Weight Loss and ADHD Medications (part 2 of 2)

Posted by on April 19th, 2013 | No Comments

Reporting by the University of Maryland Center for Substance Abuse Research (CESAR) and Global Market For ADHD Medications (healthaffairs.org)

A history of appetite suppressants

The previous submission noted that Adderall, a drug frequently used to control ADHD symptoms, was a spin off of Obetrol used for weight loss in the 1950s and 1960s.

Ritalin was tested on humans in 1954. According to the University of Maryland Center for Substance Abuse Research (CESAR), “… In 1957, Ciba Pharmaceutical Company began marketing MPH as Ritalin to treat chronic fatigue, depression, psychosis associated with depression, narcolepsy, and to offset the sedating effects of other medications.

It was used into the 1960s to try to counteract the symptoms of barbiturate overdose… Research on the therapeutic value of Ritalin began in the 1950s, and by the 1960s, interest focused on the treatment of “hyperkinetic syndrome,” which would eventually be called Attention Deficit Hyperactivity Disorder.”

Lower doses of stimulant medication do seem to temporarily improve focus and reduce hyperkinetic behaviors. One must realize that their original use was not for ADHD, but for weight reduction and as drugs that could counter chronic fatigue. They are also Schedule II substances in the same class as cocaine. Thus, weight loss as a side-effect should be expected and dealt with appropriately after consulting your healthcare provider.

The US is estimated to consume the vast majority of these medications. According to the Global Market For ADHD Medications (healthaffairs.org), “In 1993, thirty-one countries had adopted the use of ADHD medications; by 2003, the number had grown to fifty-five. Our analysis aggregated data from individual countries from the year of adoption into a global sum. Because the United States is the single largest market, we also show its use, which constitutes 83–90 percent of total market share (by volume).”

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Weight Loss and ADHD Medications (part 1 of 2)

Posted by on April 18th, 2013 | No Comments
Reported by: www.webmd.com
Knowing the history may make you lose your appetiteWhen you hear, “Mom, I’m not very hungry,” do you wonder why?

Stimulant medications are frequently prescribed for the control of ADHD symptoms. According to WebMD, weight loss is a common side-effect for most stimulant medications.

If you understand the history of stimulant medications, you’ll
understand how they are associated with weight loss. If we begin with Adderall, we can trace it back to it’s origins in Brooklyn, NY in the 1950s. It was known then as Obertrol and was manufactured by Obetrol Pharmaceuticals which later became a division of Rexar Pharmacal Corp.

Obetrol [perhaps a conjugation of 'obesity control'] was used as a stimulant based diet pill to control obesity. It was popular during the 1950s and 1960s. It contained amphetamine and methamphetamine salts.

Shire Pharmaceuticals later acquired Rexar and the name was changed to Adderall when Obetrol’s use for dieting was waning and studies indicated it might be useful for controlling hyperactivity. The formulafor Obetrol has been reformulated at least once since being labeled Adderall.

While it was popular to use amphetamines (especially methamphetamine) for weight loss into the 1970s, by the 1980s, the medical community was alerted to addiction problems and began to dissuade use of these drugs for obesity control.

How did these drugs transform into ADHD medications? That’s in part 2. Stay tuned!

 

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Should Doctors Prescribe ADHD Drugs as Neuro-enahncements?

Posted by on March 21st, 2013 | No Comments

Paper released by:
William D. Graf, M.D., of Yale University in New Haven, Conn.
Full text: http://www.neurology.org/content/early/2013/03/13/WNL.0b013e318289703b.full.pdf+html
Pediatric neuroenhancement
www.neurology.org

A statement paper advises against

Parents want the best for their children. Since ADHD stimulant meds tend to improve memory and attention in all users, some parents think giving them to a healthy child will enhance the child’s performance. Give them an edge so to speak.

