Study: Significant association between obesity and ADHD

A recent study showed a significant association between obesity and ADHD in adults and children.

Results from a meta-analysis published in the American Journal of Psychiatry indicated a significant association between obesity and attention-deficit/hyperactivity disorder among children and adults.

“The putative association between ADHD and obesity might seem paradoxical because, rather than being hyperactive, individuals with obesity are often described as ‘lazy.’ However, the impulsivity and inattention that characterize ADHD might lead to dysregulated eating patterns with consequent weight gain,” Samuele Cortese, MD, PhD, of the University of Southampton, United Kingdom, and colleagues wrote. “The role of possible confounders, including low socioeconomic status and comorbid mental health conditions, in explaining the association between obesity and ADHD is still unclear. In addition, the role of age, gender, study setting, or study country is also uncertain.”

Researchers conducted a meta-analysis of 42 studies to assess the association between ADHD and obesity. The analysis included 728,136 study participants, of which 48,161 had ADHD.

Researchers found a significant association between obesity and ADHD among children (OR = 1.2; 95% CI, 1.05-1.37) and adults (OR = 1.55; 95% CI, 1.32-1.81).

Pooled prevalence of obesity increased by approximately 70% for adults with ADHD compared with those without ADHD, and by approximately 40% for children with ADHD vs. those without ADHD.

The significant association between obesity and ADHD remained when limited to studies that adjusted for potential confounding factors, diagnosed ADHD by direct interview and directly measured height and weight.

Researchers also found a significant association between ADHD and overweight.

Individuals medicated for ADHD did not have a higher risk for obesity.

“We found meta-analytic evidence of a significant association between obesity/overweight and ADHD, regardless of possible confounders. Mediational effects and causal mechanisms underlying the association, as well as the long-term effects of ADHD medications on weight status in individuals with obesity and ADHD, deserve further attention because of their important public health implications,” the researchers concluded.”

Read more here

Study: 1 in 5 adults with epilepsy has ADHD symptoms

A study claims that 1 in 5 adults who has epilepsy also shows symptoms of ADHD.

Nearly one in five adults with epilepsy also has symptoms of attention-deficit/hyperactivity disorder (ADHD), a new study finds.

Researchers surveyed almost 1,400 adult epilepsy patients across the United States. They found that more than 18 percent had significant ADHD symptoms. In comparison, about 4 percent of American adults in the general population have been diagnosed with ADHD, the researchers noted.

Compared to other epilepsy patients, those with ADHD symptoms were also nine times more likely to have depression, eight times more likely to have anxiety symptoms, suffered more seizures and were far less likely to be employed.

"Little was previously known about the prevalence of ADHD symptoms in adults with epilepsy, and the results were quite striking," study leader Dr. Alan Ettinger, director of the epilepsy center at Neurological Surgery, P.C. (NSPC) in Rockville Centre, N.Y., said in an NSPC news release.

"To my knowledge, this is the first time ADHD symptoms in adults with epilepsy have been described in the scientific literature. Yet, the presence of these symptoms may have severe implications for patients' quality of life, mood, anxiety, and functioning in both their social and work lives," he added.

The findings suggest that doctors may have to take a broader approach to treating some epilepsy patients to improve their family, school and work lives.

"Physicians who treat epilepsy often attribute depression, anxiety, reduced quality of life and psychosocial outcomes to the effects of seizures, antiepileptic therapies and underlying central nervous system conditions. Our findings suggest that ADHD may also be playing a significant role," said Ettinger, who is also a professor of clinical neurology at Albert Einstein College of Medicine in New York City.

Two experts in epilepsy care said the study is an important one.

"This study reaffirms what we've always said -- that patients with epilepsy have a high risk for attention-deficit disorder," said Dr. Steven Wolf, an associate professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City. "We see this in our own clinical experience here," he added.

Dr. Cynthia Harden is director of North Shore-LIJ's Comprehensive Epilepsy Care Center in Great Neck, N.Y. She said, "Hopefully, this important information will motivate patients, families and the medical community who care for epilepsy patients to be vigilant for these disabling symptoms and to provide appropriate resources for addressing psychiatric issues."

Easing seizures may be key, Harden added. "If a person with epilepsy can become seizure-free through appropriate medical and surgical interventions, this will go a long way toward eliminating the depression, anxiety, medication burden and ADHD symptoms that too often accompanies living with seizures," she said.

