Study: Those with ongoing central pain may be linked to ADHD

A study indicates that those with central pain could also have ADHD.

More than a third of people with ongoing "central pain" may also have ADHD, a small study suggests.

Central pain stems from damage to the central nervous system -- the brain, brain stem and spinal cord. It differs from ongoing pain from bone or muscle conditions such as arthritis, or peripheral nerve pain like diabetic neuropathy.

Researcher Forest Tennant, MD, of Intractable Pain Management, presented the findings at the PAINWeek 2015 conference.

For the study, 45 people with chronic pain attending a treatment clinic completed a 16-item questionnaire. The questions asked whether the person had trouble with concentration, attention, distractibility, impulsivity, reading and retention, coordination, temper, and short-term memory.

A positive answer to five or more questions was considered to indicate ADHD

Results showed that 37.8% of the people met these criteria for the disorder.

Most people with centralized pain have an overactive autonomic nervous system, the part of the nervous system responsible for functions like breathing. This contributes to the ADHD (which is sometimes called ADD, or attention deficit disorder).

The finding might help explain why some people with pain have trouble with activities in their daily lives, Tennant says.

"For years, I've seen the same kind of ADD in these patients that you see in children -- they can't remember half the time, they can't concentrate," he says. "It's amazing how many of these patients actually quit reading or doing things, but they won't tell you."

But once they start taking medication for ADHD, "their pain gets better and they can remember and concentrate."

Tennant stressed that the findings [do not apply to] those with arthritis or neuropathic pain.

Jack LeFrock, MD, a pain specialist at Above and Beyond Pain Management and Laser Center, says Tennant's finding "makes sense."

"I agree with him; I think he's right on," he says.

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Potential link between pesticides and ADHD

A study indicates a possible link between a pesticide and ADHD.

There's evidence -- but not proof -- of a link between a commonly used household pesticide and attention deficit hyperactivity disorder (ADHD) in children and young teens, according to a new study.

Specifically, researchers found an association between exposure to pyrethroid pesticides and ADHD, as well as ADHD symptoms such as hyperactivity and impulsivity.

The link between the pesticides and ADHD was stronger in boys than in girls, according to the findings published online in the journalEnvironmental Health.

However, researchers only found an association between pesticides and ADHD. The study did not prove a cause-and-effect relationship.

Pyrethroid pesticides -- considered safer than organophosphate pesticides -- are the most widely used pesticides for home and public health pest control, and their use in agriculture is increasing, according to the researchers.

"Given the growing use of pyrethroid pesticides and the perception that they may represent a safe alternative, our findings may be of considerable public health importance," study corresponding author Dr. Tanya Froehlich, a developmental pediatrician at Cincinnati Children's Hospital Medical Center, said in a hospital news release.

She and her colleagues analyzed data from nearly 700 children between the ages of 8 and 15. The children had taken part in the 2000-2001 National Health and Nutrition Examination Survey. The researchers looked at levels of 3-PBA -- a chemical indicator of exposure to pyrethroids -- in the children's urine.

Boys with detectable levels of 3-PBA in their urine were three times more likely to have ADHD than those without detectable 3-PBA. For every 10-fold increase in 3-PBA levels in boys, there was a 50 percent increased risk for hyperactivity and impulsivity -- both symptoms of ADHD.

In girls, levels of 3-PBA were not associated with increased risk of ADHD or symptoms of the disorder.

"Our study assessed pyrethroid exposure using 3-PBA concentrations in a single urine sample," Froehlich said. But because these chemicals don't stay in the body for long, she suggested that future studies need to take multiple measurements over time. Such studies would need to be done before "we can say definitively whether our results have public health ramifications," she said.

Previous studies have found that pyrethroid exposure increases hyperactivity, impulsivity and abnormalities in the dopamine system in male mice, according to the researchers. Dopamine is a brain chemical believed to play a role in many activities, including those that govern ADHD, the researchers said.

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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.

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Does your child have ADD, ADHD, or both?

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

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

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

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

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

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

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Study claims children with ADHD had more common and more severe autistic traits

A study showed that children who have ADHD not only are more likely to have autistic traits, but that their autistic traits are more severe.

Children with attention deficit hyperactivity disorder (ADHD) were more likely than controls to have autistic traits, and those traits were generally more severe, researchers found.

Compared with children who did not have ADHD, those with the disorder were significantly more likely to show a positive autism trait profile (18% versus 0.87%,P<0.001), according to Joseph Biederman, MD, of Massachusetts General Hospital in Boston, and colleagues.

