Study: Children with ADHD and congenital heart disease can take stimulants

According to a recent study, it is safe for children with both ADHD and congenital heart disease to take stimulant medication.

A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects.

In a study to be presented at a national meeting Oct. 4, researchers at Cincinnati Children's Hospital Medical Center have found no increased risk for death or changes in cardiac vital signs, such as blood pressure or heart rate, even for children with ADHD and severe heart conditions. They also found that when treated with stimulant medications, patients had significant improvements in ADHD symptoms as measured by standardized rating scales.

"Children with congenital heart disease are at high risk for ADHD, but fears about cardiovascular side effects, including sudden death, limit the use of stimulant medications," says Julia Anixt, MD, a developmental and behavioral pediatrician at Cincinnati Children's and senior author of the study. "This study indicates that stimulants are both effective and safe when prescribed with appropriate monitoring and in collaboration with the patient's cardiologist."

The study will be presented by Pon Trairatvorakul, MD, a fellow in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's, at the annual meeting of the Society for Developmental and Behavioral Pediatrics in Las Vegas.

The researchers studied 44 children between the ages of 6 and 18 seen in the Cincinnati Children's Heart Institute Kindervelt Neurodevelopmental and Educational Clinic. They compared these patients to those with similar heart disease but who were not treated with stimulants. The researchers' next step is to study the effect of stimulant medications on electrocardiograms (EKGs), which measure electrical activity of the heart.

Since 2006, the U.S. Food and Drug Administration has required labeling of stimulant medications to include a warning that they generally should not be used in children and adolescents with serious structural cardiac abnormalities, cardiomyopathy or arrhythmias. However, stimulants are the most effective medication to treat ADHD symptoms, and patient families, cardiologists, and developmental pediatricians must together weigh the risks and benefits of medication treatment options for each individual patient, according to Dr. Anixt.

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ADHD medication to help with binge eating

A study found that ADHD medication may be an effective treatment for binge eating disorders.

A drug approved for the treatment of attention deficit-hyperactivity disorder (ADHD), lisdexamfetamine dimesylate, cuts the number of binge eating days in people with binge eating disorder, according to a study published in JAMA Psychiatry^[1].

There is currently no approved medicine for binge-eating disorder, an eating disorder characterized by recurrent episodes of excessive food consumption, a sense of loss of control and psychological distress, and being overweight or obese.

Guidance from the UK’s National Institute for Health and Care Excellence, published in 2004, recommends that patients follow an evidenced-based self-help programme as a first step or a trial course of a selective serotonin reuptake inhibitor. Patients may also be offered a course of cognitive behavioural therapy (CBT), which has been shown to have an impact on binge eating behaviour, it says.

In this study, researchers from the Lindner Center of HOPE in Mason, Ohio, compared 11 weeks of treatment with 30mg/day, 50mg/day or 70mg/day lisdexamfetamine (marketed at Elvanse in Europe and as Vyvanse in the United States) with placebo in a randomised trial including 260 adults with moderate to severe binge-eating disorder.

The number of binge eating days per week decreased in the 50mg/day and 70 mg/day treatment groups compared with placebo – log-transformed binge eating days per week decreased with the 50-mg/day (least squares [LS] mean [SE] change, −1.49 [0.066]; P = .008) and 70-mg/d (LS mean [SE] change, −1.57 [0.067]; P < .001) but not in the 30 mg/day group (LS mean [SE] change, −1.24 [0.067]; P = .88).

Fewer patients also achieved four-week binge eating cessation in the placebo group (21.3%) compared with the 50 mg/day (42.2%) and 70 mg/day (50%) treatment groups.

Patients who took lisdexamfetamine also lost weight over the 11 weeks: the mean (SD) change in body weight was −3.1kg (3.64) for 30mg/day, −4.9kg (4.43) for 50mg/day, and −4.9kg (3.93) for 70mg/day (P < .001). The weight of patients in the placebo group remained unchanged at −0.1kg (3.09).

The authors say their findings support the need for further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behaviour in adults with moderate to severe binge-eating disorder. “Confirmation of these findings in ongoing clinical trials may result in improved pharmacologic treatment for moderate to severe binge-eating disorder,” they say.

“Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship” was involved, they add, and “the lisdexamfetamine safety profile was generally consistent with findings in adults with ADHD”.

Susan Ringwood, chief executive officer of Beat, the charity that supports and campaigns on behalf of people with eating disorders, says: “We know how important it is for people to get evidence-based psychological treatment for their eating disorder, and that pharmacological treatment is not sufficient by itself. This study seems to be saying that because it isn’t easy to access CBT and other evidence-based psychological treatments, these drugs are an alternative.”

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What is causing the global surge in ADHD diagnoses?

What is causing the global surge in ADHD diagnoses? This article believes it has to do more with marketing than medicine.

You can't catch attention deficit hyperactivity disorder (ADHD). Yet the diagnosis and treatment of this behavioral condition is spreading like a contagion -- surging as much as tenfold in some countries.

