schedule II drugs should get a heart screening or EKG prior to taking the drugs. The American Heart Association (AHA) cited the fact that approximately 2.5 million children taking these drugs are at risk of elevated blood pressure and increased heart rate.

    The FDA recently insisted that a warning be placed on the medication’s labels indicating risks for sudden deaths in patients with heart problems. Approximately 20-30 sudden deaths have been reported related to stimulant medication in the US and Canada.

    The longest study on families and their use of medication, the Multi-modal Treatment of ADHD Children (MTA) study also indicated other side-effects including decreased height and weight.

    The American Academy of Pediatricians (AAP) has taken the stance that children taking stimulant medication do not need and ECG or EKG (electrocardiogram) tests because the rate of death is very small in respect of the overall number of children taking the medication. The AAP contends that EKGs are expensive [around $100] and could delay access to effective ADHD treatments which “could have serious implications.” The AAP does advocate careful physical examination, and a review of family history of heart problems including sudden death. It does not, however, advocate routine EKGs.

    According to the Associated Press, policy co-author Dr. James Perrin, a Massachusetts General Hospital pediatrician said the academy’s policy makes clear that there’s no scientific evidence to support “this fairly dramatic practice change.”

    This is a rather disconcerting stance for several reasons. The first reason is that there are no long-term data demonstrating the safety or risks of stimulant medication especially in conjunction with cardiovascular risk. Secondly, according to the AHA, children with heart abnormalities have a higher incidence of ADHD. Third, stimulant medications are known to decrease both height and weight in children.


    It’s also perplexing that the APA advocated cholesterol drug treatment for children as young as 8 years old. Given this history, then it is not out of character for the APA to minimize heart risk.  

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