Children with ADHD and autistic traits were significantly more impaired in psychopathology, interpersonal, school, family, and cognitive domains than those with autistic traits and without ADHD, they wrote online in the journal Pediatrics.

Other research has shown a shared heritability of ADHD and autism spectrum disorders and that autism spectrum disorders or autistic traits co-occur in 20% to 30% of children with ADHD. Those studies have also shown that children with both conditions are more impaired, particularly in interpersonal communication and empathy, though these results have not been replicated.

A 2011 study from the CDC and Maternal and Child Health Bureau found that rates of autism and ADHD were on the rise from 1997 to 2008.

Researchers have long sought to better understand the workings of social behavior "and it's interesting that we have clear ideas of what kids shouldn't do socially, but often we don't know what they should do," noted Catherine Lord, PhD, of Weill Cornell Medical College in White Plains, N.Y.

"We need to find out more what it is that these kids were having trouble with, how does it overlap with autism, and what we can do to help them," Lord said in an interview withMedPage Today.

The study "reinforces the long-standing idea that children referred for evaluation of ADHD may have a more complex picture," added David Urion, MD, of Boston Children's Hospital.

"The main aim of the current study was to examine the prevalence and correlates of [autism traits] in youth with ADHD," according to the report, through an analysis of 469 children.

Participants were gathered through other longitudinal, case-control family studies at Massachusetts General Hospital and patients attending the pediatric medical clinic and included those ages 6 to 18, with a mean age of 11.3. Control patients were not excluded for having other psychiatric disorders.

Nearly all of the participants were white (99%). Roughly half (52%) required tutoring (61% of those with ADHD and 22% of controls), repeated a grade (25% of those with ADHD and 7% of controls), or took a special class (26% of those with ADHD and 2% of controls).

Among controls, a third of the 27% who had academic difficulties met criteria for one or more psychiatric disorders, versus 28% of those without academic difficulty. For those with ADHD, three quarters had academic difficulty, 81% of which met criteria for one or more psychiatric disorders; among those not having academic problems, 73% met the criteria for psychiatric disorders.

"These numbers suggest that the presence of a psychiatric illness may account for the increased prevalence of academic functioning difficulties," they wrote.

Researchers interviewed participants ages 12 and older through the Kiddie Schedule for Affective Disorders and Schizophrenia-Epidemiologic Version, and interviewed participants' mothers for those younger than 12. Participants were also evaluated for social withdrawal, social problems, thought problems, anxiety and depression, aggression, social disability, family functioning, and intellectual functioning.

More children with ADHD had autistic traits than did children without ADHD. Those with autistic traits and ADHD had higher rates of additional ADHD-related symptoms, including clumsiness, equal parts inattention and hyperactivity, hyperactivity, peer fighting, and rejection by peers, compared with those who only had ADHD.

Those with ADHD overall had a significantly higher prevalence of all comorbid psychiatric conditions, including disruptive behavior disorders, mood disorders, multiple anxiety disorders, language disorders, elimination disorders, and substance use disorders (P<0.001 for all).

Those who also had autistic traits had a higher prevalence of disruptive behaviors (P=0.001), mood disorders (P<0.001), multiple anxiety disorders (P<0.001), and language disorders (P=0.01). They also had more impaired scores in all child behavior checklist clinical and composite scales than those with ADHD alone (P<0.001).

Rates of social disability were higher in both groups with ADHD than control, but higher in those with autistic traits than in those with ADHD alone. Those with autistic traits also had significantly impaired scores in school behavior, spare time problems, activities and problems with peers, and problems with siblings and parents.

Despite a number of methodological problems, the study "raises the interesting point that there is a significant overlap in people being referred for evaluation and treatment of ADHD and those who have some features of autism," Urion told MedPage Today.

He added that future research should evaluate children under the new DSM-5 criteria for autism.

The study was limited by a lack of comparison with those diagnosed with autism spectrum disorders, potential missed diagnosis of autism spectrum disorder in the sample, and generalizability.

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Omega-3 makes ADHD symptoms less severe in rats

A study shows that rats when eating more omega-3 fatty acids reduce their ADHD symptoms.

A new multidisciplinary study shows a clear connection between the intake of omega-3 fatty acids and a decline in ADHD symptoms in rats.

