Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

 Is there a relationship between medication use and a LOWER risk of accidents? 

Yes. 

Short term? Yes.

Long-term? Yes.

Men? Yes.

Women? Yes. 

Please take your medicines. 

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Question

Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings

In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning

Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

ADHD & Accidents Crashes Violations Suspensions in Motor Vehicles - New Data

 Do teens with ADHD have more accidents? More Moving Violations?

Yes. For Years,

Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD

Allison E. Curry, PhD, MPH,a,b Benjamin E. Yerys, PhD,c,d Kristina B. Metzger, PhD, MPH,a Meghan E. Carey, MS,a and Thomas J. Power, PhDb,d

Abstract

Methods: We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license (N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression.

Objectives: To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD).

Results: Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD.

Conclusions: Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564068/figure/fig2/?report=objectonly

Diagnosing and Treating the Aging ADHD Brain

Inside the Aging ADHD Brain

The latest research on how the ADHD brain changes over time. Plus the differences among normal aging, mild cognitive impairment, early dementia, and some classic attention deficit symptoms, and why it is never too late to be diagnosed and treated for ADHD.

by Linda Roggli, PCC

Great article from ADDitude magazine outlining the diagnosing and treatment of ADHD in the adult brain. Discusses differences between ADHD, MCI, and dementia as well as milestones of aging (including menopause) on the ADHD brain. -JR

After more than 40 years of psychoanalysis,behavioral therapy, and bitter frustration, it was a 2006 TV talk show that finally pointed 63-year-old Zophia in the right direction.

“Everyone told me there was nothing wrong with me,” she said. “But I had such yearning, such anguish inside. I wanted to excel, but something was holding me back.” Zophia flipped on the TV one Saturday morning, and the host launched into a frank confession about her own ADHD. “The more I heard, the more I knew she was talking about me, too,” said Zophia.

She made an appointment with a local psychologist, who ordered a battery of eight one-hour tests. The conclusion was unambiguous: ADHD. “After I found out about ADHD, I thought, ‘Gee, Zophia, why didn’t you come up with that answer a long time ago?’”

For John Washbush, the road to diagnosis took seven decades. “For 70 years, I lived my life day-by-day in the dark, totally clueless,” he said. “I got the same instructions as everyone else, I went through the same motions as everyone else, but rarely did I get the same results.”

In his early 60s, he suspected he had ADHD, but it was still a long road to the official verdict. “I was diagnosed at 70 and took my first dose of Ritalin on my 72nd birthday,” he said. “I knew within 20 minutes that I was on a path to discovering the real me.”

Your Brain on Attention Deficit

Zophia and John are among a growing number of older adults who are being diagnosed with ADHD at 40, 50, 60, and beyond. Clinicians report a steady increase in requests for ADHD testing by bewildered yet determined adults who grew up in the 1940s, 1950s, and 1960s, when ADHD was rarely recognized in children, let alone adults.

There is a lack of hard data on the aging ADHD population. Most researchers are reluctant to add the confounding factor of age (50+) to ADHD studies. A few pioneering studies from around the world indicate that the prevalence of ADHD among older adults (ages 45-85) is probably about 3 percent, slightly lower than the estimated 4.4 percent prevalence among adults up to age 44. The prevalence for children is estimated at 8 to 9 percent.

Like Zophia and John, most older ADHD adults have spent years trying to answer a question: “What’s wrong with me?” Most have been previously diagnosed with other psychological disorders, most frequently depression, anxiety, bipolar disorder, and learning difficulties. ADHD coexists with several other conditions, so the original diagnoses were probably accurate but were incomplete.

FULL ARTICLE HERE:

Children with issues in classroom may have sleep disorder

Children who show ADD or ADHD symptoms in the classroom may be experiencing a sleep disorder.

More parents are waking up to the fact that sleep disorders are more common than most of us think. Now the American Academy of Pediatrics and doctors continue to warn parents that sleep disorders can trick you into thinking you’re dealing with something else all together.

Dr. Akinyemi Ajayi, the Medical Director of Children’s Sleep Lab, says that when a child is tired and can’t focus in the classroom or they’re fidgeting to stay awake, a teacher sees that and may presume the child has ADD and ADHD.

Parents Garrett and Joey Myers had the same problem with their twin daughters Monica and Megan. The girls were never diagnosed with a learning disorder, and it was a journey of many doctor visits to figure out why there girls where having behavioral problems.

“It’s a never ending battle of what looks like eating disorder or anxiety or OCD,” said Garret Myers, the girls’ father.

As the parents visited one medical expert after the next, mom Joey Myers, tried to ask doctors if the twins could possibly have narcolepsy, like she was diagnosed with in adulthood. So finally, the Myers met Dr. Ajayi, who after a series of test, determined the twins did have narcolepsy.

The girls are now being treated at separate therapeutic boarding schools out of state. “They basically have to finish growing up,” said Garrett Myers. “They stopped and at 10-years old, they regressed.”

