Adult ADHD and Job Performance

Posted by on June 20th, 2008 | Comments off

As I reported earlier (Do ADHD Adults Really Lose 3 Weeks of Work Each Year?), a study published in the journal Occupational and Environmental Medicine, found that ADHD adults worked 22.1 days less than other workers each year. Furthermore, the study found that they were unable to carry out normal work activities an average of 8.4 days per year, 21.7 days of reduced work quantity and 13.6 days of reduced work quality.

However the study actually begs the question of what is adult ADHD. If you’ve found that it’s difficult to concentrate because you may be hyperactive, have trouble remembering appointments or finishing a project once the challenge is gone, are easily distracted, or avoid tasks that require concentration the World Health Organization (“WHO”) says that you may have adult ADHD! The WHO also thinks that many adults do not know they have the condition.

Who (no pun) hasn’t felt easily distracted or avoids boring tasks? I wonder if the shaky diagnosis of adult ADHD – which by the way, is totally subjective – is being exaggerated so that more people can be ‘treated’ i.e. prescribed medication.

The researchers (World Health Organization (“WHO”) research consortium at Harvard Medical School in Boston Medicine) formed their conclusions by evaluating data from 7,075 adult workers in several countries. The workers ranged in ages from 18 to 44 and were screened for ADHD as part of the World Health Organization World Mental Health Survey Initiative. The researchers surveyed the workers about their performance at work in the last month.

Both the media and the pharmaceutical industries have helped spur the diagnosis of ADHD by clinicians. However it will remain a controversial diagnosis shrouded by concerns about context; we are now required to sit and perform focused and organizational tasks more now than ever before in history. This has changed greatly from work at standard manual labor and assembly lines of the past. Is it natural for us to become distracted at tedious or boring jobs? Do we need medication to improve our work? For whose benefit? Furthermore, an ADHD diagnosis can be symptomatic of personal learning problems or family dysfunction among many other scenarios that comprise the human situation.

Adult ADHD is caught in the midst of a tug-of-war between pharmaceutical marketing, changes in the workplace, and a very loose, subjective diagnosis. Buyer beware.

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Hospital Begins Screening for Heart Conditions in ADHD Children

Posted by on May 2nd, 2008 | Comments off

The American Heart Association’s (AHA) recent recommendation that children be screened for possible heart problems before taking ADHD stimulant medication has spurred great anxiety among parents and professionals. The recommendation was given as a response to a number of deaths due to heart failure associated with ADHD stimulant medication.

In response to the AHA’s recommendation, the Pediatric Cardiology Division at the University of Virginia Children’s Hospital will begin offering electrocardiograms (ECG or EKG) for ADHD children taking stimulant medications for the disorder.

According to Dr. George McDaniel, director of the Pediatric Electrophysiology Program at UVA Children’s Hospital, this exam is important because not all children show obvious signs of a heart condition or abnormality.

The AHA also recommends that ADHD children receive a thorough family history and an EKG by their healthcare providers to screen for problems before they may arise.

Experts at UVA Children’s Hospital say the recommendations are conservative but the information is worth knowing.

Families should be reassured that there is no real urgency for a patient who is not having any difficulties,” said Dr. Paul Matherne, director of the Division of Pediatric Cardiology at UVA Children’s Hospital. “According to the guidelines parents should not stop their child’s medication and can have this screening done by their medical care provider at their next appointment.”

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Women with ADHD affected more?

Posted by on April 12th, 2008 | Comments off

In most clinical settings, boys are treated for ADHD at least 4 to 1 over girls. Boys, it is thought, tend to present symptoms outwardly more than girls resulting in physical behaviors that are easily noticeable (hyperactivity).

In an article reported in the Journal of Clinical Psychiatry, February 2008, author of the University of Utah in Salt Lake City and his colleagues find that the roles are reversed in adults; females seem to be more impacted than men.

“We found that adult women with ADHD frequently have high levels of emotional symptoms as well as the cognitive problems found in ADHD,” Dr. Frederick W. Reimherr told Reuters Health.

Reimherr’s conclusions were drawn from analysis of data from two clinical trials of Strattera. Strattera is a non-stimulant medication for ADHD produced by Eli Lilly, a pharmaceutical giant.

