Signs and treatments for obstructive sleep apnea in children

Obstructive sleep apnea in children may be missed due to misdiagnosis of symptoms such as hyperactivity, tossing and turning, and irregular breathing at night.

Is your hyperactive child having trouble learning at school? Does your son constantly toss and turn at night? Can you hear your daughter's irregular breathing during sleep?

All of these symptoms could be the result of obstructive sleep apnea, a serious but treatable disorder that can lead to health problems, behavioral issues and learning difficulties in children and adolescents.

"One to 4 percent of all children have obstructive sleep apnea, but many go undiagnosed and untreated because people do not recognize the symptoms," says Dr. Rochelle Goldberg, director of sleep medicine services at Main Line Health and an associate professor at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Further complicating matters is that some children with sleep apnea are misdiagnosed with attention deficit hyperactivity disorder because, unlike adults, disrupted sleep makes kids hyperactive, experts say.

"As many as 25 percent of children diagnosed with ADHD may in fact have obstructive sleep apnea," says Tracy Nasca, executive director of the American Sleep Apnea Association, a nonprofit organization based in the District of Columbia.

Blocked Airways Impede Breathing

Sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. People with untreated sleep apnea stop breathing repeatedly during sleep, often waking or almost waking multiple times during the night.

"The result is fragmented sleep that can impact every aspect of your life," Goldberg says.

Sleep apnea can occur at any age, but the prime ages for children to develop the condition is between 4 to 7 years, when the tonsils and adenoids are largest, Goldberg says. Those most at risk include males, children with special needs and youth who are obese.

"With increasing childhood obesity comes increasing risk for sleep apnea," Goldberg says, noting thatobesity among youth has skyrocketed in the past three decades. Obesity rates in children ages 6 to 11 increased from 7 to 18 percent from 1980 to 2012, while the rate in youth ages 12 to 19 jumped from 5 to 21 percent, according to the Centers for Disease Control and Prevention.

Hyperactivity in Sleepy Children

Diagnosing sleep disorders in children requires special expertise because youngsters respond differently than adults when it comes to a lack of sleep, says Amber McAfee, a pediatric nurse practitioner at the Sleep Center at Seattle Children's Hospital.

"Adults with sleep apnea may feel sluggish during the day," McAfee says. "But children with sleep apnea are quite active and may even be hyperactive. They may also start experiencing learning difficulties at school because they can't remember things as well."

Adds Goldberg: "Unfortunately some of these kids get mislabeled by their well-meaning teachers as having ADHD and start taking medications they don't need." She advises parents to seek the expertise of a pediatrician and pediatric sleep specialist before assuming their child has ADHD.

In recent years, more parents have been requesting sleep evaluations for children diagnosed with ADHD, McAfee says. "We have seen an improvement in hyperactivity after treatment and we have parents who report taking their children off medication for ADHD because their hyperactivity was related to sleep apnea," she says.

Nighttime symptoms between children and adults vary, too. Kids are more likely to be restless and wake up. "The symptoms are a little more subtle in kids because their brains are responsive," McAfee says. "The brain alerts them that they aren't breathing well."

Some children may sleep with their head hanging from the end of the bed as a way to extend their neck and open their air pathway, Goldberg says. At times, children with sleep apnea may experience increased bedwetting or a recurrence of bedwetting.

Expert Diagnosis and Treatment

Experts recommend that parents whose children are experiencing sleep problems or sudden difficulties at school visit a certified pediatric sleep specialist for evaluation and testing, including an overnight sleep study, to rule out or confirm a diagnosis.

"We do a lot of hand holding and comforting," says Nasca, who assures parents that pediatric specialists can provide a child-friendly diagnostic experience. "Many pediatric sleep labs allow a parent to spend the night in the testing room and also encourage the children to bring a favorite 'blankie' or stuffed animal to create a more home-like sleep setting."

At Seattle Children's Hospital, parents are welcome to stay at the Sleep Center while their children are monitored overnight. Monitors gather information about brain activity, oxygen levels, heart rate, sleep quality and stages, eye movement, air flow, limb movement and more.

"I tell kids they're going to sleep like a robot for one night," McAfee says. The Sleep Clinic conducts approximately 200 sleep studies a month.

For many youngsters, surgically removing the tonsil and adenoids can resolve sleep apnea. Children who are overweight or obese may also need to focus on weight loss, experts say.

Some children find relief by wearing a nasal mask that uses continuous positive airway pressure, also known as CPAP. "CPAP is 100 percent effective in improving your breathing," McAfee says. "But only about 40 percent of the pediatric population wear the mask effectively through the night."