Now the parents are trying to educate others moms and dad to be vigilant if they feel their child might be experiencing problems because of a sleep disorder.

Read more here

Attention issues may be helped by music therapy

Children with ADD, ADHD, and attention issues might be able to be helped by music therapy.

Focus can be a real struggle for people with learning disabilities like ADHD and ADD, but music is being found to be a powerful tool to train minds.

Middle school student Thomas Beckman has the developmental disability Down syndrome and uses music to help him focus.

He takes adapted music lessons at Rhythm & Rehab in Durham, where he gets to play his favorite instrument -- the drums -- as a form of neurologic music therapy.

"Music therapy is using music to accomplish non-musical goals," said Paula Scicluna, the founder and executive director of Rhythm & Rehab. "So, using music to improve speech skills, language, sensory motor skills, cognitive skills, social emotional skills."

At the beginning of his lesson, Thomas banged the drums loudly, looked around at his surroundings and was not focused. He was very distracted.

Encouraging him to keep in time, Scicluna patted the drums saying, "Together, together, together. Can you do it together?"

Thomas ignored instruction.

However, as the session progressed -- in a matter of minutes -- something clicked and his focus increased.

He and Scicluna then moved to the keyboard, and as they attempted to play a duet, he was more in tune to the rhythm and "making music." He intently glanced up at his song sheet and glanced down making sure he hit each key precisely.

"I don't expect him to leave here playing Chopin," said Donna Beckmann, Thomas' mother.

She said the benefits of playing music, such as hand-eye coordination, helps him in his everyday life.

"Whether he's writing something, whether he's helping in the kitchen and cutting up vegetables, it's all connected, she said.

Scicluna pointed out that the quality of Thomas' playing is not what matters, but rather he "continued to play and that he stayed with the activity until I told him to stop."

She said music helps organize the brain, and repetition is key.

"Once you add that rhythm and you add that structure, it helps actually organize the firing of the neurons. Focus, attention [and] impulse control -- all those behaviors that you see children with ADHD and ADD struggle with," Scicluna said. "That's how music therapy is helpful to those children."

So, while some may view Thomas' drumming as noise, he hears music.

"He gets a lot of feedback from heavy movements. So for him to be banging on the drums, that does something for him," his mother said. "The type of focus that this trains him in is to focus when he needs to. The therapy gives him tools to reach his goals."

Beckmann said the structure grounds him, and his instructors have high expectations.

"They know the potential. They know what these individuals are able to do, and they don't settle for less," she said. "That's why you see the phenomenal things my son can do."

Thomas was so focused, he continued to play the keyboard.

"To see him so focused and visually tracking and using the right fingers on the right keys," Scicluna said. "For those of us that don't have to really think about all of those skills independently, you think of all those skills that have to come together in order for that to happen, it's incredible."

Beckmann said, "It's working on so many different pieces of what he needs. I see a more whole child because of music therapy. It's music, it's fun."

Read more here

App offers non-medication treatment for ADD/ADHD

An app created in Israel offers a medication-free alternative treatment for children with ADD and ADHD.

Aziz Kaddan, one of the co-founders of Myndlift, didn’t flinch when asked in front of an audience at the recent BrainTech conference in Tel Aviv how he plans to go up against the better-funded American companies with his alternative non-drug treatment for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD).

Myndlift uses neurofeedback, also known as electroencephalographic (EEG) biofeedback, to train the brain to focus. It’s a computer-based technique developed and tested by NASA to improve attention, focus, and learning. Kaddan, the 22-year-old phenom taking Israel’s brain-tech world by storm, knows the path to changing hyperactivity treatment is a tough one, but he’s positive his app-based, wearable neurofeedback solution, coupled with specially tailored mobile games that only work through concentration, can increase attention levels with just 10 minutes of play time a day.

“I know that I have a product that has a value to a lot of people,” he said, from his co-working space for high-tech entrepreneurship and innovation at Tel Aviv’s public library. Myndlift’s idea is to get sufferers of ADD and ADHD off medications like Ritalin, which suppresses appetite and has other negative side effects, and help them focus their minds using a mobile app, neurofeedback, and a brain-sensing wearable technology.

“Myndlift brings personalized neurofeedback training to mobile, making it easier for people with hyperactivity, professionals in demanding careers, students, athletes and anyone concerned about brain fitness to improve concentration abilities effectively without prescription drugs, inconvenience to visit specialized clinics and huge bills, thus saving thousands of dollars and tens of commuting hours,” according to the company’s elevator pitch.

Read more here

Sleep apnea in children and behavioral problems

This article explains the link between sleep apnea in children and behavioral problems such as ADD and ADHD.