ADHD symptom data were collected ADHD on 515 individuals. Approximately one third of this population were women. Seventy-five percent of the women in this population had a combined-type ADHD as opposed to only 62% of the male population represented in this study.

Women also presented more problems with sleep than did males in the study. Women had higher scores measuring both anxiety and depression than did their male counterparts.

Women presented poor temper control, mood volatility, and emotional over-reactivity than did their male counterparts (37 % in women as opposed to 29 % of males).

In an interview with Reuter’s Health correspondents, Reimherr cites that, “these symptoms – depression, temper control problems, feelings of tension, and over-reacting to life stresses – might cause a doctor to miss the diagnosis of ADHD … We feel that this will lead to problems in treatment for such women.”

Such studies are limited to the initial data collected by the original researchers at Lilly. Therefore, one is not able to draw positive conclusions regarding the origins of the differences cited by Reimherr. For example, do hormones, age differences, economic statuses, education, or marital statuses, affect the data? We cannot know due to the limitations of the data in this study.

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States sue over costly ADHD drug program

Posted by on January 29th, 2008 | Comments off

Florida undecided as states sue over costly drug program

By M.C. MOEWE, staff Writer

They’re powerful psychotic drugs, used to treat conditions like schizophrenia. No one knows what their effects are on children, especially infants, yet within seven years the number of children prescribed the drugs in Florida’s health insurance program for the poor has nearly doubled.

There’s no doubting one side effect, though — drug companies watched sales soar, aided by a Florida program they helped create.

Florida is far from unique. Several states also noted the costly boom of atypical antipsychotics — a new class of the drug that was touted to have fewer side effects. The states are suing drug makers, alleging the companies pushed newer, untested drugs that proved no more effective in treatments — but were far more costly.

In Florida, the taxpayers’ bill for the drugs jumped from $9 million seven years ago to nearly $30 million in 2006. Whether Florida will join states like Texas, Pennsylvania and South Carolina in trying to recoup some of those costs is unclear.

“Our office is aware of concerns with antipsychotics in Florida’s Medicaid program but we cannot acknowledge nor provide any information pertaining to ongoing criminal investigations,” said Sandi Copes, a spokeswoman with the Florida Attorney General’s office.

Florida Medicaid records show the number of children — some just months old — who were prescribed the drugs went from 9,364 seven years ago to 18,137 in 2006. No records for privately insured patients are available.

“The situation is out of control,” said David Cohen, a professor at Florida International University who has been studying the use of antipsychotics since 1983. While no long-term studies have been done on the effects the drugs have on children, there is evidence children on the drugs face greater risks of diabetes, hyperglycemia and extreme weight gain, Cohen said.

‘MOOD STABILIZERS’

Orange City child psychiatrist Manuel Mota-Castillo said age shouldn’t be a factor in determining whether the drug is needed. He has prescribed antipsychotics to children frequently, with the youngest being a 25-month-old child.

“I don’t want to use the name ‘antipsychotic.’ I use ‘mood stabilizer,’ ” said Mota-Castillo, who also worked for three years at Act Corp., the area’s main mental health facility.

The 25-month-old child had been kicked out of five day-care centers where complaints included punching other children, he said. “The child’s mother came to me in shorts so I could see the bruises and marks (on her),” he said.

Crystal Lamson of Sanford said Mota-Castillo has been treating her bipolar son for more than two years. Ryland, now 7, broke a Plexiglas window at a day-care center when he was 5.

“I get criticized all the time from family members,” Lamson said. “(But) there are some children out there who do need them.”

Another Sanford parent, Richard Davis, said he watched in horror as his daughter Ciara, then 6, gained 40 pounds, developed breasts and had uncontrollable tongue and facial movements.

“Those drugs were killing her,” Davis said.

Over his objections, he said Ciara was given antipsychotics by her mother and while in foster care. A court-appointed guardian also noted the effects in an August 2003 report, describing a visit in which Ciara “never once kept her tongue in her mouth.”

Ciara, now 11, was taken off the drugs after about a year, her father said, and she quickly dropped the added weight.

‘TAINTED’ MONEY

In Florida, even as drug makers were being told to issue warnings about risks, a Florida Legislature-directed program partly funded by pharmaceutical companies was recommending the drugs as treatment for attention deficit hyperactivity disorder (ADHD) with tics or intermittent explosive disorder, according to the program’s Web site that has since been shut down.