Call it an economic and cultural plague, but not necessarily a medical one, says Brandeis professor Peter Conrad. In a recent paper in the journal Social Science and Medicine, Conrad and coauthor Meredith Bergey examined the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil.

Until recently, North America tallied by far the most ADHD diagnoses, and the United States consumed 90 percent of all Ritalin, one of the most common ADHD drugs. ADHD diagnoses continue to grow in the U.S., but Americans account for only 75 percent of Ritalin users today.

Conrad and Bergey attribute ADHD's growth to five trends. Drug companies are effective lobbyists, and have spurred some countries to relax marketing restrictions on stimulants. Psychoanalytic treatment with talk therapy is giving way to biological psychiatry -- treating psychological problems with drugs. More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD. Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment. Lastly, the easy availability of ADHD information and self-diagnosis via the Internet empowers consumers to ask for prescription treatment.

Many websites promoting ADHD drugs offer checklists with questions like these:

• Do you fidget a lot?
• Is it hard for you to concentrate?
• Are you disorganized at work and home?
• Do you start projects and then abandon them?

"These checklists turn all kinds of different behaviors into medical problems," Conrad says. "The checklists don't distinguish what is part of the human condition and what is a disease."

According to the study, in the U.K., diagnosis of the disorder in school-age children grew from less than one percent in the 1990s to about five percent today. In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.

Growth in Italy and France has been slower, in part due to those countries' more restrictive pharmaceutical drug laws. However, even those nations are becoming more lax, says Conrad. In Brazil, a rising number of ADHD advocacy groups, many with close ties to the pharmaceutical industry, are raising awareness of the disorder.

"There is no pharmacological magic bullet," says Conrad. No drug can account for nonmedical factors that may contribute to behavior. A fidgety student may be responding to the one-size-fits-all compulsory education system, Conrad says, not a flaw in his brain chemistry.

ADHD continues a long history of medicalizing behaviors, especially in the U.S., Conrad says. A century ago, masturbation was considered a disease. Men and women diagnosed with masturbatory insanity were institutionalized or subjected to surgical treatment.

"I think we may look back on this time in 50 years and ask, what did we do to these kids?" Conrad says.

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Few children with ADHD get behavioral therapy

A study found that children who take ADHD medication get little psychotherapy or behavioral treatment to complement their medication.

Few children who take medication for attention-deficit/hyperactivity disorder (ADHD) also undergo behavioral therapy, and the rates vary six-fold across counties in the United States, a new study finds.

Medication alone can manage symptoms for many children with ADHD, but some do better if they also receive behavioral therapy (psychotherapy), the Rand Corp. researchers noted.

The researchers analyzed data in more than 1,500 counties across the United States that included more than 300,000 privately insured children, aged 17 and younger, who were prescribed ADHD drugs. Less than a quarter of them received any psychotherapy in the same year they took ADHD medications; 13 percent had at least four therapy visits, and seven percent had at least eight therapy sessions.

In some counties, fewer than 10 percent of kids taking ADHD drugs got behavioral therapy, according to the study, which was published as a research letter in the Sept. 22 issue of the journal JAMA Pediatrics.

Those who lived in counties with fewer licensed psychologists were less likely to receive psychotherapy while taking ADHD drugs, the data showed. But even in some counties where the number of psychologists were the same, the rates varied.

In California's Sacramento County, almost half the kids with ADHD received therapy along with drugs, compared to only about 20 percent of those in Florida's Miami-Dade County, the researchers noted.

"Treatment of ADHD in children generates lots of controversy, primarily because of potential for overuse and abuse of stimulant medications," study author Dr. Walid Gellad, an adjunct scientist at Rand, said in a news release from the nonprofit research organization.

"We wanted to find out among those who receive ADHD medications, how many are also receive billed psychotherapy services? The answer is few, but it actually depends on where you live," Gellad said.

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Study: ADHD Medications will not stunt children's growth

A study shows that taking ADHD medications will not stunt a child's growth.

Stimulant medications -- such as Adderall, Ritalin and Concerta -- used to treat attention-deficit/hyperactivity disorder (ADHD) in children, won't stunt their growth, a new study suggests.

"Stimulant medication did not affect children's final height as adults," said study researcher Dr. Slavica Katusic, an associate professor of pediatrics at the Mayo Clinic in Rochester, Minn.

Katusic noted that results of earlier studies have been mixed, with some showing these drugs retard growth and others showing they don't. But, most of the previous studies had limitations, such as having too few children or spotty information about adult height, she said.

Katusic said this study is unique because it followed a group of people with ADHD who were taking stimulant medications and compared them with a group with ADHD who were not taking medication and also a group that didn't have ADHD. These individuals were followed from childhood to adulthood, she said.

ADHD is one of the most common disorders of childhood, according to the U.S. National Institute of Mental Health (NIMH). Symptoms include difficulty paying attention or staying focused on one task, overactivity and impulsive behavior, the NIMH explains.

Stimulant medications are a mainstay of ADHD treatment, and while it may seem odd to use stimulant medication on an overactive child, stimulant drugs have a calming, focusing effect on youngsters with ADHD, according to the NIMH. Katusic said these drugs are important for improving school and social functioning.