Attention deficit hyperactivity disorder (ADHD) is the most-commonly diagnosed behavioral disorder in children. The current standard of care for youngsters with attention deficit disorder (ADD) and ADHD is prescription medication such as Adderall, Ritalin and Dexadrine. These medications may have concerning side effects such as reduced height and weight, cardiovascular effects, tics, evidence of carcinogenic and reproductive effects, and substance abuse.

Sadly, many of these children are being misdiagnosed. A child who exhibits behavior problems or difficulty paying attention at home or school may actually be suffering from another disorder, an underlying undiagnosed sleep-related breathing disorder known as obstructive sleep apnea (OSA).

Dr. Stephen Sheldon, professor of pediatrics at Northwestern University School of Medicine and director of the Sleep Medicine Center says, “There are a number of sleep disorders that if looked at, an attention deficit problem can be identified. If you take a large number of children that have attention deficit and you evaluate them for sleep-disordered breathing, about a fifth to a quarter of those youngsters will have pediatric obstructive sleep apnea.”

He continues, “The most important aspect of evaluating a child for ADHD or other attention problems is to do a sleep evaluation in every single child. One hundred percent of these children need a sleep evaluation.”

...

Nighttime symptoms of youngsters with sleep-related breathing disorders are: snoring, bruxism, mouth breathing, bed wetting, frequent awakenings, nightmares, insomnia and physically restless sleep. Resulting daytime symptoms and findings are neurocognitive impairment, headaches, hyperactivity, behavioral issues, tiredness and poor school performance.

Lack of sleep and/or poor-quality sleep affects a child’s physical and emotional health, cognitive function, behavior and academic success. Parents, teachers, counselors or anyone concerned with the growth and development, academic performance, or health and well-being of a child must have greater awareness of sleep issues. Sleep screening and interventions to improve sleep must become part of every child’s routine clinical exam.

Early diagnosis and treatment of pediatric OSA is vital if we are going to have an impact on the epidemic of OSA in our country. Today, research indicates that one in four adults in this country suffers from obstructive sleep apnea. Of these, 80 percent remain undiagnosed and untreated. Although there is a growing awareness and therefore an increase in the number of adults treated for OSA, the key is prevention and early intervention.

A YouTube video, “Finding Conner Deegan,” tells a mother’s story of her struggling son who was labeled a “troubled child” early in his life. Having exhausted every resource, potential diagnosis and treatment known to his medical community, there appeared no other options. But through his mother’s perseverance, love, relentless search and striving to understand her son, her prayers were answered. Conner, in fact, suffered from undiagnosed pediatric OSA. He simply couldn’t breathe!

Parents, teachers, counselors and doctors need to be made aware of the need to screen children for sleep-related breathing disorders and understand the significant role timely diagnosis and thorough treatment play in the healthy growth and development of our children.

Read more here

More boys are diagnosed with ADD and ADHD

This article discusses an apparent gender bias which causes more boys than girls to be diagnosed with ADD and ADHD.

There's a gender bias when it comes to diagnosing Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder.

That's according to the woman who runs the largest ADHD coaching program in North America.

Shanna Pearson, the founder and president of One Focus Total Success Inc., told CFRA it's because the symptoms present more clearly in men.

"It's more noticeable in men, so a lot more of them are actually going to seek a diagnosis or it's just being pointed out to them," she said. "With women a lot of them, it's just going under the wire. They're not being noticed. They're not picking up on it."

Research shows two out of every three women with ADD or ADHD are misdiagnosed by doctors as having depression.

"And it's almost understandable how they would, because a lot of ADHD symptoms, especially for women because it's more on the emotional spectrum, a lot of ADHD symptoms can look like depression," she said.

She said women need to be aware about what is going on for them.

"It's not necessarily that they're just overly emotional or very scattered or absent-minded or some of the other labels that people put on women who are like that," Pearson said.

"It could be that they have ADHD, so I would say that if you're a woman who has more drama in your life than most people you know, if you're somebody who gets overwhelmed very, very easily or you experience a lot of anxiety on a regular basis or you tend to get frozen in your thoughts or overwhelmed and you can't move forward - those types of symptoms, I would say you might want to get a diagnosis," she added.

Pearson said once a person is properly diagnosed by a specialist, they can learn how to better manage the symptoms that come with the disorder.

Read more here

Adults with ADHD report childhood abuse

30% of adults who have ADHD reported that they also were abused as children.

Thirty percent of adults with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) report they were physically abused before they turned 18. This compares to seven per cent of those without ADD/ADHD who were physically abused before 18. The results were in a study published in this week's onlineJournal of Aggression, Maltreatment, and Trauma.

"This strong association between abuse and ADD/ADHD was not explained by differences in demographic characteristics or other early adversities experienced by those who had been abused," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "Even after adjusting for different factors, those who reported being physically abused before age 18 had seven times the odds of ADD/ADHD."

Investigators examined a representative sample of 13,054 adults aged 18 and over in the 2005 Canadian Community Health Survey including 1,020 respondents who reported childhood physical abuse and 64 respondents who reported that they had been diagnosed by a health professional with either ADHD or ADD.