According to a study that looked at three years of data, about 40 percent of the antipsychotics prescribed to Florida Medicaid children were given to children diagnosed with ADHD — a use not approved by the Food and Drug Administration.

The Florida program was patterned after a Texas project that has spurred a whistle-blower lawsuit. The Florida Algorithm Project used some of the Texas-developed medical formulas that recommended drug treatments for mental diseases.

A year ago Texas joined the whistle-blower suit against Janssen Pharmaceutica and several other Johnson & Johnson subsidiaries. The suit alleges the program’s treatment guidelines — “improperly influenced” and paid for by the drug companies –increased sales of the antipsychotic Risperdal.

An official with Janssen said the company will defend its actions.

“We believe our participation in all aspects of our Texas Risperdal activities were in accordance with what the law required,” said Ambre Morley, a company spokeswoman.

Florida pilot programs using the Texas-developed guidelines began in 2001, according to state documents. Act Corp. in Volusia County was one of 15 sites that adopted the program until it was discontinued in September 2004.

James Bax, a former director of the Florida program, said the project began with funding from pharmaceutical companies.

“It did not take me long to realize that the money from the drug companies was tainted,” Bax said. “Once I got into it, I saw what I thought was very insidious.”

According to the program’s defunct Web site, Bax was director only a couple of months before a retired Johnson & Johnson employee took the title.

In 2002, the Florida Legislature permitted the Department of Children & Families to accept grants from pharmaceutical manufacturers to develop training for health care organizations serving public sector clients, according to a September 2003 Agency for Health Care letter about the Florida program.

When first interviewed, those familiar with the program said they did not recall any ADHD-related information. But archived pages from the program’s Internet site show the program had more guidelines on how to treat ADHD than any other ailment. A 2004 report about the program’s progress pointed to the development of an ADHD guideline as an accomplishment.

Rajive Tandon, chief psychiatrist for the Mental Health Program Office with Florida’s Department of Children & Families, said he’s not sure how much impact the Florida program had on the increased use of antipsychotics.

“It certainly was a contributing factor,” he said.

Doctors believed the new antipsychotics were better, Tandon said, citing “aggressive marketing.”

But the new antipsychotics proved no more effective than older drugs in two significant studies — one published in 2005 in the New England Journal of Medicine and another in the Journal of the American Medical Association published in 2003, said Cohen, the antipsychotics expert at Florida International.

Tandon said Florida should consider a lawsuit like other states.

“Should we at least look into it? Absolutely,” he said, calling for, at minimum, an investigation into the Florida program’s funding and impacts. “Then basically hold the appropriate people responsible.”

– News researcher Janice Cahill contributed to this report.

More Drugs

Atypical antipsychotics were touted to have fewer side effects than older antipsychotics, and their use increased among children in Florida’s Medicaid program under guidelines that drug companies helped create between 2000 and 2006.

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ADHD Medications: Mayo Clinic Study Contradicts MTA Study

Posted by on January 29th, 2008 | Comments off

As I wrote earlier, the longest study actually performed while following live children was the MTA and its 3-Year Follow-up of the NIMH MTA (multi-modal treatment) recently published in the journal of the American Academy of Child and Adolescent Psychiatry.

Co-author, Professor William Pelham, of the University at Buffalo, says: “The children had a substantial decrease in their rate of growth so they weren’t growing as much as other kids both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects – none.”

Pelham adds, “In the short run [medication] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Here’s the most telling observation of the study: “I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run.”

It’s obvious that this information was not good for the pharmaceutical industry. As is now common practice, a study will be launched to counter this kind of negative press. So, it was no surprise that the respected Mayo Clinic released a study two months later that “…reveals that compared to children without AD/HD, children with ADHD are at risk for poor long-term school outcomes such as low achievement in reading, absenteeism, repeating a grade, and dropping out of school. Both studies appear in the current edition of the Journal of Development & Behavioral Pediatrics, (http://www.jrnldbp.com).”

“In this study, treatment with stimulant medication during childhood was associated with more favorable long-term school outcomes,” explains William Barbaresi, M.D., Mayo Clinic pediatrician and lead author of the reports.

The MTA study focused on real families in real-time. The researchers were able to observe family dynamics, environment, pharmacological interventions and their relationships to academic and behavioral outcomes. This, of course, takes a significant amount of time and field researchers.