Study author Ettinger suggested that "as a next step, we need to validate measures to screen for ADHD specifically in epilepsy and clarify the nature of ADHD symptoms in adults with epilepsy. This will lay the foundation for future trials of treatments that offer the promise of rendering major improvements in the quality of life of adult epilepsy patients."

The study was published online Jan. 15 in the journal Epilepsia.

Read more here

Adulthood with ADHD Podcast

At the link below, view a podcast about the transition from childhood to adulthood for a person with ADHD.

ADD and ADHD don’t just affect children. More and more adults are being diagnosed with the condition, especially young women. According to a recent report, between 2008 and 2012, the number of women taking ADHD drugs jumped 85 percent. This hour we’ll talk about the disorder, how adults are affected and how they live with it.

Listen to the podcast here

Study: Brain scans show difference between those who have recovered from ADHD and those who have not

Very interesting news about ADD!! We have observed that half of kids grow out it.- JR

A study looked into brain scans from adults who recovered from ADHD versus those who have not recovered from ADHD and noted differences in the brain scan results.

About 11 percent of school-age children in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD). While many of these children eventually "outgrow" the disorder, some carry their difficulties into adulthood: About 10 million American adults are currently diagnosed with ADHD.

In the first study to compare patterns of brain activity in adults who recovered from childhood ADHD and those who did not, MIT neuroscientists have discovered key differences in a brain communication network that is active when the brain is at wakeful rest and not focused on a particular task. The findings offer evidence of a biological basis for adult ADHD and should help to validate the criteria used to diagnose the disorder, according to the researchers.

Diagnoses of adult ADHD have risen dramatically in the past several years, with symptoms similar to those of childhood ADHD: a general inability to focus, reflected in difficulty completing tasks, listening to instructions, or remembering details.

"The psychiatric guidelines for whether a person's ADHD is persistent or remitted are based on lots of clinical studies and impressions. This new study suggests that there is a real biological boundary between those two sets of patients," says MIT's John Gabrieli, the Grover M. Hermann Professor of Health Sciences and Technology, professor of brain and cognitive sciences, and an author of the study, which appears in the June 10 issue of the journal Brain.

Shifting brain patterns

This study focused on 35 adults who were diagnosed with ADHD as children; 13 of them still have the disorder, while the rest have recovered. "This sample really gave us a unique opportunity to ask questions about whether or not the brain basis of ADHD is similar in the remitted-ADHD and persistent-ADHD cohorts," says Aaron Mattfeld, a postdoc at MIT's McGovern Institute for Brain Research and the paper's lead author.

The researchers used a technique called resting-state functional magnetic resonance imaging (fMRI) to study what the brain is doing when a person is not engaged in any particular activity. These patterns reveal which parts of the brain communicate with each other during this type of wakeful rest.

"It's a different way of using functional brain imaging to investigate brain networks," says Susan Whitfield-Gabrieli, a research scientist at the McGovern Institute and the senior author of the paper. "Here we have subjects just lying in the scanner. This method reveals the intrinsic functional architecture of the human brain without invoking any specific task."

In people without ADHD, when the mind is unfocused, there is a distinctive synchrony of activity in brain regions known as the default mode network. Previous studies have shown that in children and adults with ADHD, two major hubs of this network -- the posterior cingulate cortex and the medial prefrontal cortex -- no longer synchronize.

In the new study, the MIT team showed for the first time that in adults who had been diagnosed with ADHD as children but no longer have it, this normal synchrony pattern is restored. "Their brains now look like those of people who never had ADHD," Mattfeld says.

"This finding is quite intriguing," says Francisco Xavier Castellanos, a professor of child and adolescent psychiatry at New York University who was not involved in the research. "If it can be confirmed, this pattern could become a target for potential modification to help patients learn to compensate for the disorder without changing their genetic makeup."

Lingering problems

However, in another measure of brain synchrony, the researchers found much more similarity between both groups of ADHD patients.

In people without ADHD, when the default mode network is active, another network, called the task positive network, is suppressed. When the brain is performing tasks that require focus, the task positive network takes over and suppresses the default mode network. If this reciprocal relationship degrades, the ability to focus declines.