"Our data do not allow us to know the direction of the association. It is possible that the behaviors of children with ADD/ADHD increase parental stress and the likelihood of abuse," says co-author Rukshan Mehta, a graduate of the University of Toronto's Masters of Social Work program. "Alternatively, some new literature suggests early childhood abuse may result in and/or exacerbate the risk of ADD/ADHD."

According to co-author Angela Valeo from Ryerson University, "This study underlines the importance of ADD/ADHD as a marker of abuse. With 30 per cent of adults with ADD/ADHD reporting childhood abuse, it is important that health professionals working with children with these disorders screen them for physical abuse."

Read more here

Does your child have ADD, ADHD, or both?

This article presents many common symptoms of ADD and ADHD to help parents determine if their child should be further evaluated for these conditions.

Does your child have Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder or both?

People with ADHD show a persistent pattern of inattention or hyperactivity-impulsivity that interferes with functioning or development, according to the Center for Disease Control. If a child exhibits six or more of each of the following patterns of symptoms, they may require further evaluation by a professional, according to the CDC:

Inattention
■Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
■Often has trouble holding attention on tasks or play activities.
■Often does not seem to listen when spoken to directly.
■Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.
■Often has trouble organizing tasks and activities.
■Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time, such as schoolwork or homework.
■Often loses things necessary for tasks and activities, such as pencils and books.
■Is often easily distracted.
■Is often forgetful in daily activities.

Hyperactivity and Impulsivity
■Often fidgets with or taps hands or feet, or squirms in seat.
■Often leaves seat in situations when remaining seated is expected.
■Often runs about or climbs in situations where it is not appropriate.
■Often unable to play or take part in leisure activities quietly.
■Is often "on the go" acting as if "driven by a motor".
■Often talks excessively.
■Often blurts out an answer before a question has been completed.
■Often has trouble waiting his/her turn.
■Often interrupts or intrudes on others.

Other indications of possible concerns include that several inattentive or hyperactive-impulsive symptoms were present before the child was 12, that symptoms are present in two or more settings, such as at home and school, that the symptoms interfere with socializing, school and work, and that the symptoms are not better explained by another mental disorder, according to the CDC.

Read more here

Natural treatment for ADHD symptoms

Natural treatments to remedy ADHD, such as fixing sleep issues or monitoring screen time, may help reduce symptoms of ADHD.

I call it the September phenomenon. My practice fills with children getting ready for school, college students grabbing their last-minute prescriptions and everyone questioning whether they should refill their ADD/ADHD medicine of choice.

It is always interesting to see the diversity amongst my ADD population. Many young children and adolescents love the feeling of being "hyper-focused" and are able to accomplish massive amounts of work in a short period of time. Others stare at me, looking pale and fatigued, wanting off their medications.

Medications for ADD have come under increased scrutiny, with recent statistics showing that use of these medications has increased by 50 percent in the last six years. Abuse of Ritalin, one of the most commonly used ADHD medications is also rampant on college campuses. Research continues to debate the effectiveness of the medications for improving grades and helping students "study."

I am always trying to help my patients understand the cause and options for treating their ADD/ADHD. While some patients do need medication, we have seen attention and hyperactivity improve with alternative regimens. Spending time educating patients about prevention of inattention and hyperactivity has proven to be effective in our practice.

ADD and ADHD are the result of neurotransmitter and neuroendocrine imbalances. The four main imbalances include high norepineprine and cortisol, dopamine dysfunction, serotonin deficiency, and insulin irregularity. Each of these imbalances are rooted in nutritional deficiencies that with correction, improve symptoms of hyperactivity and inattention. Food allergies and intolerances also contribute to malabsorption of nutrients.

While my practice goal is to identify each patient's unique ADD/ADHD type, there are general patterns that seem to be consistent for the majority of patients.

Correct Irregular Sleep Cycles

Children with inattention, as well as adolescents, need more sleep than their non-ADD counterparts. Most children require at least 10 hours of uninterrupted sleep. I have noticed that many children become wired at night, fighting sleep and bedtimes. Creating a calming sleep routine that is consistent helps children with ADD/ADHD relax. Reading, journaling, guided imagery tapes and yoga are great pre-bed activities. Warm baths with Epsom salts may also help.

Keep Insulin Stable

Teaching children and parents tips to keep blood sugar and insulin levels stable improve inattention and hyperactivity symptoms. Many children leave their homes with a high-sugar breakfast, followed by sugary snacks and unhealthy lunches. Emphasizing the importance of protein and decreasing total sugar consumption daily to under 40 grams is critical for children with ADD/ADHD. Small servings of protein should be eaten at regular intervals. Convenient protein sources include nuts, yogurt, hummus, protein bars and protein smoothies.