Katusic's team studied 340 children with ADHD and 680 without the condition. "We compared the height when they were children and when they were grown up," she said.

The average follow-up time was 26 years for those with ADHD and 23 years for people without ADHD. Approximately 70 percent of those with ADHD who completed the study had taken stimulant medication for more than three months, the researchers noted.

There was no difference in adult height between those who took ADHD drugs and those who didn't, the investigators found.

"Neither childhood ADHD itself nor stimulant medication was associated with shorter stature as adults," Katusic said.

Boys with ADHD who were treated with stimulants for three or more months had a later growth spurt than boys who didn't take these drugs, but there was no difference in the size of the growth spurt, the researchers noted.

In addition, no connection was seen between the amount of time a child took stimulant drugs and adult height, the study authors found.

"But despite our findings, doctors should monitor growth when making medication decisions," she said. "Our study says don't worry at all, but human beings are all different and you always have to be careful."

The report was published online Sept. 1 in the journal Pediatrics.

Dr. Marcel Deray, a pediatric neurologist at Miami Children's Hospital, said, "This is good news, because we discuss this issue with parents of kids with ADHD."

Deray hopes the study will be replicated to prove the point that these stimulants don't affect height. "It would good to have a couple of studies showing the same thing," he said.

He also said this finding should be reassuring to parents who may be reluctant to allow their children to use these drugs because of the potential risk of stunting their child's growth.

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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

ADHD diagnosis by involuntary eye movements

A study shows that ADHD can accurately be diagnosed by a person's involuntary eye movements.

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed -- and misdiagnosed -- behavioral disorder in children in America, according to the Centers for Disease Control and Prevention. Unfortunately, there are currently no reliable physiological markers to diagnose ADHD. Doctors generally diagnose the disorder by recording a medical and social history of the patient and the family, discussing possible symptoms and observing the patient's behavior. But an incorrect evaluation can lead to overmedication with Ritalin (methylphenidate), which has parents everywhere concerned.

Now a new study from Tel Aviv University researchers may provide the objective tool medical professionals need to accurately diagnose ADHD. According to the research, published in Vision Research, involuntary eye movements accurately reflect the presence of ADHD, as well as the benefits of medical stimulants that are used to treat the disorder.

Keeping an eye on the eyes

Dr. Moshe Fried, Dr. Anna Sterkin, and Prof. Uri Polat of TAU's Sackler Faculty of Medicine, Dr. Tamara Wygnanski-Jaffe, Dr. Eteri Tsitsiashvili, Dr. Tamir Epstein of the Goldschleger Eye Research Institute at Sheba Medical Center, Tel Hashomer, and Dr. Yoram S. Bonneh of the University of Haifa used an eye-tracking system to monitor the involuntary eye movements of two groups of 22 adults taking an ADHD diagnostic computer test called the Test of Variables of Attention (TOVA). The exercise, which lasted 22 minutes, was repeated twice by each participant. The first group of participants, diagnosed with ADHD, initially took the test un-medicated and then took it again under the influence of methylphenidate. A second group, not diagnosed with ADHD, constituted the control group.

"We had two objectives going into this research," said Dr. Fried, who as an adult was himself diagnosed with ADHD. "The first was to provide a new diagnostic tool for ADHD, and the second was to test whether ADHD medication really works -- and we found that it does. There was a significant difference between the two groups, and between the two sets of tests taken by ADHD participants un-medicated and later medicated."

Foolproof, affordable, and accessible diagnosis

The researchers found a direct correlation between ADHD and the inability to suppress eye movement in the anticipation of visual stimuli. The research also reflected improved performance by participants taking methylphenidate, which normalized the suppression of involuntary eye movements to the average level of the control group.

"This test is affordable and accessible, rendering it a practical and foolproof tool for medical professionals," said Dr. Fried. "With other tests, you can slip up, make 'mistakes' -- intentionally or not. But our test cannot be fooled. Eye movements tracked in this test are involuntary, so they constitute a sound physiological marker of ADHD.

"Our study also reflected that methylphenidate does work. It is certainly not a placebo, as some have suggested."

The researchers are currently conducting more extensive trials on larger control groups to further explore applications of the test.

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Study claims that ADHD medication can increase risk of heart issues

A study claims that medication used to treat ADHD might increase the risk of heart complications in children.

Whether drugs used to treat attention deficit hyperactivity disorder boost the risk of heart conditions in children remains a subject of concern. Now, research from Denmark suggests medications such as Ritalin and Concerta make rare cardiac problems twice as likely, although still uncommon.

"The risk of adverse cardiac effects of ADHD medication is real and should not be forgotten," said study lead author Dr. Soren Dalsgaard, an associate professor at Aarhus University.

However, doctors and parents should not be alarmed and take kids off stimulant medication if they have benefits from it and no cardiac symptoms, he said. "But we should continue to monitor cardiovascular status," he added.

The findings aren't definitive because they don't prove cause-and-effect and they seem to conflict with some previous research that looked at fewer heart conditions over shorter periods of time.