Both groups of adult ADHD patients, including those who had recovered, showed patterns of simultaneous activation of both networks. This is thought to be a sign of impairment in executive function -- the management of cognitive tasks -- that is separate from ADHD, but occurs in about half of ADHD patients. All of the ADHD patients in this study performed poorly on tests of executive function. "Once you have executive function problems, they seem to hang in there," says Gabrieli, who is a member of the McGovern Institute.

The researchers now plan to investigate how ADHD medications influence the brain's default mode network, in hopes that this might allow them to predict which drugs will work best for individual patients. Currently, about 60 percent of patients respond well to the first drug they receive.

"It's unknown what's different about the other 40 percent or so who don't respond very much," Gabrieli says. "We're pretty excited about the possibility that some brain measurement would tell us which child or adult is most likely to benefit from a treatment."

Read more here

Brain Development Determines ADHD Recovery

Studies show that around 50% of children with ADHD grow out of the condition while the rest become adults with ADHD. This article claims that the pattern of a child's brain development could determine if a child grows out of their ADHD or not.

Some people grow out of their childhood attention-deficit/hyperactivity disorder (ADHD) and some don't. In fact, around 50% of individuals diagnosed as children continue to suffer from ADHD as adults.

Researchers are trying to understand the reasons why, and relatedly, whether there are any differences that distinguish the two groups. Gender, ethnicity, socioeconomic class, and symptom severity have already been ruled out as potentials. So, perhaps there is a distinguishing variable in the brain? Dr. Philip Shaw at the National Human Genome Research Institute and his colleagues conducted a study to find out.

They already knew from prior work that cortical structure is thinner in adults with ADHD, particularly in regions of the brain that play important roles in cognitive functioning and attention. However, that work was cross-sectional, meaning it was conducted at a single point in time, so any changes over time weren't captured. Thus, they focused on those same regions in this study, but conducted a longitudinal study so they could link trajectories of symptoms with trajectories of brain development, particularly the structure of cortical regions that control attention.

They recruited 92 children with ADHD, with a mean age of 11, who underwent repeated structural imaging scans and clinical assessments over the years, including as adults at a mean age of 24 years. For comparison, they also scanned 184 volunteers without ADHD.

They found that ADHD continued into adulthood in 37 (40%) of the participants diagnosed with childhood ADHD, and these individuals showed increased rates of thinning. In contrast, the cortical thickness of individuals who achieved remission of their ADHD developed toward the normal range.

"We find that differences in patterns of brain growth are linked with differences in the adult outcome of childhood ADHD. Differences in these regions -- specifically a thinner cortex -- are found in childhood ADHD," Shaw further explained. "However, for the group whose ADHD improved with age, these differences tend to resolve and by adulthood, these regions did not differ significantly from individuals who never had ADHD. By contrast, for the group with persistent ADHD, childhood differences persisted in the 'attention' regions of the brain."

These findings seem to suggest that the trajectory of cortex development differentiates people who recover from childhood ADHD from people whose disorder continues into adulthood.

"The development of the cortex seems to be a critical factor influencing the recovery from childhood ADHD. However, there is much that we do not understand about this relationship," commented Dr. John Krystal, Editor of Biological Psychiatry. "Cortical thinning may be related to the pruning of connections in the brain, in this case, connections with the prefrontal cortex. The current data would seem to suggest that excessive trimming of connections is a risk factor for the persistence of ADHD into adulthood. But we do not yet understand which connections are being trimmed, why these connections disappear, and how this loss of connections contributes to ADHD symptoms."

More work will be necessary to answer these questions, but Shaw concludes that "understanding how differences in brain development are tied to the course of ADHD is the first step in developing tools to help us predict the outcome of childhood ADHD."

Read more here

Adults with ADHD

This article discusses the problems adults with ADHD face, and treatment options.

Do you remember when you used to stare out of the window in the classroom in elementary school and watch the butterfly dance on the flower? And that fly that landed on your desk was always a little more entertaining than the teacher? Or when students in the hallway outside the classroom always distracted you just when the teacher called on you? How your desk was always filled with crumpled papers and books always falling out onto the floor? When you knew the answer you blurted it out in excitement and the teacher would always remind you to raise your hand first? Sometimes people used big words to describe you like "impulsive," but you thought you just faster at reacting than everybody else was. That seemed like a good thing. It was a little hard to get along with some children, and you frequently did not get picked for teams because you weren't able to kick or throw the ball as well as the other kids.