Correct Nutritional Deficiencies

Nutrition is often underplayed in ADHD management, but there are nutritional deficiencies that appear in my patients repeatedly. These deficiencies are also important in neurotransmitter balance. The most common nutritional deficiencies we see in practice include low B vitamin levels, low magnesium, and low levels of amino acids. If you or your child may have ADD/ADHD, have your physician or nutritionist evaluate your potential nutritional deficiencies, prior to supplementation.

Morning Exercise

For many children, serotonin imbalance is the cause of ADD. Beginning a quick morning workout before heading to class gives the brain a serotonin boost. Try running up and down the stairs five times or 10 jumping jacks. A brisk morning walk may also help "wake up" your serotonin.

Create an Electronic Budget

Children and adults with ADD/ADHD often find their symptoms worsen with constant stimulation from iPhones, iPads and other electronics. Most children should have an "electronic budget" that limits use of TV, video games, phones and other gadgets to one hour per day. Adults need an electronic budget as well. While jobs may force us all on the computer for long periods of time, having "electronic-free" hours can help build focus and attention. Turn off your electronics by 10 p.m. and keep four hours at least one day per week gadget/electronic-free.

Although many patients will still need ADD/ADHD medications, trying natural alternatives can keep us all less medication dependent and living healthier. Focus on alternatives in beating your ADD/ADHD, naturally.

Read more here

Study: Smoking during pregnancy may cause conduct issues in children

New research shows that smoking while pregnant is a risk factor for conduct problems, such as ADD, in offspring.

Research led by University of Leicester examines relationship between maternal smoking during pregnancy and offspring conduct problems among children.

Smoking during pregnancy appears to be a prenatal risk factor associated with conduct problems in children, according to a study published byJAMA Psychiatry, a JAMA Network publication.

Conduct disorder represents an issue of significant social, clinical, and practice concern, with evidence highlighting increasing rates of child conduct problems internationally. Maternal smoking during pregnancy is known to be a risk factor for offspring psychological problems, including attention deficits and conduct problems, the authors write in the study background.

Professor Gordon Harold and Dr. Darya Gaysina, of the University of Leicester, with colleagues in the United States and New Zealand, examined the relationship between maternal smoking during pregnancy and offspring conduct problems among children raised by genetically related mothers and genetically unrelated mothers.

Three studies were used: The Christchurch Health and Development Study (a longitudinal cohort study that includes biological and adopted children), the Early Growth and Development Study (a longitudinal adoption-at-birth study), and the Cardiff IVF (In Vitro Fertilization) Study (an adoption-at-conception study among genetically related families and genetically unrelated families). Maternal smoking during pregnancy was measured as the average number of cigarettes per day smoked during pregnancy.

According to the study results,a significant association between maternal smoking during pregnancy and offspring conduct problems was observed among children raised by genetically related mothers and genetically unrelated mothers. Results from a meta-analysis affirmed this pattern of findings across pooled study samples.

"Our findings suggest an association between pregnancy smoking and child conduct problems that is unlikely to be fully explained by postnatal environmental factors (i.e., parenting practices) even when the postnatal passive genotype-environment correlation has been removed." The authors conclude, "The causal explanation for the association between smoking in pregnancy and offspring conduct problems is not known but may include genetic factors and other prenatal environmental hazards, including smoking itself."

Read more here

How to tell if your child should be checked for ADD or ADHD

This article gives much information on ADD/ADHD including medicines and other treatment options.

Does the child have ADD/ADHD?
 

Attention Deficit Disorder (ADD) is a medical condition with problems in attention, focus, distraction, organization and impulse control. Attention Deficit Hyperactivity Disorder (ADHD) also has more motor hyperactivity than expected for children of similar age/maturity levels.
 

Valid, reliable screening forms for ADD, such as the Connors Scale or the free Internet-available Vanderbilt Scale, are much more accurate when filled out by multiple teachers observing children in groups, in addition to rating parental and therapist/nurse/doctor observations. These multiple observer’s rating scales do as well as specific “on/off task” computer tests especially now that kids are so familiar with video games.
 

Although we know that certain brain areas mediated by neurotransmitters dopamine and norepinephrine may be the source of impulse and focus problems, we have not been able to translate research into a clear ADD/ADHD test. No brain image, blood or neurological test is currently available. So parents and teachers use observations and rating forms to screen for possible ADD/ADHD.
 

What to try before medicines?
 

How helpful an active parent/school evaluation can be! It is important to find out the child’s academic ability as measured by cognitive and achievement tests. Are there specific areas of underachievement (eg., just the math) or is there general lack of success? It is necessary to diagnose defiant, manipulative, negative-attention-seeking behavior. Does the child do more homework than texting, video games and phone time?
 

Parental supports and consequences for school grades should be clarified. Is the student anxious, frustrated, sick, unable to see well, depressed, hungry, sleepy, worried about home life or using illegal substances? Once a parent/school evaluation has been done, parents and school can try accommodations to help needy students receive tutoring, prompts, sessions with school counselors and better communication with parents. Is there homework, and has the homework been done and brought to school?
 