According to the Mayo Clinic Press Release, “The two Mayo Clinic studies are the first population-based, long-term studies to investigate links between ADHD, school performance and factors that modify long-term school performance of children with ADHD.”

Here’s how research like this works: researchers are given access to school files and medical records. They select and review data from files to draw their conclusions. This is becoming more popular than live research because it is less expensive, doesn’t require a significant number of field researchers, and can be done in less time. Unlike real-time research like the MTA, the Mayo study’s limitations are significant; it doesn’t allow real-time access to families or teachers to gain information regarding environment, family issues, etc; to interpret information; or to clarify written information. So the researchers are fairly limited to test scores and medical records. While this makes it easy to prepare and select data, it falls far short the information gather by a real-time study.

The Mayo study press release summarizes the research:

Dr. Barbaresi believes that both studies provide the first solid evidence of the long-term negative academic performance associated with untreated ADHD – as well as evidence for the best way to manage this problem. Dr. Barbaresi says, “The finding that treatment with stimulant medications is associated with long-term improvement in school outcomes is significant. Previously, there was evidence that treatment with stimulant medications improved short-term academic performance, but there was no good evidence that long-term outcomes are better with stimulant treatment. Our data can guide clinicians in their efforts to help children with ADHD succeed in school.”

Note that no mention is made of height and weight loss of children in the Mayo Clinic study as was found by the MTA. Furthermore it also directly contradicts information released by the MTA. Here’s the rub, funding for the Mayo study was contributed by grants from the U.S. Public Health Service; National Institutes of Health; Mayo Clinic Foundation for Biomedical Research; and McNeil Consumer and Specialty Pharmaceuticals.

Obviously the one extraordinary contributor was McNeil Consumer and Specialty Pharmaceuticals. McNeil is the producer of Concerta, a stimulant medication for ADHD. Is it likely that McNeil would contribute to a study that would indicate weight loss and stunted growth from use of its product? Not likely.

Would McNeil contribute to a study whose researchers said, “I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run.” Not likely.

It is a direct conflict of interest for a pharmaceutical company to participate in research with universities, hospitals, or other entities. I’ve never seen negative information released from a study performed by a pharmaceutical company on their own drug. Strange, isn’t it?

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ADHD Medications and Neurofeedback

Posted by on December 17th, 2007 | Comments off

The Multimodal Treatment Study of Children With ADHD has been one of the longest studies performed on a select group of ADHD children. Recently published in the journal of the American Academy of Child and Adolescent Psychiatry, the data are somewhat alarming.

Data from the study were used to evaluate whether stimulant medication effects physical growth in children. The data collected over three years indicates that both height and weight are decreased in children using stimulant medication.

Co-author, Professor William Pelham, of the University at Buffalo, says: “The children had a substantial decrease in their rate of growth so they weren’t growing as much as other kids both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects – none.”

Pelham adds, “In the short run [medication] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Here’s the most telling observation of the study: “I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run.”

Our good professor, Dr. Russell Barkley just spoke at a national conference citing that medication is by far the best and most trusted method. Unfortunately dinosaurs like Barkley do exist, are respected, and yet completely propagate information that has no substance in current research. Barkley is also a critic of neurofeedback.

On another front –

ADHD Drugs To Be Examined

“Two federal agencies will collaborate in the broadest study ever of prescription drugs for the treatment of attention deficit hyperactivity disorder (ADHD) and the potential for cardiovascular problems.

Over the next two years, the Agency for Healthcare Research and Quality and the Food and Drug Administration (FDA) will examine clinical data of some 500,000 adults and children who have taken such medications to determine whether they increase the risk of heart attack or stroke, the U.S. Department of Health and Human Services announced.

The FDA’s Gerald Del Pan, MD, said case reports describe “adverse cardiovascular events in adults and pediatric patients with certain underlying risk factors who receive drug treatment for ADHD, but it is unknown whether … these events are causally related to treatment.”

The study of all ADHD drugs by class will be coordinated by Vanderbilt University, with analysis by its researchers, Kaiser Permanente of California, the HMO Research Network and i3 Drug Safety, plus the FDA and AHRQ, the government said.”