Perhaps you were among that 10 percent of the children in school who had attention deficit hyperactivity disorder but, in your case, it was not recognized. People often said that you were just lazy and immature. It seemed as if they were probably right since you struggled with school work ever since you started school. It sure didn't help your self-esteem either because you knew you were somehow different from the other kids and sometimes you got teased. Maybe you compensated for the ADHD by working harder and being intelligent enough to overcome some of your limitations.

But that is all behind you now and you are an adult. Adults grow out of things like that. Or do they? Unfortunately, approximately 50 percent of the children who had ADHD as children continue to have some of the symptoms even into adulthood. It is important to understand that this disorder does not involve an actual deficit in attention but a problem with "attention regulation” or keeping your attention on what is most important at the time. As an adult it is may be referred to as ADD because there are few symptoms of hyperactivity. Problems of attention, concentration, organization and impulsivity are more common. Hyperactivity symptoms may look more like restlessness, getting bored easily and trying to do too many things at once. Daily routine tasks such as being on time, starting and finishing a  project, remembering things, paying attention when someone talks and staying focused on a job are just some of the common challenges that you can continue to experience. Adults may find that they have trouble keeping a job, managing finances and maintaining relationships. Self-esteem can suffer as ADHD adults struggle with things that come naturally to others.

The causes for ADHD are unclear. It seems to have a neurological basis involving the chemical messengers in the brain known  as neurotransmitters. The cerebral cortex of the brain is also believed to play a role in the areas of  "executive functioning” such as planning, problem solving, and impulse control. A genetics seems likely since parents who are ADHD are much more likely to have children with the disorder.

Making a diagnosis of ADD requires more than identifying a cluster of symptoms. Anyone can experience some of these symptoms at times. They must be of sufficient intensity, duration and frequency that they interfere with important life functions. The diagnosis can be determined by a qualified physician or psychologist after an extensive interview, psychological and cognitive testing, and gathering information from collateral sources. It is not uncommon for ADHD adults to also have other conditions such as anxiety, depression, or substance abuse ... confounding the task of making an accurate diagnosis.

Treatment for ADHD adults generally involves use of some type of medication to achieve some balance in brain neurotransmitters. Education and counseling is also recommended as an adjunct to medication to help individuals learn to manage those the most troubling characteristics of the disorder and to teach them strategies to manage problems with attention, distraction, social skills, organization, budgeting and planning. With treatment adults with this disorder can lead successful lives and develop the skills to manage work, relationships and life in general.

Read more here

Identifying the tipping point for those with ADHD

This article discusses warning signs for a "tipping point" when strategies that help with ADHD symptoms seem to stop working. Identifying issues before the tipping point could help get a person back on track.

The tipping point is basically a time in people’s lives when, for various reasons, the strategies they have been using to compensate for theirADHD challenges no longer seem to be working. This tipping point often is experienced along with feelings of overwhelm and chaos.

Before reaching a tipping point, people often are able to balance known or unknown ADHD challenges with strategies they may not have even realized they were using. They had been able to adapt and cope well with their symptoms. Their symptoms may not have interfered with their functioning, so that they avoided an official ADHD diagnosis.

But for some reason a life change — a job promotion, relationship change, school change, or myriad other things — renders the current strategies ineffective. Over time there is a sense that things are no longer going well and in fact, life seems to be falling apart in a big way.

Here are some life situations that could be possible tipping points:

1. New problems at school.

Often, when higher elementary or middle school hits, students begin unraveling. They experience more responsibility in juggling multiple classrooms, more homework and larger classes. Suddenly it seems like nothing is working anymore. They can’t get things done that they want to get done, everything becomes chaotic, things start to come undone. Their schoolwork starts to suffer; they may have trouble concentrating in class, forget to hand in homework or start to experience difficulties with old friendships.

Often, no one recognizes these warning signs as being ADHD-related because the students previously had managed or were able to compensate for their challenges. Parents and educators start to feel helpless when a previously successful student seems to become unmotivated. Students are told they just need to try harder. Everyone is unsure how to get the child back on track and the students begin to feel stupid, lazy and incapable.