School accommodations such as a 504 Plan and Individual Education Plan have helped many impatient, disorganized, distracted students, but these plans depend on 100 percent student and parent participation with the school.
 

Medicines for ADD/ADHD
 

Try school evaluations, academic extra help, therapy, and good pediatric evaluation first. Because there are potential benefits and possible major adverse side effects, all custodial “parents” need to be part of the medicine discussion. Today, this may include married, divorced, or never-married parents or custodial relatives.
 

Types of medicines
 

Stimulants are controlled substances. They are written on a special nonrefillable script for medicines with abuse and addiction potential. Each script is follow by the U.S. Department of Justice Drug Enforcement Administration. Urine drug screens and Kasper reports (indicate prescriptions from multiple doctors) follow controlled substance stimulant scripts. Stimulants are increasingly used inappropriately without prescriptions by older students who hope for “cognitive enhancement,” or a quick fix at the last minute as they cram for exams or finish papers.
 

Types of stimulants
 

Methylphenidates are Ritalin, Methylin, Focalin, Metadate, Concerta and Daytrana.
Mixed amphetamines are Dexadrine, Adderall and Vyvanse.
 

Possible adverse side effects
 

1. Cardiac risk, especially for unrecognized pre-existing heart problems.
2. Increased pulse and blood pressure.
3. Appetite suppression and rebound binge eating.
4. G.I. upset.
5. Decreased growth.
6. Transient tics or twitches
7. Insomnia
8. Rare brief psychotic reactions or obsessive over-focus.
 

Nonstimulant Strattera: It can be used with seizure disorder. Takes one to two months for maximum benefit.
Possible adverse side effects: Similar to stimulants except no tics.
 

Nonstimulants Intuniv (Tenex, Guanfacine) and Kapvay (Clonidine)
Possible adverse side effects:
 

1. Sedation
2. May lower pulse and blood pressure
3. Do not discontinue quickly!
 

Thanks for your attention, and I hope you were not reading this with one hand on your phone and the other on the steering wheel! Our whole society is distracted, hurried, overstimulated and overstressed.
 

First, try to set priorities in your own life. Limit the video games. Turn off the TV. Increase your child’s exercise and active learning time. Second, work with your school, child and therapist. See your child psychiatrist when you are already trying the nonmedical approaches and we will work with you to coordinate nonmedical and possible medical intervention.

Read more here

Potential causes of ADD and ADHD

This article discusses possible causes of ADD and ADHD compiled from different sources. Causes include genetic factors, premature birth, and other complications. ADD/ ADHD is a complex illness with few simple solutions. JR

A study in the British Medical Journal, Lancet, has reported for the first time, direct evidence of a genetic link with ADHD. Another study published in the medical journal, Pediatrics, has suggested that increased exposure to pesticides may also be linked to ADHD. Other causes may include premature birth, complications during childbirth such as hypoxia (lack of oxygen), and prolonged exposure to anesthesia at early ages.

The study on the genetic link with ADHD, even more so, makes it increasingly clear that ADHD is not caused by bad parenting or high sugar diets. There has been too much misunderstanding about the causes of ADHD with the child and the parents being unfairly stigmatised. Misconceptions such as if the parents did a better job of parenting or if the child tried harded and wasn't lazy, then the child would not have ADHD. These are all misconceptions that only do harm to the child's self esteem as well as the parents' self esteem.

It needs to be understood that ADHD or ADD is a neurophysiologic disorder, not a result of parenting.....

The most important point is that early intervention for the child's ADHD or ADD is likely to produce the best clinical outcome. Parenting a child with ADD or ADHD is a much more challenging child rearing experience than parenting a child without ADHD or ADD. Normal parenting methods frequently are not adequate as the parents are likely to experience increased frustrations with normal parenting methods not having the impact that they desire. 

The child is more vulnerable to developing low self esteem as they feel they are not as smart as their peers, or that it will never get better for them academically,or why try hard if it doesn't make a difference. If they are impulsive, then they will trigger a lot of disapproval from adults and may get rejected by peers.

Neurologically, the ADHD or ADD child's concentration or attentional system is underfunctioning so they are unable to successfully meet their academic and even sometimes day to day challenges. When their self esteem suffers, the parent's self esteem may also suffer. Again, the earliest intervention can produce the best clinical outcome and prevent psychological problems as they get older.

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ADD and ADHD and its Mimics in Children with Down Syndrome

This article from the National Down Syndrome Society discusses the similarities between symptoms of ADHD, Down Syndrome, and other issues in children.

Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed childhood problem. ADHD is characterized by consistent demonstration of the following traits: decreased attention span, impulsive behavior, and excessive fidgeting or other nondirected motor activity.