William D. Graf, M.D., of Yale University in New Haven, Conn., and colleagues, on behalf of the American Academy of Neurology, Child Neurology Society, and American Neurological Association, released a position paper on the implications of ADHD drug use for enhancement. They argue that the ethical, legal, and neurodevelopmental implications are far to great to prescribe ADHD drugs for neuro-enhancements.

“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication. The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable,” Graf said in a statement. “The physician should talk to the child about the request, as it may reflect other medical, social, or psychological motivations such as anxiety, depression, or insomnia. There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits, and exercise regimens.”

Full text: http://www.neurology.org/content/early/2013/03/13/WNL.0b013e318289703b.full.pdf+html
Pediatric neuroenhancement
www.neurology.org

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Do Young ADHD Kids Benefit from Medicine?

Posted by on February 14th, 2013 | No Comments

The answer may shock you.

A long-term study by the prestigious Johns Hopkins Children’s Center reveals that 90% of children with moderate to severe ADHD continue their symptoms for years even while taking medication.

In fact, the researchers at Johns Hopkins found that ADHD children taking medication had symptoms as severe as ADHD children that did not take medication. The researchers followed the children for six years past their diagnoses.

The children were diagnosed and followed typical treatment patterns. They were then referred to pediatricians for further care. Johns Hopkins researchers determined the ongoing levels of severity through reports from teachers and parents to track issues at school and home.

Specifically, 62 percent of children taking anti-ADHD drugs had clinically significant hyperactivity and impulsivity, compared with only 58 percent of those not taking medicines. And 65 percent of children on medication had clinically significant inattention, compared with 62 percent of their medication-free counterparts.

This indicates that far better cognitive, behavioral, and social interventions need to be employed to get the results we expect. We at Play Attention have been advocating this for nearly 20 years.

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Doctors with Links to Drug Companies Influence Treatment Guidelines

Posted by on February 12th, 2013 | No Comments

Life Extension cites an article by the Milwaukee Journal Sentinel and MedPage Today which reports that doctors with financial ties to drug companies have heavily influenced treatment guidelines recommending the most lucrative drugs in American medicine, an analysis by has found.

This echoes previous findings. For example, in 2007, Dr. Joseph Biederman, Harvard child psychiatrist, was ranked as the second highest producer of high-impact papers in psychiatry overall throughout the world with 235 papers cited a total of 7048 times over the past 10 years as determined by the Institute for Scientific Information, but was disciplined by Harvard University in 2011 after an investigation led by Iowa Republican Senator Charles Grassley found he failed to disclose potential conflicts of interests that could have arisen due to payments from pharmaceutical companies.

It’s intelligent to be informed. Read the full article here:

http://www.lef.org/news/LefDailyNews.htm?NewsID=17649&Section=DISEASE&utm_source=DailyHealthBulletin&utm_medium=email&utm_term=Disease&utm_content=Body+ContinueReading&utm_campaign=DHB_121220

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New Study Finds ADHD Rates on Rise

Posted by on January 25th, 2013 | No Comments

The study, published in Monday’s issue of JAMA Pediatrics, examined health records from California and found that rates of ADHD have jumped by 24% since 2001.

“That is a very significant increase,” says Darios Getahun, a research scientist with the Kaiser Permanente Southern California Medical Group who conducted the study.

Many experts theorize that the rise in diagnoses can possibly be attributed by growing awareness of the condition. If one were cynical, one could also point out the increased rate of marketing for ADHD medications. Let’s not be blind; ADHD is a multi-billion dollar business to the pharmaceutical industry.

Kaiser Permanente reviewed the health records of more than 840,000 children, ages 5-11, and also found that boys were three times more likely to be diagnosed than girls. The cynic might say that boys are more boisterous than girls. They display greater signs of hyperactivity.

“I don’t agree with the language about ‘epidemic’ proportions [in the study] and ‘dramatic’ increases,” says Paul Hammerness, an ADHD expert at Harvard Medical School and Massachusetts General Hospital. “It is my impression that absolute rates are fairly stable over time, from country to country as well.”