2. Inability to cope after significant life changes.

Some people with ADHD experience their first tipping point after a significant life change, even a positive one such as getting married or moving into a new home. These major life celebrations are anticipated with great joy, but often may be a change that tips the balance. Perhaps you’ve been able to balance your own life and your own schedule and where you put things up until now. But then you get married and now your spouse has a different way of doing things or expectations of the way things should be organized that differ from your views. That’s not to mention having to deal with the extra stuff in your space.

Slowly you notice that things are not working as well as they had before, and because this is supposed to be the happiest time of your life, you think there must be something wrong with you — right? Wrong! Significant life changes such as getting married, having another child or moving homes often can upset an unknown balance.

3. Unable to transition successfully into a new role at work.

Up until your “tipping point” you have been performing really well in your job — so well, in fact, that you are promoted. Slowly you may start to notice that you are not doing this new job as well as everyone expected, and you begin to isolate yourself, dread going to work and may eventually get fired.

What happened? You reached your tipping point. Not because you didn’t deserve the job, but because changes in work often come with changes of staff, support, work space, etc. that throw you off.

4. Change in family dynamics.

If you find yourself with new responsibilities and changes in your family, such as taking in an elderly parent, adding members to your family, or getting a new roommate, the additional responsibilities, change in routine and stress can gradually sink in and leave you overwhelmed and unable to cope as you have previously. It is so easy to begin to think you are a terrible mom, unfit for the responsibilities of a family or that you may be destined to live alone.

It’s not you. You were thrown off-balance, and your ability to compensate for your ADHD with your old routine, structures or systems is no longer working. But instead of seeing the truth, that it isn’t anything you’ve done wrong, or knowing that you can fix this, you’re filled with undeserved guilt and shame.

5. Physical injury.

People often experience their tipping point when an ADHD-management strategy such as exercise decreases or activity level changes. Unbeknownst to many people with ADHD, participation in sports or daily exercise provides some additional dopamine to our brain and helps to create structure and routine in our lives that help to better manage ADHD symptoms.

Tipping points are common for high school athletes who have earned success not only in their sports but academically, only to go off to college and experience failure for the first time. Without the rigorous physical training and structure of high school, they begin slowly to fall apart. Another common tipping point for people with ADHD is when they have experienced an injury and have to decrease their activity or exercise level. This change in routine and absence of daily dopamine boosts can challenge previous steadiness, energy levels and ability to focus. Life begins to wobble.

As you can see, there are many reasons, often beyond your control, that might lead you to your tipping point. A tipping point means that you are at a crossroads. You have a choice which way you will react. You can continue down that path to chaos and overwhelm, or you can get restructured and relearn ways to to cope and get back on track.

Read more here

Childhood ADHD Lasts Into Adulthood

A study that followed children with ADHD into adulthood shows their ADHD symptoms lasted in adulthood and are associated with other psychiatric issues.

The first large, population-based study to follow children with attention-deficit hyperactivity disorder into adulthood shows that ADHD often doesn't go away and that children with ADHD are more likely to have other psychiatric disorders as adults. They also appear more likely to commit suicide and to be incarcerated as adults. The findings appear in the March 4 online issue ofPediatrics.

"Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes," says lead investigator William Barbaresi, M.D., of Boston Children's Hospital, who started the study when he was at Mayo. "That's a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults."

The study is unique because it followed a large group of ADHD patients from childhood to adulthood, says Slavica Katusic, M.D., an epidemiologist and Mayo Clinic's lead researcher on the study.

ADHD is the most common neuro-developmental disorder of childhood, affecting about 7 percent of all children and three times as many boys as girls. Most prior follow-up studies of ADHD have been small and focused on the severe end of the spectrum -- such as boys referred to pediatric psychiatric treatment facilities -- rather than a cross-section of the ADHD population.

The study followed all children in Rochester who were born between 1976 and 1982, were still in Rochester at age 5 and whose families allowed access to their medical records. That amounted to 5,718 children, including 367 diagnosed with ADHD. Of this group, 232 participated in the follow-up study. About three-quarters received ADHD treatment as children.

At follow-up, the researchers found:

*29 percent of children with ADHD still had ADHD as adults.

*57 percent of children with ADHD had at least one other psychiatric disorder as adults, as compared with 35 percent of those studied who didn't have childhood ADHD. The most common were substance abuse/dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety and major depression.