Read more here

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.

Read more here

ADHD affects school performance as early as 2nd grade

A study claims that ADHD can negatively affect a child's performance in school as early as the 2nd grade.

Attention-deficit/hyperactivity disorder can harm a child's academic performance and social skills as early as the second grade, a new Australian study contends.

Children between 6 and 8 years old who were tested and scored high for ADHD symptoms were more likely to get lower grades in elementary school and have trouble fitting in with other kids, compared with children without ADHD, the study authors reported.

Kids with ADHD also were more likely to have other mental health or developmental disorders, including anxiety, depression and autism, according to the study.

"Already at this stage, which is relatively young, it's very clear the children have important functional problems in every domain we registered," said study lead author Dr. Daryl Efron, a developmental-behavioral pediatrician with the Royal Children's Hospital Melbourne. "On every measure, we found the kids with ADHD were performing far poorer than the control children."

The researchers also said they discovered that about 80 percent of the young children with ADHD symptoms had not been diagnosed with the disorder, a finding called "striking" by Dr. David Fassler, a clinical professor of psychiatry at the University of Vermont College of Medicine.

"For this reason, I would fully agree with the authors' conclusion that the results of the study underscore the need for earlier recognition and treatment of ADHD in young children," Fassler said.

The study, published online Sept. 29 in the journal Pediatrics, is one of the first reports from the Children's Attention Project, a long-term examination of ADHD funded by the Australian government.

The researchers tested nearly 400 children between 6 and 8 years of age at 43 Melbourne schools, identifying 179 with ADHD and another 212 without ADHD who will serve as a "control group." These children will be observed throughout their academic careers.

By the second grade, the children with ADHD were already struggling. They were more likely to score below-average in reading and mathematics, and more likely to have problems connecting socially with their peers, the researchers said.

For example, 33 percent of kids with ADHD were reading below average and 46 percent had math skills below average. For non-ADHD kids, only about 6 percent were reading below average and nearly 15 percent had below-average math skills, the researchers found.

And the ADHD children were more likely to have other mental health or developmental problems -- such as anxiety, obsessive-compulsive disorder, depression, mania and autism, said Efron, who's also a senior lecturer at the University of Melbourne.

"Some people think it's only when kids get older you can pick up these comorbidities [overlapping health issues]. But we've shown you can pick them up at this early stage if you are looking for them," he said.

What's more, these problems seem to accumulate in some kids with ADHD, with 30 percent having two such impairments and 24 percent having three. By comparison, about 6 percent of non-ADHD kids had two such impairments, and about 1 percent had three, according to the study.

The investigators found that boys and girls with ADHD were equally impaired by the disorder.

"There hasn't been that much research into girls with ADHD, so we don't know that much," Efron said. "When we do see girls, in my experience, they are as impaired as the boys. But it is a novel research finding."

In another study published in the same issue of Pediatrics, researchers presented disappointing results for a drug that some had hoped would ease the insomnia experienced by many children with ADHD.

The drug, eszopiclone, failed to help children aged 6 to 17 with their ADHD-related insomnia. Both low and high doses of the drug proved ineffective, the researchers found.

Read more here

Children with ADHD may be unable to recognize facial expressions

Research has shown that children with ADHD may be unable to recognize specific facial expressions such as anger and happiness.

Inattention, hyperactivity, and impulsive behavior in children with ADHD can result in social problems and they tend to be excluded from peer activities. They have been found to have impaired recognition of emotional expression from other faces.

The research group of Professor Ryusuke Kakigi of the National Institute for Physiological Sciences, National Institutes of Natural Sciences, in collaboration with Professor Masami K. Yamaguchi and Assistant Professor Hiroko Ichikawa of Chuo University first identified the characteristics of facial expression recognition of children with ADHD by measuring hemodynamic response in the brain and showed the possibility that the neural basis for the recognition of facial expression is different from that of typically developing children.

The findings are discussed in Neuropsychologia.

The research group showed images of a happy expression or an angry expression to 13 children with ADHD and 13 typically developing children and identified the location of the brain activated at that time. They used non-invasive near-infrared spectroscopy to measure brain activity. Near-infrared light, which is likely to go through the body, was projected through the skull and the absorbed or scattered light was measured. The strength of the light depends on the concentration in "oxyhemoglobin" which gives the oxygen to the nerve cells working actively. The result was that typically developing children showed significant hemodynamic response to both the happy expression and angry expression in the right hemisphere of the brain.