The inattention, hyperactivity and impulsivity associated with ADHD can make it hard for children with the disorder to learn and socialize. Stimulant drugs taken on a daily basis can help control these behaviors.

Worldwide, the number of children and teens with ADHD who take stimulant medications is increasing, according to background research in the study. Experts say these drugs can boost heart rate and blood pressure.

"The most common cardiac effects are benign -- very small, clinically insignificant increases in heart rate or blood pressure," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park.

Alarms sounded because of reports of sudden deaths, heart attack and stroke related to ADHD drugs, which has led some physicians to assess heart health before starting young people on the drugs.

But a 2011 study of U.S. children and young adults published in the New England Journal of Medicine found no link between ADHD drugs and heart attacks, sudden death and stroke. And in 2012, a study in the Journal of the American Medical Association found no sign of a link in young and middle-aged adults either.

The new study, published online recently in the Journal of Child and Adolescent Psychopharmacology, followed 714,000 children in Denmark, born from 1990 to 1999, for an average of 9.5 years. Of those, 8,300 were diagnosed with ADHD after age 5.

Of the total with ADHD, 111 kids -- or a little more than 1 percent -- had a heart problem such as high blood pressure, cardiac arrest, irregular heartbeat or general cardiovascular disease.

When the researchers adjusted their statistics to take into account certain differences, they found those who took methylphenidates such as Ritalin or Concerta -- whether diagnosed with ADHD or not -- were about twice as likely to suffer from heart problems.

The researchers didn't examine whether ADHD itself could be linked to heart problems.

In a news release, journal editor Dr. Harold Koplewicz said the study "confirms the small but real risk we have understood for some time through prior reports and clinical experience." Koplewicz is president of the Child Mind Institute in New York City.

The findings raise the question of whether the benefits of the drugs outweigh the possible harms. In the big picture, few children who took the drugs actually developed heart problems, study lead author Dalsgaard said.

"Indeed, the benefits from ADHD medication can be worth the risk of adverse effects, but we should not underestimate the risk of cardiac effects," he said.

Adesman emphasized the rarity of heart problems in ADHD patients. Parents may wish to talk to a pediatric cardiologist if their child has an existing heart problem and they wish to put them on a stimulant for ADHD, he said.

"In my experience, most cardiologists will support treatment with stimulant medication for most children with congenital heart disease -- even for kids who have had open heart surgery to repair a malformed heart," he said.

More research is planned, Dalsgaard said, especially to unravel an unusual finding in the study. Children seemed at higher risk of heart problems if their doctors had lowered their drug dosage. It's not clear if the change in dose contributed to the heart issues or whether there's another explanation.

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Study shows that ADHD treatment does not increase suicide risk

A study shows that drug therapy for ADHD does not increase suicide risk.

A new register-based study from Karolinska Institutet in Sweden shows that drug therapy for ADHD does not entail an increased risk of suicide attempts or suicide, as was previously feared. The results are published in the British Medical Journal (BMJ).

"Our work in several ways shows that most likely there is no link between treatment with ADHD drugs and an increased risk of suicide attempts or suicide. The results rather indicate that ADHD drugs may have a protective effect," says Henrik Larsson, researcher at the Department of Medical Epidemiology and Biostatistics, who headed the study.

Earlier research has indicated that ADHD drug treatment would increase the occurrence of suicidal thoughts. However, these studies have been small scale and/or the methods used have been limited, which make the results uncertain. To gain clarity in this matter, researchers at Karolinska Institutet have now used national patient registers to identify all patients in Sweden diagnosed with ADHD between 1960 and 1996; a total of 37,936 individuals. These people were then followed over the period 2006-2009, in terms of drug treatment and events that could be linked to suicide attempts and suicide.

Among other things, the study compared the rate of suicidal behaviors while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication. Using this design the researchers were able to determine that there was no evidence to support that ADHD drug therapy would increase the risk of suicide attempts/suicide. One strong point of the study now being published is that all the individuals were compared to themselves, as this allowed the researchers to take into account the differences between those taking the drugs and those who do not.

"Many epidemiological studies on the risks related to drugs fail to adjust for the differences between individuals who take the drugs and those who do not. This is a critical limitation given that the individuals on medication are usually more severely ill than the others," says Henrik Larsson.

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Treating ADHD lowers the chance that a child will smoke

A study shows that treating ADHD lowers the chances that children with ADHD will smoke.

Children taking medications to treat attention-deficit/hyperactivity disorder (ADHD) -- such as Adderall, Ritalin and Vyvanse -- are less likely to smoke, according to a new analysis.

Kids with ADHD who were treated with these so-called stimulant medications were about half as likely to smoke as children with this disorder who weren't treated with these medications, researchers found.

"We found an association between getting treated with stimulant medications and having a lower risk of smoking in adolescence and adulthood," said study researcher Erin Schoenfelder, clinical psychologist at Duke University School of Medicine in Durham, N.C.

The study, which was funded by the U.S. National Institute on Drug Abuse, is published online May 12 and in the June print issue of the journalPediatrics.