*Of the children who still had ADHD as adults, 81 percent had at least one other psychiatric disorder, as compared with 47 percent of those who no longer had ADHD and 35 percent of those without childhood ADHD.

*Seven of the 367 children with ADHD (1.9 percent) had died by the time the study began, three of them from suicide. Of the 4,946 children without ADHD whose outcomes could be ascertained, 37 children had died, five by suicide.

*Ten adults who had childhood ADHD (2.7 percent) were incarcerated when the study started.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that's overtreated," Dr. Barbaresi says. "This couldn't be further from the truth. We need to have a chronic disease approach to ADHD as we do for diabetes. The system of care has to be designed for the long haul."

Dr. Barbaresi thinks the study findings may underestimate the bad outcomes of childhood ADHD. Most of those studied were white and middle class, with good educations and access to health care.

"One can argue that this is potentially a best-case scenario," Dr. Barbaresi says. "Outcomes could be worse in socioeconomically challenged populations."

He advises parents of children with ADHD to ensure that their children are in high-quality treatment -- and remain in treatment as they enter adolescence. Children also should be assessed for learning disabilities and monitored for conditions associated with ADHD, including substance use, depression and anxiety.

Read more here

ER visits increase for adults with ADHD

This article discusses the possible link between ADHD medication and the increase in emergency room visits for people with ADHD.

U.S. emergency department visits involving attention-deficit/hyperactivity disorder (ADHD) drugs more than doubled from 2005 to 2010, with the largest hike occurring among adults, says a new government report.

In that period, such ER visits rose from about 13,400 to 31,200, according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

"ADHD medications, when properly prescribed and used, can be of enormous benefit to those suffering from ADHD, but like any other medication they can pose serious risks -- particularly when they are misused," SAMHSA administrator Pamela Hyde said in an agency news release.

In adults, cases rose from about 2,100 to 8,100 among those aged 18 to 25, from about 1,750 to 6,100 among those aged 26 to 34 and from roughly 2,500 to nearly 8,000 among those over 35, during the time period.

Rates among children and teens remained largely unchanged from 2005 to 2010, according to the findings published Jan. 24 in SAMHSA's DAWN Report.

The investigators also found that the number of ER visits involving the nonmedical use of ADHD medications nearly tripled during this time, from about 5,200 to nearly 15,600. In 2010, nonmedical use of ADHD drugs made up half of all ER visits involving ADHD medications.

The gap between males and females in the number of ER visits related to nonmedical use of the drugs narrowed during the study period. In 2005, the numbers were about 3,800 for males and about 1,400 for females. In 2011, numbers reached 8,650 for males and about 6,900 for females.

According to Hyde, "this study indicates that a better job has to be done alerting all segments of society -- not just the young -- that misuse of these medications is extremely dangerous."

There were 2.3 million U.S. emergency department visits related to the misuse of all drugs in 2010, according to background information in the news release.

Read more here

Study: Treating mothers with ADHD may improve outcomes in their children

A new study looks at the effect of treating a mother with ADHD on the child and how the child's outcome is improved.

University of Illinois at Chicago researchers are conducting a study to determine if treating mothers with Attention Deficit Hyperactivity Disorder -- either with medication or parent training -- will help children at risk for ADHD.

"About 25 percent of the time, when a child has ADHD, there's a parent that has ADHD," said Mark Stein, UIC professor of pediatrics and psychiatry and principal investigator of the study. "We realize this is a weakness in our service delivery models, because often clinicians focus on just treating the child and ignore the fact that another family member has ADHD."

Two treatments are very effective for children with ADHD: behavior modification and stimulant medication. Both require "a very dedicated, organized person, which, if you have ADHD, that's going to be a challenge for you," said Stein, who noted that treatment is often administered by the mother, and that women are less likely to have their ADHD identified.

The Treating Mothers First Study will identify mothers of children between ages 4 and 8 with behavior problems who are at risk for ADHD -- and evaluate both the mother and child.

Mothers with ADHD will receive either a long-acting stimulant or behavioral training for eight weeks. Afterward, the mother, family and child will be re-evaluated and then receive treatment for another eight weeks with the same treatment or a combination of medication and parent training.