 All children, including children with Down syndrome, display these traits from time to time. But the child with Down syndrome may exhibit these traits more often than other children his age.  

How Common Is ADD in Children With Down Syndrome? 

The frequency of ADHD in children with Down syndrome is not known with certainty. However, ADHD-like symptoms are more common in young children with Down syndrome compared to children from the general population. Compounding symptoms such as stereotypy (repetitiveness), anxiety or extreme irritability in the presence of ADHD-like symptoms may indicate another disorder such as autism, bipolar disorder or obsessive compulsive disorder.

Uncomplicated ADHD is common in younger children with Down syndrome. However, many school age children with ADHD frequently have other behavioral conditions including oppositional defiant disorder, disruptive behavior disorder or obsessive compulsive traits.

Does That Mean That Your Child Has ADHD?

It may, but more often it means that a medical problem needs to be addressed, or that your child's educational program or communication method needs some adjustment. In children with Down syndrome who have difficulty paying attention, ADHD is a diagnosis of exclusion. Other problems must be ruled out first. 

What Are Medical Problems That Can Look Like ADHD? 

HEARING AND VISION ISSUES

In order for a child to pay attention to classroom material, she has to be able to hear and to see it. Both hearing and visual problems are common in children with Down syndrome. Ear infections are overwhelmingly common and, even if treated, can cause hearing loss for weeks. People with Down syndrome have middle ear structural abnormalities that can cause lifetime mild to moderate hearing loss.

Both near- and far-sightedness are common in individuals with Down syndrome, as well as cataracts and "lazy eye."

RULING OUT SIGNIFICANT HEARING AND/OR VISUAL LOSS AS A CAUSE OF ATTENTIONAL PROBLEMS

To monitor hearing, an auditory brainstem response test (ABR) or otoacoustic emission (OAE) should be performed early in the child's life (by three months of age at the latest) as a baseline. Hearing screens should be performed annually until three years of age, and every other year thereafter. Children with abnormal hearing evaluations should be seen by an ear-nose-throat physician (otolaryngologist) to manage treatable causes of hearing loss.

A child with Down syndrome should be evaluated by an eye doctor during the first year of her life, and yearly thereafter. Some children may need more frequent followup depending on their visual diagnosis.

GASTROINTESTINAL ISSUES

People with Down syndrome are at increased risk for an intestinal condition called celiac disease, which is a condition in which the body cannot process a protein found in wheat and certain other grains. While typical symptoms of celiac disease include loose stools, diarrhea, and poor weight gain, the condition often presents only with subtle effects on energy and behavior. People with Down syndrome are also predisposed to significant constipation, which when severe can cause abdominal pain, lack of appetite, and restlessness.

Current recommendations for gastrointestinal monitoring include screening for celiac disease between two and three years of age. This screening should include measurement of IgA antiendomysium antibodies, as well as total IgA. Your child's primary care provider will want to review your child's bowel status with you at each visit, as well.

THYROID ISSUES

About 30% of people with Down syndrome have thyroid disease at some point in life. Most have hypothyroidism, or underactive thyroid gland; a few have disease that results in overactive thyroid gland (Graves' disease). An underactive thyroid gland can, among other things, make a child very tired and apathetic.

Too much thyroid activity can cause agitation and restlessness. Therefore, both conditions can look like poor attention and behavior.

Because thyroid disease is so prevalent in this population, and because it is difficult for doctors to detect just by examining your child, an annual blood test for thyroid hormone is recommended by the Down Syndrome Health Care Guidelines.  

SLEEP ISSUES

Sleep disorders are extremely common in Down syndrome. These disorders are a group of conditions with many different causes but one thing in common: they all interfere with getting a good night's sleep. As a parent, you know that tired children can behave very differently from tired adults: they can become restless, whiny, and difficult to calm. And people of all ages have difficulty focusing and learning new information when they are sleep deprived.

Sleep apnea, or short periods of not breathing during sleep, is especially common. People with Down syndrome have small, often "floppy" airways, which can sometimes be completely or partially blocked during sleep by large tonsils and adenoids, or by the floppy walls of the airway collapsing as air is exhaled. Regardless of the cause of obstruction, the sleeper must awaken briefly to resume breathing. Some patients with sleep apnea awaken hundreds of times per night.

Symptoms associated with but not specific to sleep apnea include snoring, lots of "thrashing" while asleep, excessive daytime sleepiness, mouth breathing, and unusual sleep positions such as sleeping in a seated or hunched forward position.

Children suspected of having a sleep disorder should undergo a sleep study evaluation at an accredited sleep center.

What Types of Communication Difficulties Can Look Like ADHD?  

People with Down syndrome may have many barriers to effective communication. The receptive language skills of children with Down syndrome (how well they understand what is being said) are often much stronger than their expressive language skills (how well they can say it). Parents often comment, "He knows what he wants to tell us, he just can't seem to put the words together or we can't make out what he is saying." Classroom participation is thus more difficult, as well. The child may express his frustration by acting out or by inattention.