About 11 percent of American children aged 4 to 17 have a diagnosis of ADHD, according to the U.S. Centers for Disease Control and Prevention (CDC). Children with ADHD can be impulsive, have trouble concentrating and may have other behavior problems. About 70 percent to 80 percent of children respond to stimulant medicine, according to the CDC. Behavior therapy can also help.

Experts have long known that children with ADHD have a higher risk of starting to smoke cigarettes. Teens with ADHD are two to three times more likely to smoke cigarettes than their friends who don't have the diagnosis, according to Schoenfelder, citing previous research.

But, research on the effects of ADHD stimulant medicine on the risk of smoking has been conflicting.

To try to better answer the question of whether or not these medications could help prevent kids from smoking, the Duke researchers re-analyzed the results of 14 studies of cigarette smoking and ADHD treatments. The studies included more than 2,300 children with ADHD. About 1,400 of the kids were being treated with stimulant medications, according to the new analysis.

The studies were published between 1980 and 2013. The average follow-up time was about seven years. The researchers compared the teens treated with stimulants to those who weren't to see which group was more likely to smoke.

Overall, those on medications were about half as likely to smoke as those not on the medications, Schoenfelder said.

"Those who took their medication consistently and for a longer period of time had an even lower risk of smoking," she added.

The data she analyzed overwhelmingly showed that medications appear to decrease the risk of smoking, according to Schoenfelder.

Like all medications, ADHD medicines have side effects. This analysis showed a "slight effect" on growth, she said. However, that finding must be weighed against the many positive long-term benefits, she explained.

Schoenfelder pointed out that the researchers "can't say based on this study that the treatment caused the lower rate of smoking, but there is an association we found."

However, association does not prove a cause-and-effect relationship.

One potential reason medication might have an effect is that both nicotine and the stimulant medications used to treat ADHD operate on the same pathways in the brain. They both improve the same processes that are disrupted in ADHD, according to Schoenfelder.

"Kids who have ADHD know that something is not quite right," said Dr. Trevor Resnick, chief of the department of neurology at Miami Children's Hospital, who commented on the study.

"They try to self-medicate," he explained, and "cigarettes would be an example of self-medication." As a result, children with ADHD have a much higher risk in general of turning to cigarettes, pot or illicit drugs, he said.

"What this study shows, similar to previous research, is that successful treatment of ADHD with stimulant medication decreases the risk of self-medication in these children," Resnick noted.

While stimulant medications do have several possible side effects, Resnick said, "most kids are able to tolerate" the medication.

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Antipsychotic drugs being used to treat foster children with ADHD

A study shows that more and more foster children with ADHD are being treated with antipsychotic drugs.

Antipsychotic drugs are increasingly being prescribed to treat attention-deficit/hyperactivity disorder (ADHD) in children and teens in foster care, according to a new study.

The use of these drugs to treat ADHD has not been approved by the U.S. Food and Drug Administration, and is known as an "atypical" use, the researchers explained.

But their study found that antipsychotics were used to treat nearly one-third of foster care youth aged 2 to 17 who had been diagnosed with ADHD. The most common types of antipsychotics used were risperidone, aripiprazole and quetiapine.

The study looked at administrative data on more than 260,000 youths aged 2 to 17, enrolled in one state's Medicaid program in 2006, to determine the average number of days of atypical antipsychotic use in kids. Researchers also looked specifically at a subgroup of kids with ADHD who were not diagnosed with any other mental health conditions.

The findings by researcher Julie Magno Zito, at the University of Maryland at Baltimore, and colleagues were published online recently in theJournal of Child and Adolescent Psychopharmacology.

"This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry," Dr. Harold Koplewicz, journal editor-in-chief and president of the Child Mind Institute in New York City, said in a journal news release.

"Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight. The highlight of [the] paper for any reader should be the simple but necessary recommendations for antipsychotic prescribing and monitoring in these populations," he added.

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ADHD medication use leads to BMI rebound

A study of ADHD stimulant medication shows that its use is associated with BMI rebound later in adolescence.

A new study from researchers at Johns Hopkins Bloomberg School of Public Health found that children treated with stimulants for attention deficit hyperactivity disorder (ADHD) experienced slower body mass index (BMI) growth than their undiagnosed or untreated peers, followed by a rapid rebound of BMI that exceeded that of children with no history of ADHD or stimulant use and that could continue to obesity.

The study, thought to be the most comprehensive analysis of ADHD and stimulant use in children to date, found that the earlier the medication began, and the longer the medication was taken, the slower the BMI growth in earlier childhood but the more rapid the BMI rebound in late adolescence, typically after discontinuation of medication. Researchers concluded that stimulant use, and not a diagnosis of ADHD, was associated with higher BMI and obesity. The study was published in Pediatrics.

"Our findings should motivate greater attention to the possibility that longer-term stimulant use plays a role in the development of obesity in children," said Brian S. Schwartz, MD, MS, Professor of Environmental Health Sciences, Epidemiology, and Medicine at the Bloomberg School of Public Health and lead author of the study. "Given the dramatic rise in ADHD diagnosis and stimulant treatment for it in recent decades, this is an interesting avenue of research regarding the childhood obesity epidemic, because the rises in each of these roughly parallel one another."