On the other hand, children with ADHD showed significant hemodynamic response only to the happy expression but brain activity specific for the angry expression was not observed. This difference in the neural basis for the recognition of facial expression might be responsible for impairment in social recognition and the establishment of peer-relationships.

Read more here

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

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

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

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

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

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

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

Shifting brain patterns

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

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

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

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

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

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

Lingering problems

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

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

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

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

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

Read more here

More boys are diagnosed with ADD and ADHD

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

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

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

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

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

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

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

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

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

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

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

Read more here

Link between sleep apnea and ADHD

This article discusses the potential link between sleep apnea and ADHD in children.

Parents with toddlers displaying symptoms like decreased attention span, hyperactivity, irritability, sleep walking, snoring or breathing through the mouth must check with doctors if the child is suffering from sleep apnea.

Experts emphasize that even if two of these symptoms are seen, the child should be taken to a specialist and tested. If any form of sleep apnea is detected during the sleep study, then appropriate treatment should be sought, they said.

Even two-year-olds can be affected by sleep apnea, and if left untreated, it may hamper the child's growth.

"I have seen children affected almost in the same numbers as adults, and if left undetected and untreated for a long period, may affect the growth of the facial structure of a child," said Seemab Shaikh, ENT surgeon and sleep specialist. He is also the founder and national president of the Indian Association of Surgeons for Sleep Apnea. He sees at least three children with sleep apnea symptoms every day.

Sleep apnea is a condition in which the breathing pauses for a few seconds to minutes during sleep. Typically, normal breathing starts again, with a loud snort or a choking sound. If left untreated, sleep apnea may result in poor performance in academics and physical activities, and behavioral problems such as attention deficit which is sometimes diagnosed as attention deficit hyperactivity disorder (ADHD).

"Various parts of the body do not get proper supply of oxygen and over a longer period of time, this affects the cardiovascular system and the nervous system," said Shaikh.

Shripal Shrishrimal, who specializes in pulmonary medicine and is an American Board certified sleep specialist, said the common symptoms of sleep apnea in children would be - snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness, drop in academic performance and improper growth.

Just like adults, children too may suffer from any form of sleep apnea - obstructive, central and mixed. Obstructive sleep apnea (OSA), is the most common form and is caused by partial or complete blockage of the upper airway. Central sleep apnea occurs when the brain does not send proper signals to the muscles to control the breathing.

Shrishrimal said the most common causes of sleep apnea in children are swelling or enlargement of tonsils and adenoids, also kn as adenotonsillar hypertrophy. Children who are obese or overweight may also suffer from sleep apnea, and are in this case, asked to first lose weight and then treated through medicines.

"Though surgery is prescribed to remove polyps or correct adenotonsillar hypertrophy, in case symptoms persist, then the continuous positive airway pressure (CPAP) method is used, in which masks are to be worn over the face or nose," said KT Mohan, pulmonologist and sleep disorder breathing specialist.

Doctors say minimally invasive technologies are available to remove extra tissue and enable better breathing, such as radiofrequency ablation and coblation. Although, with early diagnosis, sometimes surgical intervention can be avoided, said Shaikh.

Shrishrimal added that if untreated, sleep apnea over a long term in children may cause cardiac complications, growth failure, learning problems and behavioral problems.

"Often, OSA is the underlying cause of various serious health problems and due to lack of awareness, goes undetected. People with no history of heart or high blood pressure suffer from life-threatening strokes," said Shaikh. "Cases of depression, poor memory, mood disorders and even marital problems happen because of sleep apnea," he added.

Don't ignore the snore

As many as four percent children are affected by sleep apnea

Symptoms

Decreased attention span, drop in academic performance, snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness

Treatment options

Surgery in case of enlarged tonsils, adenoids or polyps

Weight loss combined with medicine for overweight children

Positional therapy

CPAP therapy, where positive air pressure is forced through the throat by a mask worn over the nose or face

Tests for sleep apnea are a must for children who are obese, have family history of sleep apnea, have cerebral palsy, Down syndrome, or craniofacial anomalies

Study: ADHD in children linked to tylenol use in pregnancy

A recent study claims that women who took tylenol (acetaminophen) while pregnant may have a higher chance of having a child with ADHD.

If you were pregnant, did you ever take a Tylenol?

If not, you have unreal levels of tolerance for discomfort but if you did, and you think your child is hyperactive, a new study may have some answers. Not 'why' answers, just a 'perhaps' answer. But look for mainstream media to declare that Tylenol causes attention-deficit/hyperactivity disorder (ADHD) in kids.