What Types of Educational Problems Can Look Like ADHD?  

Children with Down syndrome have a wide range of learning styles. Your child's educational team may need to try more than one method of presenting material before finding the one that works best for your child. If material is presented in a way that is not compatible with a child's learning style (for example, oral lectures for a student who needs visual aids and prompts) that child may appear bored, fidgety, and hyperactive.

The level of the material may also be a problem. If a child is presented with concepts that are too difficult for his cognitive level, he might "tune out" and appear inattentive. A child who is bored with overly easy material also may attend poorly and act out.

What Types of Emotional Issues Can Look Like ADHD?

Because of the communication problems discussed above, people with Down syndrome may have difficulty talking about things that make them sad or angry. Major life changes such as loss or separation may prompt decreases in appropriate behavior at school or work.

What Are the Next Steps?

If you are concerned about decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity in your child, it is appropriate to consult your pediatrician, a developmental and behavioral pediatrician or child psychiatrist.

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Children, like adults, are affected by sleep disorders

A good night's sleep is eluding an increasing number of people, and children are not immune.

The Centers for Disease Control has labeled "insufficient sleep" a public health epidemic. From bedwetting to loud snoring, a host of symptoms can indicate an underlying sleep problem in children. Many children suffer with disorders but are undiagnosed or misdiagnosed, says Dr. Larry Salberg, clinical associate professor of medicine at the Indiana University School of Medicine Northwest. "Approximately 2 percent of children have sleep apnea, and most of the kids are going undiagnosed," he says.

In some cases, children diagnosed with attention problems, such as ADD/ADHD, actually have a sleep disorder. Some of the symptoms are the same, such as changes in behavior and attention. "There are studies that show that up to 38 percent of our children who are on stimulant medication for ADD/ADHD do not have ADD/ADHD," Salberg says. "They have sleep deprivation or poor sleep, most of which is due to sleep apnea."

Any child that visits a doctor for possible ADD/ADHD should be screened for apnea or another disorder, says Salberg, founder of Neurological Institute and Specialty Centers in Merrillville.

People with sleep apnea have breathing that repeatedly stops and starts as they sleep, according to the Mayo Clinic. Common signs are loud snoring or feeling tired after a full night's sleep. Obese adults have an increased risk of sleep apnea, and the same rings true with children. "It's a common pathological problem," Salberg says. "It's easy to diagnose and it's easy to treat."

Left untreated, it can lead to serious health problems, such as high blood pressure. In adults, it can result in heart attacks, stroke, congestive heart failure and other maladies.

Good sleep helps reduce weight, but obesity causes poor sleep. "It's a vicious cycle," says Salberg, who has been practicing sleep medicine since 1978.

Dr. Muhammad Najjar, medical director for the Sleep Disorders Center of Franciscan Physicians Hospital in Munster, says sleep disorders in children are not new, but medical technology has improved. "Now we have the tools to treat them," he says.

The Munster center treats children, but the majority of its patients are adults. The facility just started accepting pediatric patients in February. "To the best of my knowledge, no one offers this in Northwest Indiana," Najjar says.

Aside from sleep apnea, children are susceptible to other sleep-related disorders, such as sleepwalking, insomnia, loud snoring and bedwetting. When a doctor recognizes symptoms of a sleep disorder in a child, the child may be recommended for a sleep study.

At Sleep Disorders Center, two rooms are designated for pediatrics. Designed to have a feel that's comfortable for children, it has toys, pictures on the wall and smaller beds. During a sleep study, a child spends the night in a sleep center, hooked to machines that monitor brain waves, eye movement, flow of air in the nose and mouth, heart and oxygen levels and more, Najjar says. The data are recorded and analyzed. It takes a few days to process the results and another appointment to discuss the best course of treatment.

In adults, prescribing a continuous positive airway pressure (CPAP) machine, which is a breathing mask worn at night, is a common treatment for sleep apnea.

For children with sleep apnea, a possible first step is to remove their tonsils and adenoids. If that does not correct the problem, then a doctor can explore nasal or orthodontic treatments or address a child's weight, if he is overweight, Najjar says. If fixing those issues does not work, then a CPAP machine is an option.

Salberg says children have to be re-studied in a sleep center after various treatments are tried, to ensure what appears to be working truly is working. "You have to prove that you've treated it. The only way you can document and make a diagnosis is by going through a sleep test."

If someone quits snoring, that does not mean the sleep apnea is gone. "One does not beget the other, necessarily," Salberg says.

Parents who think their child may have a sleep disorder should talk to the child's doctor. If the doctor ignores the concern or does not seem to know, parents should not be afraid to ask for a consultation with a board certified sleep specialist, Salberg says.

"We spend a third of our life sleeping," he says. "What we do during sleep has a lot to do with the day."

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