Researchers at the University of Oslo have observed the behaviour of rats and have analyzed biochemical processes in their brains. The results show a clear improvement in ADHD-related behaviour from supplements of omega-3 fatty acids, as well as a faster turnover of the signal substances dopamine, serotonin and glutamate in the nervous system. There are, however, clear sex differences: a better effect from omega-3 fatty acids is achieved in male rats than in female.

Unknown biology behind ADHD

Currently the psychiatric diagnosis ADHD (Attention Deficit/Hyperactivity Disorder) is purely based on behavioural criteria, while the molecular genetic background for the illness is largely unknown. The new findings indicate that ADHD has a biological component and that the intake of omega-3 may influence ADHD symptoms.

"In some research environments it is controversial to suggest that ADHD has something to do with biology. But we have without a doubt found molecular changes in the brain after rats with ADHD were given omega-3," says Ivar Walaas, Professor of Biochemistry.

The fact that omega-3 can reduce ADHD behaviour in rats has also been indicated in previous international studies. What is unique about the study in question is a multidisciplinarity that has not previously been seen, with contributions from behavioural science in medicine as well as from psychology, nutritional science and biochemistry.

Hyperactive rats

The rats used in the study are called SHR rats -- spontaneously hypertensive rats. Although this is primarily a common type of rat, random mutations in their genes have resulted in genetic damage that produces high blood pressure. It is therefore first and foremost blood-pressure researchers who have so far been interested in these rats.

However, the rats do not suffer from high blood pressure until they have reached puberty. Before that age they present totally different symptoms -- namely hyperactivity, poor ability to concentrate and impulsiveness. It is exactly these three criteria that form the basis for making the ADHD diagnosis in humans. The animals also react to Ritalin, the central nervous system stimulant, in the same way as humans with ADHD: the hyperactive responses are stabilized. SHR rats are therefore increasingly used in research as a model for ADHD.

Supplements as early as the fetal stage

Researchers believe that omega-3 can have an effect from the very beginning of life. Omega-3 was therefore added to the food given to mother rats before they were impregnated, and this continued throughout their entire pregnancy and while they fed their young. The baby rats were also given omega-3 in their own food after they were separated from their mother at the age of 20 days. Another group of mother rats were given food that did not have omega-3 added, thus creating a control group of SHR offspring that had not been given these fatty acids at the fetal stage or later.

The researchers started to analyze the behaviour of the offspring some days after they were separated from the mother. They studied behaviour driven by reward as well as spontaneous behaviour. Substantial differences were noted for both types of behaviour between the rats that had been given the omega-3 supplement as foetuses and as baby rats and those that had not.

Rewards made male rats more concentrated

The reward-driven behaviour was such that the rats were allowed access to a drop of water each time they pressed an illuminated button. The ADHD rats that had not been given omega-3 could not concentrate on pressing the button, whereas the rats that had been brought up on omega-3 easily managed to hold their concentration for the seconds this takes and were able to enjoy a delicious drop of water as a reward.

Surprisingly enough, it was only male rats that showed an improvement in reward-driven behaviour. However, with regard to the rats' spontaneous behavior, the same type of reduction in hyperactivity and attention difficulties was noted in both male and female rats that had been given the omega-3 supplement.

Changes in brain chemistry

Professor Walaas and his research group became involved in the study at this point in order to analyze the molecular processes in the rats' brains.

The group analyzed the level of the chemical connections in the brain, the so-called neurotransmitters that transfer nerve impulses from one nerve cell to another. The researchers measured how much of the neurotransmitters such as dopamine, serotonin and glutamate was released and broken down within the nerve fibres. A key player in this work was Kine S. Dervola, PhD candidate, who reports clear sex differences in the turnover of the neurotransmitters -- just as there had been in the reward-driven behaviour.

"We saw that the turnover of dopamine and serotonin took place much faster among the male rats that had been given omega-3 than among those that had not. For serotonin the turnover ratio was three times higher, and for dopamine it was just over two and a half times higher. These effects were not observed among the female rats. When we measured the turnover of glutamate, however, we saw that both sexes showed a small increase in turnover," Ms Dervola tells us.

Transferrable to humans?

The researchers are cautious about drawing conclusions as to whether the results can be transferred to humans.

"In the first place there is of course a difference between rats and humans, and secondly the rats are sick at the outset. Thirdly the causes of ADHD in humans are in no way mapped sufficiently well. But the end result of what takes place in the brains of both rats and humans with ADHD is hyperactivity, poor ability to concentrate and impulsiveness," says Professor Walaas, and concludes:

"Giving priority to basic research like this will greatly increase our detailed knowledge of ADHD."

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