Acetaminophen is the most commonly used medication for pain and fever during pregnancy. But some studies have suggested that acetaminophen has effects on sex and other hormones, which can in turn affect neurodevelopment and cause behavioral dysfunction. The authors of a new paper in JAMA Pediatrics studied 64,322 children and mothers in the Danish National Birth Cohort (1996-2002). Parents reported behavioral problems on a questionnaire, and hyperkinetic disorders (HKDs, a severe form of ADHD) diagnoses and ADHD medication prescriptions were collected from Danish registries.

They found that more than half of the mothers reported using acetaminophen while pregnant. No surprise there. But then they also found that the use of acetaminophen during pregnancy appeared to be associated with a higher risk of HKD diagnosis, of using ADHD medications or of having ADHD-like behaviors at age 7 years. The risk increased when mothers used acetaminophen more than one trimester during pregnancy.

“Maternal acetaminophen use during pregnancy is associated with a higher risk for HKDs and ADHD-like behaviors in children. Because the exposure and outcomes are frequent, these results are of public health relevance but further investigations are needed,” they conclude.

In an accompanying editorial (JAMA Pediatr doi:10.1001/jamapediatrics.2013.5292), Miriam Cooper, M.R.C.Psych, M.Sc., of Cardiff University School of Medicine, and colleagues write, “Indeed, causation cannot be inferred from the present observed associations, and Liew et al are right to point out that a replication of their study is needed. 

“In summary, findings from this study should be interpreted cautiously and should not change practice. However, they underline the importance of not taking a drug’s safety during pregnancy for granted, and they provide a platform from which to conduct further related analyses exploring a potential relationship between acetaminophen use and altered neurodevelopment.”

Read more here

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.

Read more here

Sunny climates may reduce ADHD prevalence

A study shows that the prevalence of ADHD may be influenced by sunny climates and amount of sunlight.

Attention-deficit/hyperactivity disorder, or ADHD, is the most common childhood psychiatric disorder. Scientists do not know what causes it, but genetics play a clear role. Other risk factors have also been identified, including premature birth, low birth weight, a mother’s use of alcohol or tobacco during pregnancy, and environmental exposures to toxins like lead.

ADHD is characterized by an inability to focus, poor attention, hyperactivity, and impulsive behavior, and the normal process of brain maturation is delayed in children with ADHD. Many individuals with ADHD also report sleep-related difficulties and disorders. In fact, sleep disorder treatments and chronobiological interventions intended to restore normal circadian rhythms, including light exposure therapy, have been shown to improve ADHD symptoms.

Estimates suggest that the average worldwide prevalence of ADHD ranges from about 5 to 7%, but it also varies greatly by region. A simple visual comparison of data maps released by the U.S. Centers for Disease Control and Prevention and the U.S. Department of Energy that display ADHD prevalence rates by state and solar intensities (sunlight) across the country, respectively, reveals an interesting pattern indicative of an association. So does this mean that there could be an identifiable relationship between ADHD prevalence rates and the sunlight intensity levels of particular regions?

The accumulation of these points led Dr. Martijn Arns and his colleagues to systematically and scientifically investigate this question. They collected and analyzed multiple data-sets from the United States and 9 other countries. Reporting their findings in the current issue of Biological Psychiatry, they did find a relationship between solar intensity and ADHD prevalence.

Even after controlling for factors that are known to be associated with ADHD, both U.S. and non-U.S. regions with high sunlight intensity have a lower prevalence of ADHD, suggesting that high sunlight intensity may exert a ‘protective’ effect for ADHD.

To further validate their work, they also looked at this same relationship with autism and major depressive disorder diagnoses. They found that the findings were specific to ADHD, with no associations observed between the other two disorders.

“The reported association is intriguing, but it raises many questions that have no answers,” commented Dr. John Krystal, Editor of Biological Psychiatry. “Do sunny climates reduce the severity or prevalence of ADHD and if so, how? Do people prone to develop ADHD tend to move away from sunny climates and if so, why?”

As with all scientific research, further work is necessary, including a prospective replication of these findings. It is also important to realize that this data reflects only an association – not a causation – between ADHD and solar intensity levels so worried parents should not start planning cross-country moves.

However, these findings do have significant implications, explains Dr. Arns. “From the public health perspective, manufacturers of tablets, smartphones and PCs could investigate the possibility of time-modulated color-adjustment of screens, to prevent unwanted exposure to blue light in the evening.”