Curiously, this study has already been done with results published by the University of Oregon. I’ve published the results of this study before, but it was not at all favorable for ADHD drugs. Real data on long term effects, safety, comparative analysis, and general efficacy are lacking. Let’s hope the new study treats the subject with the objectivity and professionalism of the University of Oregon.

As I’ve said in past entries, I’m not a proponent of clinical neurofeedback, and I find there are limitations to some of its research, much of the research, especially research performed over the last few years, demonstrates the possibility that the brain can and will make changes provided it is given the right stimulation. Unfortunately, clinical neurofeedback training doesn’t address other core issues like organization, memory, discriminatory processing, auditory processing, time on-task, and other cognitive skills. That’s exactly why I created Play Attention. It addresses far more than clinical neurofeedback.

Probably most importantly, neither neurofeedback or Play Attention cause any stunted growth, weight loss, tics, or any side effects like medication. From our follow-up with our clients over the last eleven years, positive training effects last as well. Far unlike medication which “In the short run will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

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Study finds divorce increases Ritalin use in children

Posted by on August 14th, 2007 | Comments off

ADHD does not seem to be a condition like pregnancy where one is either pregnant or one is not. Rather it is a matter of degree. Some children and adults range from mildly inattentive to profoundly inattentive. The degree seems to be directly affected by a variety of environmental factors including divorce, parenting skills, etc. More frequently than not, drugs are prescribed to allay the symptoms. Obviously, they do not affect core issues that affect the child like divorce, marital discord, or learning disabilities.

Study finds divorce increases Ritalin use in children

HELEN BRANSWELL
Canadian Press
June 4, 2007 at 8:46 PM EDT

TORONTO — Children whose parents divorce are nearly twice as likely to be prescribed Ritalin in the aftermath of the split, a Canadian study reports.

But the author, a sociologist from the University of Alberta, cautioned against concluding that children of divorce are over-prescribed the drug, which is used to treat Attention Deficit and Hyperactivity Disorder, or ADHD.

Lisa Strohschein said the data she used can only identify the phenomenon and cannot reveal why Ritalin use rates are double when children of divorced parents are compared to children whose parents stay married.

“I’ve got the what, but not the why,” Ms. Strohschein said from Edmonton.

Ms. Strohschein suggests there may be a variety of answers. Some kids may need the drug to cope with the stress of the split, some kids may have ADHD and some kids may be getting a drug they don’t really need.

“The problem is I can’t be clear about it,” she said.

“I mean, I would love to be able to say ‘Yes, it’s divorce. That’s the problem,’ But it’s not necessarily so. It could just be our perceptions about divorce — and that’s the thing that makes me really cautious here.”

“(But) I don’t want to come out on the other side, either and say ‘Ritalin is bad’ because I think it clearly does help some kids.”

The psychiatrist-in-chief of the Hospital for Sick Children in Toronto said the study should serve as a reminder to doctors to move cautiously when prescribing Ritalin or other methylphenidate-based drugs to children in these circumstances.

“What we need is a deeper understanding of this issue, at the level of the primary care practitioners,” said Dr. Abel Ickowicz.

“Because . . . if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing.”

The study, published in the Canadian Medical Association Journal, used data gathered by Statistics Canada through its National Longitudinal Survey of Children and Youth. The survey, which was first conducted in 1994, is completed every two years; Ms. Strohschein used data collected between 1994 and 2000.

Previous researchers had identified the fact that children who live in a household with only one parent or with a parent-step-parent combination were more likely to be on Ritalin than children growing up in households with both parents.

But it wasn’t clear whether the increased use was among all children in a single-parent household — in other words, children whose parents had divorced, children who had lost a parent to death and children born to a single mother — or whether some subset of these children was more heavily prescribed the drug.

Ms. Strohschein compared prescription rates among 4,151 children whose parents hadn’t divorced and 633 children who had. She found that 3.3 per cent of children in the two-parent families were prescribed Ritalin; among the children whose parents had divorced, that figure rose to 6.1 per cent.

The study notes a number of potential explanations for the doubling of the usage rate.

One possibility is that the stress of the divorce aggravated a child’s existing behavioural problems to the point where Ritalin would actually be helpful, she hypothesized.

It is known that ADHD can run in families. In addition to passing on the condition to their children, parents with ADHD-type behaviour might be more likely to divorce — a theory that points towards appropriate use of the drug.

