Kids with ADHD may be more likely to drink and smoke

A study shows that kids who have ADHD may be more likely to drink and smoke as teenagers.

Teens are more likely to start smoking or drinking with each additional symptom they have of attention-deficit hyperactivity disorder (ADHD) or conduct disorder, new research suggests.

"Our findings underscore the need to counsel families about the risk of substance use as [these] children approach adolescence," said study author Dr. William Brinkman, research director at Cincinnati Pediatric Research Group, which is part of Cincinnati Children's Hospital. "This need is heightened among children with ADHD and/or conduct disorder diagnoses or symptoms."

Brinkman's team analyzed data on more than 2,500 teens, aged 12 to 15, in a national survey conducted with their parents between 2000 and 2004.

First, the researchers identified the teens with an ADHD and/or conduct disorder diagnosis, as well as those with the symptoms of either disorder, regardless of whether there was a diagnosis. Conduct disorder is characterized by aggressive, destructive or deceitful behavior. Children with ADHD tend to be hyperactive, impulsive and/or inattentive.

Then Brinkman's team compared use of tobacco and alcohol among the teens, to look for a link between symptoms of ADHD or conduct disorder and substance use.

Brinkman said that 45 percent of the children in the study had at least one ADHD symptom, and nearly 15 percent had at least one conduct disorder symptom.

For each additional ADHD symptom related to inattention -- but not hyperactivity or impulsivity -- the risk that a teen would use tobacco or alcohol increased by 8 percent to 10 percent. Similarly, each additional conduct disorder symptom was linked to a 31 percent increase in the likelihood of using tobacco, according to the study.

A very small percentage of teens in the study -- about 1.5 percent -- were diagnosed with both ADHD and conduct disorder. These teens were more than three times more likely to use tobacco or alcohol, even after accounting for differences in age, race/ethnicity, sex, household income and having a household member who smoked.

The findings were published recently in the journal Drug and Alcohol Dependence.

Brinkman said more research may provide clues as to why the link exists between these disorders and substance use.

"Because nicotine can improve attention and arousal, some have speculated that the association between inattention symptoms and higher rates of tobacco use suggests a form of self-medication for ADHD," Brinkman said. "Certainly higher rates of risk taking and novelty seeking has been documented among children with a diagnosis of ADHD, as well as those with ADHD symptoms [but too few for a diagnosis]."

Social pressures may be involved as well, suggested Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

"It is important to emphasize that not all teens with ADHD follow this path, just a higher percentage than those without ADHD," Elliott said. "We believe it is a combination of impulsive decision-making and perhaps the social strain that ADHD can place on the individual, who may feel unable to connect with peers in socially acceptable ways and therefore more vulnerable to trying other methods such as doing things peers dare them to do or that they view as 'cool' or 'adult.' "

Elliott said the study provides new insights into the interplay between ADHD and conduct disorder. But it sheds little light on whether treating ADHD, either earlier in childhood or during adolescence, might change the risk of starting to smoke or drink, he said.

"We believe medication can make a difference, but the evidence is not nearly as compelling as we wish it were -- partly because teens often go through a phase of refusing to take medications just when it might do them the most good," Elliott said. "Just as with parents of any teenager, there is no guaranteed way to prevent a son or daughter from experimenting if they are determined to do so."

The best tools parents have, Elliott said, are setting consistent and clear expectations for their children, closely monitoring them, praising them for good choices and administering appropriate, meaningful consequences for poor choices -- while also showing children early on what behavior is acceptable.

"Adolescence is hard," Elliott said. "And having ADHD can make it harder. So parents need to be vigilant, caring, consistent and involved."

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Brain wave test to diagnose ADHD approved by FDA

The FDA approved a brain wave test to diagnose ADHD, one of the only objective tests for this purpose.

The first brain wave test that could help diagnose children and teens with attention-deficit/hyperactivity disorder (ADHD) has been approved by the U.S. Food and Drug Administration.

The device can be used in patients between the ages of 6 and 17 as part of a complete psychological examination to either help confirm an ADHD diagnosis or bolster a doctor's decision that more testing for ADHD or other disorders is needed, the FDA said in a news release Monday.