Parents with ADHD may have difficulty implementing consistent rules and consequences, and they may not respond to a child's appropriate or positive behavior, Stein said. As part of the study "we observe the parent trying to play with the child, trying to get the child to do things like homework or cleaning up their room," he said.

The goal is to determine if the need for stimulant medication in children can be delayed if the mother is treated first.

ADHD is often misdiagnosed as depression or anxiety in women, and it often contributes to marital, parenting, sleep and medical problems, Stein said. Many health care providers have not been trained in diagnosing and treating adult ADHD.

"When a mom complains about how bad her life is, she's given a prescription for Prozac versus understanding that she's always had issues with inattention, distractibility, or impulsivity, and that's why she's having problems," Stein says.

"When you think of ADHD, you think of a 7-year-old boy, not a mom who says 'I am overwhelmed, easily distracted, and just can't get things done,'" he said.

Read more here

Study Suggests Men Diagnosed With ADHD as Children Had Worse Outcomes as Adults

A study looks at occupational, educational, social and economic outcomes for men who were diagnosed with ADHD as a child.

Men who were diagnosed as children with attention-deficit/hyperactivity disorder (ADHD) appeared to have significantly worse educational, occupational, economic and social outcomes in a 33-year, follow-up study that compared them with men without childhood ADHD, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.

ADHD has an estimated worldwide prevalence of 5 percent, so the long-term outcome of children with ADHD is a major concern, according to the study background.

Rachel G. Klein, Ph.D., of the Child Study Center at NYU Langone Medical Center in New York, and colleagues report the adult outcome (follow-up at average age of 41 years) of boys who were diagnosed as having ADHD at an average age of 8 years. The study included 135 white men with ADHD in childhood, free of conduct disorder (probands), and a comparison group of 136 men without childhood ADHD.

"On average, probands had 2½ fewer years of schooling than comparison participants … 31.1 percent did not complete high school (vs. 4.4 percent of comparison participants) and hardly any (3.7 percent) had higher degrees (whereas 29.4 percent of comparison participants did). Similarly, probands had significantly lower occupational attainment levels," the authors note. "Given the probands' worse educational and occupational attainment, their relatively poorer socioeconomic status at [follow-up at average age of 41 years] is to be expected. Although significantly fewer probands than comparison participants were employed, most were holding jobs (83.7 percent). However, the disparity of $40,000 between the median annual salary of employed probands and comparisons is striking."

In further comparisons of the two groups, the men who were diagnosed with ADHD in childhood also had more divorces (currently divorced, 9.6 percent vs. 2.9 percent, and ever been divorced 31.1 percent vs. 11.8 percent); and higher rates of ongoing ADHD (22.2 percent vs. 5.1 percent, the authors suspect the comparison participants' ADHD symptoms might have emerged during adulthood), antisocial personality disorder (ASPD, 16.3 percent vs. 0 percent) and substance use disorders (SUDs, 14.1 percent vs. 5.1 percent), according to the results.

During their lifetime, the men who were diagnosed with ADHD in childhood (the so-called probands) also had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. And relative to the comparison group, psychiatric disorders with onsets at 21 years of age or older were not significantly elevated in the probands, the study results indicate.

The authors note the design of their study precludes generalizing the results to women and all ethnic and social groups because the probands were white men of average intelligence who were referred to a clinic because of combined-type ADHD.

"The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD," the study concludes.

Read more here

Extra Challenges for College Students with ADHD

This article discusses the hardships that college students with ADHD face.

Nearly 10% of American young people have been diagnosed with ADHD at some point in their lives. And although some grow out of the diagnosis, most don't, leaving more and more teens with labels and struggles unknown in their parents' generation.

Some flounder in college when mom, dad and homeroom teachers aren't there to offer support, and haphazard course schedules don't provide the structure of high school.

It's important for parents and other adults to take ADHD seriously, says Stephen Hinshaw, a psychology professor at the University of California, Berkeley, whose recent study found that girls with ADHD are more likely to attempt suicide or injure themselves than girls without the condition.

But figuring out how to best help those teens can be tricky, say counselors, psychiatrists and adults with ADHD, because everyone's situation and form of ADHD is different.

There are certain common threads, though: Adequate preparation, getting the right accommodations, and being on the appropriate treatment, they add.