Another possibility is that in divorce, the natural emotions children experience — anxiety, sadness, anger — may manifest themselves in behaviour that is mislabeled as ADHD-like, or that parents and doctors may be anticipating problematic behaviour because of the stress of divorce. The study suggested this type of rationale would reflect inappropriate use.

Dr. Anton Miller, a developmental pediatrician and child health researcher at the University of British Columbia’s Centre for Community Child Health Research, said it’s possible no single answer applies across the board for these children.

“None of them is an outlandish kind of suggestion. They probably all have some validity,” he said.

“It’s certainly possible in some instances that ADHD might have been prematurely diagnosed…. But I would caution anybody (against) saying ‘Well that’s why all these children are getting medication.’ “

“But there is a possibility that in a proportion of the cases we need to try and figure out how much that does happen in the real world and try and advocate … for children to have thorough and really in-depth assessments for these kinds of behaviour and emotional problems.”

Ms. Strohschein agreed: “I think the take-home message is just to be careful not to make that broad assumption that kids must necessarily be doing poorly when their parents divorce. Some kids will do better, some kids will do worse.”

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Questioning the growing popularity of drug treatments

Posted by on June 24th, 2007 | Comments off

The Tide of Medicine Is Rising

A great read is LIDIA WASOWICZ’s Suffer the Child: How the Healthcare System Is Failing Our Future, published by Capital Books.

Wasowicz questions the growing popularity of drug treatments as an almost reflexive action by healthcare providers. She indicates that current research shows a steady rise in the use of prescription drugs by children and adolescents, particularly among girls.

Wasowicz says in a recent article for United Press International, that “Numerous studies document the favoritism shown pharmaceuticals over non-chemical solutions. In many instances, medicines are the optimal option, but some worry parents, patients and practitioners are over-relying on drugs in certain cases at the cost of safer, less expensive and more effective alternatives.”

Some amazing statistics she provides:

177.9 “doctor visits with at least one drug” per 100 population, meaning for every infant, toddler and adolescent, there were nearly two meetings with a physician during which a pharmaceutical – prescription or not – was ordered, continued, administered or otherwise provided.

While many of these medications are beneficial like penicillins, antiasthmatics bronchodilators, antihistamines, etc, Wasowicz sites “…market analysts have noted a seismic shift is in an “unparalleled” jump in the number of adolescent girls using prescription drugs to treat diabetes, sleep disturbances and such psychological problems as ADHD.”

This is quite a good read and should accompany Dr. Lawrence H. Diller’s book, The Last Normal Child: Essays on the Intersection of Kids, Culture, and Psychiatric Drugs. Both are balanced and based on fact rather than emotional pharmaceutical smashing.

A different vantage point can be viewed in a study published in the May 2007 issue of the Journal of Attention Disorders. The authors of that study contend that ADHD has been traditionally viewed as a childhood disorder while ADHD in adults has been underdiagnosed and undertreated.

The study shows that treatment rates have been increasing in all age groups; however female patients show the greatest increase of all. The study also concluded that there exists a rapid growth of ADHD medication use in all demographic groups except seniors, with some groups showing markedly faster rates than others.

“Between 2000 and 2005, treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Interestingly, researchers found that methylphenidate and dextroamphetamine [Speed] use declined for both children and adults, the use of amphetamine mixtures increased for adults, atomoxetine [Strattera®]use grew rapidly across both groups, use of extended-release products increased in children more dramatically than adults, and generic ADHD medication use declined significantly in pediatric patients while remaining relatively stable in adults.”

They should thank good marketing for the shift.

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Overhead camera to detect mental illness

Posted by on June 23rd, 2007 | Comments off

I often think that research like this could only be done in the US where such idiocy is both respected and revered. However, University of California San Diego psychiatrist, William Perry believes that using overhead cameras and motion sensors to record the movements of a person may help him detect ADHD, schizophrenia, and other neurological disorders.

His research seems to be inspired by behavioral pattern monitoring (BPM). BPM is often used on laboratory animals to monitor their movements while exploring a maze or box. In the past, BPM has been used to determine the effects of drugs or other neurological intervention on the lab animal.