Called the NEBA system, the 20-minute noninvasive test uses an electroencephalogram (EEG) to calculate the ratio of two brain wave frequencies, called theta and beta, which studies have shown is higher in children and teens with ADHD.

One expert offered a word of caution about the device.

"For clinicians and researchers interested in ADHD, an objective diagnostic test that is accurate, sensitive and specific has been one of the 'holy grails' which has long been sought," said Dr. Andrew Adesman, chief of developmental & behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York, in New Hyde Park, N.Y.

However, he added, "it is doubtful that this EEG test newly approved by the FDA will be as accurate and reliable as clinicians and families would ideally want.

"Given concerns among the public and some professionals about the steady increase in the number of children and adolescents being diagnosed with ADHD, it would be wonderful if clinicians had an objective test to assist in the diagnostic process," Adesman said. "Although this new EEG test may prove helpful to clinicians, neither parents nor professionals will be able to rely upon it as a standalone 'litmus test' for whether a child has ADHD."

Adesman also noted that the FDA has approved other "objective" diagnostic tests for ADHD that have not become a common part of diagnosing the disorder, and the fate of the NEBA system remains to be seen.

The device, made by NEBA Health of Augusta, Ga., is already used to assess sleep issues, measure unconsciousness, diagnose side effects from head injuries and monitor the brain during surgery, according to CBS News.

The FDA's approval of the device was based on a company-funded study of 275 children and teens with attention or behavioral problems. The study showed that the test, when used with standard diagnostic criteria, helped doctors more accurately diagnose the disorder when compared to a doctor's exam alone, the agency said in its statement.

"Diagnosing ADHD is a multistep process based on a complete medical and psychiatric exam," Christy Foreman, director of the Office of Device Evaluation at the FDA's Center for Devices and Radiological Health, said in the news release. "The NEBA System along with other clinical information may help health care providers more accurately determine if ADHD is the cause of a behavioral problem."

ADHD is a common childhood disorder. Nine percent of American teens have ADHD and the average age of diagnosis is 7, according to the American Psychiatric Association. Symptoms of ADHD include inattention, hyperactivity, impulsivity and behavioral problems. Treatments for ADHD include medication, behavioral modifications and therapy.

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The harm of using ADHD medication to study

This article discusses the negative effects of students using ADHD medication for the purpose of studying.

Adderall and other ADHD medications are among the most prescribed drugs in America.

Quite a few of those pills don't end up being used to treat ADHD, though. They're used as "smart drugs" or "study drugs" by students who find the pills give them a mental edge.

The American Academy of Neurology now says: Stop that.

The brain docs are directing that advice first and foremost to their fellow physicians, the ones who have been writing all those scrips for people who don't have ADHD, or who perhaps don't think about all the pills their patients sell on the student black market.

"We don't believe that doctors are supposed to be drug dispensers for healthy people," says William Graf, a professor of pediatrics and neurology at the Yale School of Medicine. "This is an ethics issue."

But the message is also being sent to teenagers and their parents, some of whom who might think that giving their child a little leg up for a big test isn't such a bad thing. The buzz term for that? "Pediatric neuroenhancement."

Prescribing ADHD drugs to children who don't have the disorder is "not justifiable," according to the American Academy of Neurology's new position paper. That's because children's brains are still developing, the paper says, and they don't have the ability to weigh the risks and benefits of medication.

Prescribing study drugs is "inadvisable" in teenagers, the Academy said, a word chosen to reflect both teenagers' growing autonomy, and the fact that the Academy can't tell doctors what drugs they can and can't prescribe.

The number of children diagnosed with ADHD rose 24 percent from 2001 to 2011, according to a study published earlier this year. Over the same time, the number of prescriptions for Adderall and other ADHD drugs has soared exponentially.

More pills in circulation means more pills that can be bought, borrowed, or snitched. Various surveys report that 8 to 35 percent of college students say they have used stimulant pills to improve school performance.

The neurologists are not saying that stimulant drugs shouldn't be used to treat ADHD, which is characterized by problems with attention and hyperactivity. "We're not touching that here," Graf told Shots.