Several experts say it's important for students to figure out their own best routines and what works for them. And it's a good idea, they say, to start training teens to do this years before they're ready to leave home.

"Let them practice living independently before they come to college. Getting up and going to bed on their own. Scheduling their daily tasks and keeping their own appointments," says Jamie Davidson, a psychologist and assistant vice president for student wellness at the University of Nevada, Las Vegas.

It can be frustrating for parents, especially those who have had to advocate for their kids for so long, to be suddenly cut off when their child is at college.

But parents still play a key role in monitoring their child, staying in touch, and calling attention to small problems before they become big ones.

"I think parents have to find the right balance between continuing to be involved in their kids' lives, but allowing the son or daughter to become their own individual and figure out how to solve their problems," says physician Ralph Manchester, director of the University Health Service at the University of Rochester (N.Y.), where roughly 5% of students take prescription medication for ADHD. Demand for counseling services has jumped 45% in the last five years.

Colleges can't and won't monitor whether kids take their medications, says Jennifer Haubenreiser, president of the American College Health Association and director of health promotion at Montana State University in Bozeman.

Sometimes those legitimately prescribed ADHD medications will share it with other students, especially around finals time; some believe it will help them concentrate, but there's no data showing it actually does. Haubenreiser says that 90% of non-medical use of ADHD drugs is through friends.

That's why students should keep their ADHD diagnosis and medication status to themselves, "so that at finals time no one comes around looking for it," says psychiatrist Craig Surman, an adult ADHD expert at Harvard Medical School and Massachusetts General Hospital.

Tips for helping a teenager with ADHD adapt to college:

1. Know what helped your child thrive in the past and try to replicate it when they go off to college.

2. Keep their diagnosis and medications private.

3. Find a doctor close to school who can check in about medications without waiting for the holidays. Sometimes students will need to adjust their dosage to help cope with the more stressful, less structured environment at college.

4. Provide your teenager with as much structure and resources as will be helpful. If you foresee that laundry will be a problem, for instance, check into laundry services on campus. Tutoring from the professor or a graduate student in need of extra cash can make a big difference for some students, as can regular check-ins with an on-campus counselor.

5. Most colleges will offer accommodations such as extra time on tests, recorded lectures and help with note-taking, but offerings and costs for these services vary from school to school.

6. Make sure your teen knows the basics of how to eat healthy meals and get adequate exercise and sleep. Healthy habits may be particularly important for teens with ADHD, but also particularly challenging for them to stick to routines.

7. Help them set out goals ahead of time to make sure they keep up with school work. Don't let them wait for poor grades at the end of a semester before recognizing a problem.

8. Teach them to ask for help if they need it -- as a sign of strength, not weakness.

Read more here

Teens With ADHD May Need Help Making Transition to College

Experts offer suggestions for students on how to compensate for their disorder

Friday, August 17, 2012

"The ones who are going to do best are those who come to college prepared, who are aware of their weaknesses and have some strategies for compensating," said Kristy Morgan, a recent Kansas State University doctoral graduate in student affairs and higher education who conducted in-depth interviews with eight college freshman with ADHD about what they learned from the experience.

FRIDAY, Aug. 17 (HealthDay News) -- For students with attention-deficit/hyperactivity disorder, or ADHD, making the transition to college can be especially difficult. But by adopting certain strategies, such as sticking to a structured daily schedule and tapping into the university's disability support services, freshman with ADHD can do well, according to experts and teens with the condition.

Certain themes emerged.

While most students said they got through high school without having to study much, they found college classes much tougher -- and most felt they didn't have the study skills to handle it.

"They were able to get through junior high and high school pretty well, and get good enough grades to get into college," Morgan said. "Then they got to college. They were finding they had to study very independently, and there were less in-class opportunities for test prep, and it was more difficult."

Students with ADHD also said they looked forward to the "freedom" of a less regimented college schedule, yet they found it more difficult to manage their time without the structure that high school provides.

.....

To help students with ADHD make the transition to college, the experts offered teens and parents these tips:

• Get educated about ADHD:...
• Develop study strategies...
• Set a schedule...
• Contact disability support services: ...
• Continue taking medications:...

SOURCES: Kristy Morgan, Ph.D., Kansas State University, Manhattan, Kan., doctoral dissertation, Kansas State University; Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, N.Y.

More here