Previous research has found substantial evidence that stimulant use to treat ADHD is associated with growth deficits, and some evidence of growth delays. However, the reported associations of ADHD with obesity in both childhood and adulthood was paradoxical and somewhat unexplained. The results of this study suggest it is likely due to the strong influence that stimulants have on BMI growth, with delays in early childhood and a strong rebound in late adolescence. The study also found longitudinal evidence that unmedicated ADHD is associated with higher BMIs, but these effects were small.

ADHD is one of the most common pediatric disorders, with a 9% prevalence among children in the U.S., and ADHD medication is the second most prescribed treatment among children. Over the past 30 years, treatment for ADHD with stimulants has increased rapidly. From 2007 to 2010, 4.2.% of children under age 18 had been prescribed stimulants in the past 30 days, more than five times the amount prescribed to the same-aged children between 1988 and 1984.

The study analyzed the electronic health records of 163,820 children, ages 3 to 18, in the Geisinger Health System, a Pennsylvania-based integrated health services organization. The research geographic area included 37 counties in central and northeastern Pennsylvania. There were an equal number of boys and girls. Nearly 7% -- 11,080, or 6.8% -- had an order for stimulants. (13,789, or 8.4%, received a diagnosis of ADHD. A total of 15,473 were prescribed stimulants, some for other reasons.) There were 201,854 orders for the ADHD medications used in the analysis. The median age at first stimulant use was 8.5 years. Median use was 183 days, with 50% of children taking stimulants for less than 6 months and 50% of children for more than 6 months.

The researchers compared the BMI trajectories of those who had never had a diagnosis or prescription (the "controls") with three groups: 1.) those with a diagnosis but no stimulant prescription; 2.) those with orders for stimulants without an ADHD diagnosis and 3.) those with both an ADHD diagnosis and stimulant orders.

Those in group 3 had slower rates of BMI growth in early childhood, with more rapid rates during adolescence that eventually exceeded those of the controls. Those with a diagnosis of ADHD but no stimulant orders had more rapid BMI growth after age 10 versus the controls, but the effects were small.

"Stimulant use was strongly implicated," said Dr. Schwartz. "The earlier stimulants were started and the longer they were used, the stronger was their influence on the degree of both the delayed BMI growth in early childhood and the rebound BMI growth in late adolescence. This is an important unintended consequence of stimulant use in childhood."

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Study: Drivers with ADHD are at a greater risk for crashes

A study shows that drivers who have ADHD are significantly more likely to be in a serious car crash.

Drivers with attention-deficit/hyperactivity disorder (ADHD) are nearly 50 percent more likely to be in a serious car crash, a new study suggests.

Further, men with ADHD can dramatically decrease their risk of traffic accidents if they take medication for their condition, the Swedish researchers said.

"This study confirms the importance of treatment and medication for adults with ADHD as well as teens," said Ruth Hughes, CEO of Children and Adults With Attention-Deficit/Hyperactivity Disorder, a patient advocacy group.

"The core symptoms of ADHD include problems with sustained attention and impulsivity, which can have an adverse effect on driving safely," said Hughes, who was not involved in the new study. "All drivers with ADHD need to responsibly manage their treatment to reduce driving risks."

The new findings come from a review of more than 17,000 people in Sweden with ADHD, aged 18 to 46. Researcher Henrik Larsson and colleagues at the Karolinska Institute used databases to track whether the patients had been in a car accident between 2006 and 2009, and if they had a prescription for ADHD medication at the time.

Overall, having ADHD increased a man's risk of a traffic crash by 47 percent and a woman's risk by 45 percent, the researchers found.

They then investigated the role of medication in preventing crashes by determining whether people involved in a wreck had filled a prescription for ADHD medicine within the previous six months.

Dr. Lenard Adler, a professor of psychiatry at NYU Langone Medical Center in New York City, said despite a broad definition of taking medication, "men [who were] treated substantially lowered their risk for accidents."

Access to ADHD medication reduced men's risk of a car wreck by 58 percent compared to men who did not take medication, according to the study. Women with ADHD, however, did not receive any significant benefit from medication in terms of car crashes.

The study, published online Jan. 29 in the journal JAMA Psychiatry, did not receive any funding from drug companies.

Breaking down the numbers further, the researchers estimated that between 41 percent and 49 percent of the car accidents involving men with ADHD could have been avoided if they had been taking their medication as prescribed.

About three out of five children with ADHD carry the disorder with them into adulthood, according to the Anxiety and Depression Association of America. That amounts to about 8 million adults living with ADHD.

Previous research with ADHD patients in virtual-reality driving simulators found that they are more likely to speed, drive erratically, tap the breaks and accelerate into potential accidents, said Adler, who did not take part in the Swedish research.

"These sorts of things are more likely in individuals with ADHD than in people without ADHD," he said. "This is an important study that follows up on ... some of the shorter-term studies that have shown that people with untreated ADHD have more accidents."

Although the study found an association between having ADHD and greater risk of serious car crashes, it did not establish a cause-and-effect relationship.