“These results could also point the way to prevention of a sub-group of ADHD, by increasing the exposure to natural light during the day in countries and states with low solar intensity. For example, skylight systems in classrooms and scheduling playtime in line with the biological clock could be explored further.”

Read more here

Expensive computer programs for children with ADHD don't help their grades

Reports show that expensive computer programs and therapies for children with ADHD are not effective and do not help their grades.

Many parents spend thousands of dollars on computer-based training programs that claim to help children with ADHD succeed in the classroom and in peer relationships while reducing hyperactivity and inattentiveness. But a University of Central Florida researcher says parents are better off saving their hard-earned cash.

Psychology professor Mark Rapport's research team spent two years analyzing the data from 25 studies and found that those programs are not producing significant or clinically meaningful long-term improvements in children's cognitive abilities, academic performance or behavior.

"Parents are desperate for help," said Rapport, who runs the Children's Learning Clinic IV at UCF. "If they can afford it, they are willing to spend the money, and some parents even enroll their children in private schools because they offer these cognitive training programs. But there is no empirical evidence to show those investments are worthwhile."

Rapport initiated the study because many parents of children who have been evaluated at his clinic asked him whether they should invest in the programs. The study is featured in the December issue of Clinical Psychology Review.

His team analyzed published studies sponsored by the companies themselves as well as all independent published studies in the literature -- and he drew his conclusions based on analyzing "blinded" studies, meaning studies in which researchers and independent raters used objective measures and did not know which children were assigned to the cognitive training programs as opposed to an inactive placebo condition.

Working memory represents one of the most important core deficits in children with ADHD, and improvements in working memory are associated with improved academic performance, behavior, peer relationships and other intellectual abilities. Surprisingly, although a majority of the cognitive training programs claimed to train this important aspect of brain functioning, closer examination of their training exercises revealed that they actually train short-term memory.

Short-term memory stores information in mind for a brief interval, whereas working memory uses the stored information for accomplishing a wide range of cognitive tasks, such as reading comprehension, mental math, and multitasking.

Rapport said his conclusions do not mean that the computer-based programs cannot become a helpful tool for children with ADHD. If programs can be designed to focus on working memory, it is worth evaluating whether they can help children's cognitive abilities, academic performance and behavior, he said.

Read more here

Digestive issues in children with ADHD

This article discusses how children with ADHD also commonly have digestive issues that go untreated in the child.

Children with attention-deficit/hyperactivity disorder (ADHD) are significantly more likely to suffer from chronic constipation and fecal incontinence than kids without the neurobehavioral condition, a new study says.

The study of more than 700,000 children found that constipation nearly tripled and fecal incontinence increased six-fold among kids with ADHD.

"We also found that children with ADHD tend to have more visits to see a doctor, suggesting that these children have more severe constipation and fecal incontinence than other children," said lead researcher Dr. Cade Nylund, an assistant professor of pediatrics at the Uniformed Services University of the Health Sciences.

Taking medication to treat ADHD did not seem to affect the number of office visits for these bowel problems, according to the study, which was published online Oct. 21 in the journal Pediatrics.

In the United States, more than 8 percent of children are diagnosed with ADHD. Kids with the condition display hyperactivity, as well as difficulty staying focused, paying attention and controlling their behavior.

These ADHD-related behavioral problems may lie behind the increased risk for bathroom woes, Nylund said.

"Kids with ADHD may not respond properly to physical cues to go to the bathroom," Nylund said. "They may have difficulty interrupting other or more desirable tasks they wish to engage in at that time."

Fecal incontinence is a more severe form of constipation, Nylund said. "What happens is, kids have constipation for several years and then they lose normal cues to go to the bathroom entirely. Then ... they just overflow and leak into their underwear."

Parents who notice that their child is suffering from constipation should see their pediatrician, Nylund said. In addition, parents can prevent constipation by increasing fiber in their child's diet, he said.

"Parents need to be aware that this risk exists and hopefully prevent constipation from occurring," Nylund said.

One expert said he sees this problem all the time among his patients -- both children and teenagers -- but it is often ignored and untreated.

"Their parents are noticing that they do have constipation, but they are not bringing it to the attention of a pediatrician or child psychiatrist, and it's going unnoticed and unaddressed," said Dr. Matthew Lorber, acting director of child and adolescent psychiatry at Lenox Hill Hospital in New York City.