One must always question whether we are allowing children to be children or trying to mold them through medication.

Suggested reading: The Last Normal Child: Essays on the Intersection of Kids, Culture, and Psychiatric Drugs (Childhood in America) [Lawrence H. Diller M.D.] on Amazon.com.

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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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Creativity and ADHD

Posted by on March 3rd, 2011 | Comments off

For many years, pundits have declared that although ADHD causes many hardships, it does have a side benefit: creativity.

Previous research has suggested that adults with ADHD may be more creative than adults without ADHD (White & Shah, 2006).

A current study by professors Holly White (University of Memphis, TN) and Priti Shah (University of Michigan, MI) replicated these previous findings. The study was published in the Journal of Personality and Individual Differences (January 2011).

To the skeptic, “creativity” is a nebulous term. Like art, what is creative to one person is not creative to another. Thus, standardized tests were developed that focus on qualitative and quantitative areas of creativity called “divergent” and “convergent” thinking. Divergent thinking is the brain’s ability to produce out of the box, spontaneous, and frequently, original ideas or solutions. Convergent thinking, as the name implies, is the antithesis of divergent thinking. Convergent thinking is the brain’s ability to dispense with non-essential data, move to the heart of the problem and quickly parse options to find one correct solution. Convergent thinking is the type of skill needed for most standardized testing. It would not be helpful if you were a marketing specialist thinking of new ideas for your client.

White and Shah recruited  30 university students with ADHD and 30 without. They used a standardized measure of creativity called the Abbreviated Torrance Test for Adults (Goff & Torrance, 2002). In addition to the Abbreviated Torrance Test, the students completed the Creative Achievement Questionnaire (“CAQ”). This questionnaire asks highly specific questions about achievements in 10 creative domains among which include science, drama, writing, and humor, etc. The questions in the CAQ are designed to remove or limit subjective responses. For example, a question on the CAQ: Whether the subject’s “work has won a prize at a juried art show.” Thus, the answer reveals information from a more objective outside source.

Doctors White and Shah also wished to investigate whether these standardized measures actually extrapolated to real-world creative achievement among adults with ADHD. This would answer whether ADHD really does have side benefit.

When the researchers examined the data from all 10 domains combined, they found that the students with ADHD had significantly higher scores than those without the diagnosis. According to White, a distinctive pattern also emerged: ADHD subjects were more likely to excel at certain creative domains than at others — especially the performing arts. While the data were not statistically significant, a clear trend could be seen: domains where inhibition is not necessary seem to be the areas where these students excel, especially theater and drama. This makes sense because scientists have known that inhibitory control is lacking in most ADHD individuals. They are chastised for speaking out of turn at the office or school. They have difficulty controlling impulsive behaviors. It would make sense that they would thrive in an environment that necessitates they behave without inhibition.

Interestingly, White noted that she could find no significant differences between ADHD students on medication and ADHD students who were not. She had no answers for this riddle.

“ADHD,” she says, “tends to just increase the amount of collisions between all of your ideas, so at any given time, you have more potential processes being activated and you’re less likely to rule out any options. It’s hard to know where this operates—like someone coming up with an idea and saying, ‘No, that’s not a good idea,’ and not even writing it down, versus, they don’t even think about it because they’re inhibiting it. But the key seems to be the inhibitory control—the same thing that allows somebody to not be distracted—which possibly could put a mental wall between what is right in front of them and other possibilities.”

There are limitations to a study like this. White and Shah specifically worked with students who had achieved or accomplished all requirements necessary to be admitted to university. Therefore, the trends she sees pertain specifically to them. ADHD students who flunked out of school, were incarcerated, etc. which prevented them from attending university were not included. That would make an interesting study because we’d know what affect family support, direction, and education play in success and creativity.

So, the bottom line here is: yes ADHD students can be more creative, but the research points only to a limited group of students. Is this an upside? For some yes. For others, we just don’t know yet.

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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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