Adler said, however, that you don't necessarily have to fear getting into a car with a driver who has ADHD.

"With ADHD, there tend to be two groups: a group that is distracted and impulsive, and a group that drives fine. Not everyone with ADHD has this problem, but a substantial percentage does," he said. "This study highlights another reason why getting an appropriate diagnosis for adult ADHD is important, and why it is important to get the ADHD treated."

People with ADHD also should to take extra precautions that will help them keep their mind on the road, Hughes said.

"In addition to medication, this can mean limiting distractions like texting or cell phones, fewer passengers, breaking up monotonous drives with frequent breaks and being more vigilant about driving defensively," she said.

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Challenges for college students with ADHD

This article looks into challenges that college students with ADHD face.

Many students with Attention Deficit Hyperactivity Disorder (ADHD) attend college. College students with ADHD face a number of challenges, including choosing a supportive school and community where they can:

• find and access medical services


• get help with organizing their schedule and life


• succeed academically

Most people with ADHD are diagnosed before college. However, some people may not recognize the signs and symptoms of ADHD until they are at college. Trying to balance school work and the freedom of living away from home for the first time may be challenging. It can be natural to feel unfocused, distracted, overwhelmed, or disorganized when attending college. However, if these issues have caused significant problems in the past and are getting in the way of current functioning, the student may have ADHD.

If a student is struggling, it may be helpful to seek consultation with a qualified mental health professional. The diagnosis of ADHD is made based on a comprehensive clinical assessment. This may include information from multiple sources, including rating scales, getting history from the student, family, or past teachers if possible. There is no single test (brain imaging, blood testing, or psychological testing) that can reliably diagnose ADHD. Research shows that medication is the most effective treatment for ADHD. Cognitive-behavioral therapy, social skills training, and academic support can also be helpful.

There are many ways to successfully manage ADHD before and during college.

Preparing for and Staying Organized While at College

• Consider the best college environment to meet your needs, such as class size, workload, academic calendar, and availability of support services. Resources to help you find the best college include: high school counselors, parents, friends who are in or have attended college, and national ADHD organizations or websites.


• Learn about the medical services available at colleges before choosing where to go. Some college and university health centers do not prescribe ADHD medications. You may need to find a doctor in the surrounding community. Think about the transportation options and ease of access to that provider.


• Talk with your doctor about how to best manage your medications when at college. Do not make changes in your medication without consulting your doctor. Ask your current doctor and the doctor at college to coordinate care. It is also helpful to have a history of your medications and your response to those medications for your new doctor.


• If you have used tutors or support before college, think about continuing at college, at least for a little while.


• If you need specific support or accommodations, register at the college disability office. If you have a summary of treatment or any psychological tests that were done within the last 3 years, bring them to the visit.


• Practice using planners, calendars, or scheduling apps while still in high school. The demands on time management and organization increase greatly in college. Even if your parents helped you in the past, it is important to learn to do it yourself.

Managing Medications at College

• Many medications prescribed for ADHD have to be monitored regularly. While at college, you need to schedule and keep your own medical appointments. Changes to your medication should only be made after talking with your doctor.


• Learn how to use pharmacy services. Pay attention to prescription start dates and expiration dates. Many medications prescribed for ADHD are “controlled substances” so states may have additional rules on how these medicines can be provided, including limits on how often prescriptions can be refilled.


• Taking medication that is not prescribed for you, sometimes called “diversion” or “academic doping,” is illegal and unsafe. Your medications were prescribed by your doctor who knows you and your medical history. They should only be taken by you. There are serious cardiac, neurological, and psychological risks of misusing ADHD medications. There can also be serious risks to mixing medications with alcohol or other drugs.


• Keep medications safely stored or hidden to protect against theft. If medications are stolen, report it to campus or local police.

Adjusting to the academic, social, and organizational demands of college is difficult for most students. It can be especially difficult for students with ADHD. Arranging for support from medical and school professionals can help students with ADHD have a successful college experience, as well as a long career after graduation.

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Study: Extra medication for aggressive children with ADHD

A study shows that children who have ADHD and are also aggressive show modest improvement in behavior when a psychotropic drug is introduced.

Children with attention-deficit/hyperactivity disorder (ADHD) who also are extremely aggressive might benefit from taking an antipsychotic drug along with their stimulant medication, a new study suggests.

Prescribing powerful antipsychotic medications to children with behavioral problems is controversial. Little is known about the long-term safety of these medications, which are approved by the U.S. Food and Drug Administration to treat severe mental illnesses such as schizophrenia and bipolar disorder. And previous studies have provided little evidence to support the idea that they help quell youngsters' violent outbursts.

But the new study, which was published online in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry, suggests there might be some merit to the idea, at least for severely troubled kids.

The study looked at a subset of children with ADHD who also are physically violent, meaning they're either destructive or aggressive toward themselves or others, the researchers said.

"The children who participated in this trial had far more significant behavioral issues than the typical child with ADHD alone," said study author Michael Aman, director of clinical trials at Ohio State University's Nisonger Center.