Lorber said children with ADHD also might digest food more slowly or irregularly than children without ADHD. "Physiologically, that can lead to problems that cause constipation or fecal incontinence," he said.

Parents can help by setting consistent times for their child to go to the bathroom, such as before going to school or to bed, or before a long car trip, Lorber said.

He also said parents shouldn't "yell at their children for 'accidents.'"

Dr. William Muinos, associate director of pediatric gastroenterology at Miami Children's Hospital in Florida, agreed that children with ADHD often are distracted and forget to go to the bathroom.

"What we do is place them on lubrication therapy -- medication that will lubricate the bowel to help stimulate defecation," he said. "The other thing we do is simple behavior modification." This involves teaching the child to go to the bathroom at specific times, usually twice a day -- once before going to school and once in the evening, he said.

For the study, Nylund's team collected data on nearly 750,000 children, aged 4 to 12 years, who had a parent on active military duty. Among these children, nearly 33,000 were identified as having ADHD.

The researchers found that 4.1 percent of the children with ADHD suffered from constipation, compared with 1.5 percent of children without the condition.

In addition, 0.9 percent of the children with ADHD suffered from fecal incontinence, compared with 0.15 percent of children without ADHD.

Even when adjusted for factors such as age, gender and birth order, the researchers found the risk for fecal incontinence was more than six times greater among kids with ADHD and the risk for constipation was almost three times higher.

Although the research showed an association between ADHD and increased instances of constipation and incontinence, it did not prove a cause-and-effect relationship.

Read more here

Study: Sunny climates may reduce ADHD

A study indicates many risk factors for ADHD, and interestingly notes that sunny and warm climates may reduce the condition.

Attention-deficit/hyperactivity disorder, or ADHD, is the most common childhood psychiatric disorder. Scientists do not know what causes it, but genetics play a clear role. Other risk factors have also been identified, including premature birth, low birth weight, a mother's use of alcohol or tobacco during pregnancy, and environmental exposures to toxins like lead.

ADHD is characterized by an inability to focus, poor attention, hyperactivity, and impulsive behavior, and the normal process of brain maturation is delayed in children with ADHD. Many individuals with ADHD also report sleep-related difficulties and disorders. In fact, sleep disorder treatments and chronobiological interventions intended to restore normal circadian rhythms, including light exposure therapy, have been shown to improve ADHD symptoms.

Estimates suggest that the average worldwide prevalence of ADHD ranges from about 5 to 7%, but it also varies greatly by region. A simple visual comparison of data maps released by the U.S. Centers for Disease Control and Prevention and the U.S. Department of Energy that display ADHD prevalence rates by state and solar intensities (sunlight) across the country, respectively, reveals an interesting pattern indicative of an association. So does this mean that there could be an identifiable relationship between ADHD prevalence rates and the sunlight intensity levels of particular regions?

The accumulation of these points led Dr. Martijn Arns and his colleagues to systematically and scientifically investigate this question. They collected and analyzed multiple data-sets from the United States and 9 other countries. Reporting their findings in the current issue of Biological Psychiatry, they did find a relationship between solar intensity and ADHD prevalence.

Even after controlling for factors that are known to be associated with ADHD, both U.S. and non-U.S. regions with high sunlight intensity have a lower prevalence of ADHD, suggesting that high sunlight intensity may exert a 'protective' effect for ADHD.

To further validate their work, they also looked at this same relationship with autism and major depressive disorder diagnoses. They found that the findings were specific to ADHD, with no associations observed between the other two disorders.

"The reported association is intriguing, but it raises many questions that have no answers," commented Dr. John Krystal, Editor of Biological Psychiatry. "Do sunny climates reduce the severity or prevalence of ADHD and if so, how? Do people prone to develop ADHD tend to move away from sunny climates and if so, why?"

As with all scientific research, further work is necessary, including a prospective replication of these findings. It is also important to realize that this data reflects only an association -- not a causation -- between ADHD and solar intensity levels so worried parents should not start planning cross-country moves.

However, these findings do have significant implications, explains Dr. Arns. "From the public health perspective, manufacturers of tablets, smartphones and PCs could investigate the possibility of time-modulated color-adjustment of screens, to prevent unwanted exposure to blue light in the evening."

"These results could also point the way to prevention of a sub-group of ADHD, by increasing the exposure to natural light during the day in countries and states with low solar intensity. For example, skylight systems in classrooms and scheduling playtime in line with the biological clock could be explored further."

Read more here

Does your child have ADD, ADHD, or both?

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

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

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

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

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

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

Read more here