What they are saying is that doctors have a moral obligation to protect the best interests of the child — who doesn't yet have legal control over health care decisions — and to prevent the misuse of medication.

Amphetamines like Adderall and Vyvanse can be addictive, which is why they're classified as Schedule II controlled substances, along with Oxycontin and morphine. Side effects can be as simple as insomnia, or as serious as sudden high blood pressure, irregular heartbeat, and seizures.

Other popular ADHD drugs like Concerta and Ritalin are methlphenidates, and are considered less risky. But they can cause a wide range of side effects including insomnia, aggression, mood and behavior changes, twitching, and shaking.

About 15 percent of 12^th graders say they misuse prescription drugs, according to the 2012 Monitoring the Future survey, and about 6 percent say they've misused Ritalin or Adderall. Adderall is the only drug class that showed increased use in 2012, the federal survey reported.

"As a society we have a pill for everything," Graf says. "It's one thing if you're taking something from the Vitamin Shoppe. It's another thing if you're talking about amphetamines."

Doctors should talk with patients and parents about why they feel the need for academic performance enhancing drugs, Graf says. Then they should point out that there are other ways to deal with competition and anxiety.

"We have to get back to the basics," Graf says. "Sleep, exercise, and social interaction."

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Study: Continued Use of ADHD Drugs May Reduce Criminal Behavior

According to research from Sweden, people who routinely take their ADHD medication are less likely to be arrested.

For teens and adults who don't grow out of attention deficit hyperactivity disorder, staying on ADHD medications may help them stay out of trouble.

Males with ADHD who stayed on medications for the disorder reduced their risk of criminal behavior by 32 percent, while women who did so reduced their rates of criminal behavior by 42 percent, according to a large Swedish study.

"It seems as though ADHD medications decrease the risk for criminality while under treatment," said the study's lead author, Paul Lichtenstein, professor of genetic epidemiology at the Karolinska Institute, in Stockholm.

Results of the study are published in the Nov. 22 issue of the New England Journal of Medicine.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York, in New Hyde Park, said past research has found that adults with ADHD have a "host of increased risks later in life, like driving accidents, losing jobs, divorce and arrests." Adesman said those at greatest risk of criminal behavior are those with hyperactivity.

Adesman added that it's important for parents to know that not all children with ADHD will engage in criminal behavior, and that some children will outgrow ADHD. Still, "collectively, people with ADHD are at risk for a range of poor outcomes," he said.

For the current study, the researchers gathered information on more than 25,000 people living in Sweden with a diagnosis of ADHD. They also collected information on what types of medications were given as treatment, and any criminal convictions that occurred between 2006 and 2009.

Researchers then compared non-medication periods to medication periods and the rates of criminal behavior for each person.

The risk of criminal activity dropped by more than a third for men and women combined during medication periods, according to the study.

Lichtenstein said the researchers didn't study whether medications were more effective in reducing criminal behavior for a particular age group. They also didn't look at whether one type of medication was better at decreasing the risk of criminal activity, but he said those that influence the core symptoms of ADHD -- such as impulsivity, restlessness and irritability -- are likely to be better at reducing criminal behavior.

Lichtenstein said ADHD medications should be seriously considered for adolescents and young adults with ADHD who are at risk for criminal behavior.

"All medications have potential adverse side effects, and the clinician should weigh risks and benefits for each patient," he added. "Now, they should include the potential decreased risk of criminality in that evaluation."

For his part, Adesman said that based on the findings of this study, it looks as though treatment with ADHD medication can make a difference in the risk of criminal behavior. But, he said, it's important to realize that the population in this study isn't the same as the population in the United States, so the findings might be different if the study were done here.

Adesman said it is also important not to "presume that children diagnosed with ADHD today have the same risks of criminality as people diagnosed 20 years ago, given the greater awareness, education resources and support that is available today."

However, he added, "I suspect that symptomatic people probably do better with medications."

Although the study found an association between staying on ADHD medication and reduced criminal behavior, it did not prove a cause-and-effect relationship.

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