"These are children who are really in conflict with their communities and their families," Aman said. "They seem to be in a spiral they can't get out of."

The 168 children in the study were between 6 and 12 years old with a diagnosis of ADHD and oppositional-defiant disorder or conduct disorder. All had displayed recent episodes of serious physical aggression in which they destroyed property or, at a minimum, left bruises on themselves or others.

All were started on a stimulant medication -- typically long-acting methylphenidate (sold under the brand name Concerta), which is a common treatment for ADHD. Their parents got special training in how to manage impulsive behaviors.

After three weeks, those who had not been helped enough by the basic measures were allowed to start a second medication, which was assigned at the start of the study. Sixty-one kids who started the second medication took the antipsychotic risperidone (Risperdal) for six more weeks, while 69 children continued basic treatment and got an added placebo pill.

After nine weeks, children who took Risperdal in addition to their stimulant medication saw modest but significant improvements in behavior compared to those who continued on the stimulant by itself.

"I don't think it's a grand slam, but I do think it indicates that there is some justification for what doctors have begun to do, which is to combine treatment," Aman said.

Aman said the average improvement on Risperdal was moderate. "Buried in that moderate are kids who did much better, kids who did somewhat better and some kids who didn't do better at all," he said.

Aman said scientists really need to look more closely to understand why some children had big improvements with the addition of Risperdal while others got no further help.

In some cases, Risperdal seemed to cancel some of the most bothersome side effects of the stimulants, including loss of appetite and trouble falling asleep.

But Aman cautioned that antipsychotics must always be prescribed with great care since they cause weight gain and increase the risk for type 2 diabetes.

The study was sponsored by a grant from the U.S. National Institute of Mental Health.

About half of children with ADHD who are referred for psychiatric help have behavioral disorders as well as ADHD, according to the U.S. Centers for Disease Control and Prevention.

An expert who was not involved in the research praised the study and said it would help doctors sort out what is often a tricky treatment decision.

In kids with ADHD and aggressive behavior, "recent guidelines say you should try to treat the ADHD first," said Joseph Blader, an associate professor at the University of Texas Health Science Center at San Antonio. "Then the issue is, how long do you spend doing that if the child is having these explosions, these meltdowns, potentially hurting people, on the threshold of getting kicked out of school? Two weeks? Three weeks?"

Blader said that, because so many of the kids in the study's placebo group continued to improve on the stimulant medication alone, doctors might be justified in waiting a few more weeks to see if the aggression improves along with the ADHD.

"I think this study shows that you get a lot of bang for your buck with stimulants and parent training," he said. "Unless it's a very extreme situation, it's optimal to let those play out [before trying a second medication]."

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CDC claims 1 in 10 children has ADHD

A new poll by the CDC shows that 1 in every 10 children has ADHD. This is higher than the last poll done in 2007 showing ADHD cases are rising.

One in every 10 U.S. children has been diagnosed with attention-deficit/hyperactivity disorder (ADHD), but the steady rise in cases has started to slow, a new government survey shows.

The 2011 poll of more than 95,000 parents showed that about 11 percent -- or about 6.4 million -- of children aged 4 to 17 had been diagnosed with ADHD. That's up from a 2007 survey that found that 9.5 percent of youngsters in that age group had an ADHD diagnoses.

Nearly one in every five high-school age boys, and about one in every 11 high school age girls, was reported by their parents as being diagnosed with having ADHD, the U.S. Centers for Disease Control and Prevention report found.

Numbers also varied widely between states, as well, with 15 percent of children in Arkansas and Kentucky reporting a history of ADHD treatment, compared to just 4 percent of those in Nevada.

The number of children placed on ADHD medications -- which include stimulants such as Ritalin or Concerta -- also rose by about 1 million between 2003-04 and 2011-12, the CDC said. That means that more than 3.5 million youngsters between the ages of 4 and 17 are now taking an ADHD drug.

The survey was published Nov. 22 in the Journal of the American Academy of Child and Adolescent Psychiatry.

According to the survey, half of children with ADHD are diagnosed with the disorder by the age of 6.

"This finding suggests that there are a large number of young children who could benefit from the early initiation of behavioral therapy, which is recommended as the first-line treatment for preschool children with ADHD," study author and CDC researcher Susanna Visser said in a journal news release.

Not every child with ADHD is getting proper treatment, the study found. According to the survey, 18 percent of kids with ADHD had not received either psychiatric counseling or drug therapy during 2011-2012.

"This finding raises concerns about whether these children and their families are receiving needed services," Dr. Michael Lu, senior administrator at the U.S. Health Resources and Service Administration (HRSA), said in the journal news release.

There was some good news from the survey, however. The CDC noted that ADHD diagnoses among American children were rising at a rate of about 6 percent a year in the mid-2000s, but that rate slowed to 4 percent a year from 2007 to 2011.

Visser told the Associated Press that this slower rate of diagnoses might reflect that doctors are closer to identifying most of the youngsters with the disorder.

ADHD makes it difficult for kids to pay attention and control impulsive behaviors. Treatments can include drugs, behavioral therapy or both.

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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.

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