Since humans seem to be more complex than lab animals, Perry proposes the additional use of a sensor lined shirt to record motion. The shirt records their movements while the overhead camera records their position in the room that contains 10 objects of interest, and a desk, but no chair. Early tests have already uncovered differences in the way patients with these conditions explore an unfamiliar room.

‘Once they are kitted out in the shirt, we say ‘can you wait in this room for 15 minutes while we set up the equipment?’’ said Perry.

Here’s some true insight: Perry has experimented on about 100 subjects so far and has observed that people with ADHD move around the room more actively than ADHD people.

No kidding. We needed a study for that information.

While Perry admits it’s premature to correlate connections between mental states and movement patterns, he says, “We are building up a kind of physiological grammar, based on the sequence of different actions. That’s very useful because it is completely separate from the face-to-face impressions that can make observational study difficult.”

What could this nonsense be use for? Military assessment of a dictator’s mental state? Airport security? I’m usually so agitated at the current state of our airline industry, I’m certain I’d present as a lunatic. My wife would likely agree. How about Identifying mentally ill homeless persons on the street?

Honestly, trying to anticipate the mental state of anyone by studying their physical actions borders on the ridiculous given the vast spectrum exhibited by humans under different circumstances. BPM may work on lab animals, but in the field, it’s likely worthless. Big Brother is watching.

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ADHD and Genetics

Posted by on June 23rd, 2007 | Comments off

Research shows a gene link to ADHD

The head of child psychiatry at the Royal Children’s Hospital (University of Melbourne, Australia), Professor Alasdair Vance, thinks that children with ADHD have impaired brain function most likely linked to a genetic condition occurring during pregnancy.

Dr. Vance believes he has conclusive evidence that key areas of the brain do not develop as quickly in children with ADHD. These areas, he posits, are linked to a child’s understanding of time and space as well as the ability to use working memory.

“So their ability to read other people’s body language, to pick up on the nuances of what their peer group are up to, would clearly be affected by the sort of developmental delays in brain development that we’ve identified,” he said.

“The most exciting part of this research is the opportunity to understand in detail the brain dysfunction in this group of children so we can better understand how, by changing the child’s environment, facilitated by medication treatments, we can maximize their learning.”

Vance used fMRI on an unmedicated group of boys aged eight to 12 who were diagnosed with ADHD. The fMRI enabled Vance to examine their brains while performing mental tasks. This data was compared to a group of healthy children. Vance said the data demonstrated that ADHD was not just a behavioral issue.

“If it was, one would expect the child’s brain would be functioning normally and that at some level they are making choices to behave in this way. This suggests they are actually activating their brain differently when they are doing the same task as a healthy kid.”

In an interview with the Brisbane Times, Vance, “…believes the research strongly suggests ADHD is a genetic condition occurring most probably during the second trimester of a woman’s pregnancy, but which can be modified through medication and by adapting the child’s environment.”

“I’m not saying that because you have such brain changes the only treatment is medication. Environmental cueing can help those compensatory brain networks to develop.”

“Helping teachers and parents understand how to more frequently cue a child with ADHD through such means as positive reinforcement when the child exhibits desired behavior and through emotional connections that reward the child for better attitudes, are just some of the ways in which the condition can be helped, Professor Vance says.”

“The number and quality of empathic, confiding, nurturing, flexible and adaptive human relationships can build resilience, build compensation or, if absent, make ADHD symptoms worse,” he said.

Vance’s results are preliminary. Furthermore, one cannot forget that ADHD is diagnosed from subjective analysis; it is one of the few diagnoses that can be made over the telephone since it involves acknowledging a series of characteristics or behaviors performed over time. So, we have a problem of antecedence; Vance examined boys that were subjectively diagnosed with ADHD to compare them with boys that were not diagnosed. Does the subjective diagnosis present a problem in this research? I would think so. Could it also be possible that the brain changes in the fMRI could occur as a result of conditioning, environmental toxins, etc? Possibly. Is it equally possible that Vance’s data only accounts for one possible cause out of many? Likely. That’s why I would contend the results are preliminary. We’ll see if the future proves me wrong on this one.

On a positive note Vance does seem to understand neuroplasticity. He does see value in behavioral shaping, compensatory training, etc. While his research is NOT the Holy Grail of ADHD, there is light at the end of the tunnel if we are forging ahead in our understanding of neuroplasticity from research like this.

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