Tuesday, February 15, 2011

Newest Information on ADHD


Many readers know that boys are diagnosed as high as 3:1 versus girls for ADHD (although that seems to be changing). I've been posting information here from time to time on our newest understanding of this "disorder."

I'm posting a bit of each article, so follow the links to read the whole thing.

From the New York Times, Men, Women and A.D.H.D.

In childhood, boys are three times as likely as girls to have A.D.H.D. Boys with the disorder tend to be more hyperactive and impulsive and are more likely to develop oppositional behavior, conduct problems and later delinquency than girls, though girls, too, can develop these problems. Girls, on the other hand, may be more prone to develop anxiety, depression and eating disorders — bulimia, in particular.

By adulthood, the proportion of men to women with the disorder is nearly even, and there are few differences in the symptoms. Both men and women have significant problems with executive functioning, which involves skills like time management, self-organization and problem-solving, as well as self-restraint, self-motivation and self-regulation of emotions. All of these problems can have a major effect on daily life activities, like family relations, child-rearing, managing money, functioning at work or driving.

Where men and women may differ is in the amount of time they engage in these activities – and the subsequent impact on daily life. A woman who works full time outside the home, for instance, would have more work-related difficulties, whereas a stay-at-home mother might have more problems related to home life. To the extent that women may opt for certain roles, those roles will be more greatly affected by the disorder, and vice versa for men.

This one comes from The Australian and it seems to support an argument I have made from time to time - the diet can have an impact on ADHD symptoms - Diet change improved ADHD children's behaviour, Lancet reports:
Researchers compared the effects on behaviour of giving 50 children aged four to eight a restricted diet, against another 50 eating normal healthy fare, and reported parents and teachers found significant improvements in behaviour in 64 per cent of the restricted diet group.

* * * *

Of the 50 children given the restricted diet - comprising rice, meat, vegetables, pears and water, plus potatoes, fruits and wheat if they could tolerate them - 41 completed the five-week course.

None of the 100 children in the trial were being treated with ADHD drugs, and the study did not select children previously diagnosed with food allergies. Those already on a restricted diet were excluded.

No significant improvements in behaviour were seen in the children given the normal diet, whereas 32 of the 41 on the restricted diet did improve.

Of these 32, 30 were then subjected to a "challenge", which involved them having three foods reintroduced into their diets.

These three foods - which were different for each child - had been previously been shown to trigger either a high or a low increase in blood levels of an immune system antibody called immunoglobulin G (IgG).

This is an excellent finding - however, there needs to be further research, and the parents and teachers need to be excluded from awareness of whether or not a given child is on the diet (difficult, I know, but there is potential bias in the current design). It would be worth looking ay whether or not some foods reduce IgC.

The next one, from Science Codex, is one I can identify with as an ADHD person who also went through a few cycles of addiction - Kids with ADHD much more likely to develop substance abuse problems as they age:

Children with attention-deficit hyperactivity disorder are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood, according to a study by UCLA psychologists and colleagues at the University of South Carolina.

"This greater risk for children with ADHD applies to boys and girls, it applies across race and ethnicity — the findings were very consistent," said Steve S. Lee, a UCLA assistant professor of psychology and lead author of the study. "The greater risk for developing significant substance problems in adolescence and adulthood applies across substances, including nicotine, alcohol, marijuana, cocaine and other drugs."

Lee and his colleagues analyzed 27 long-term studies that followed approximately 4,100 children with ADHD and 6,800 children without the disorder into adolescence and young adulthood — in some cases for more than 10 years. These carefully designed, rigorous and lengthy studies, Lee said, are the "gold standard" in the field.

The research by Lee and his colleagues, the first large-scale comprehensive analysis on this issue, is published online this week in the journal Clinical Psychology Review and will appear in a print edition later this year.

Personally, I see this an effort to self-medicate - the hyperactivity element contributes to anxiety for some of us - and we discover pretty early (because we also tend to be more open experimentation) that alcohol or marijuana can take the edge off and mellow us out - for a while. The pot often ends up making it worse, and the alcohol poses its own issues.

Another article from the New York Times follows a Q&A format about ADHD, this is one of the good questions - When the Diagnosis Is A.D.H.D.:

Seeking Professional Help for A.D.H.D.


It’s difficult as a parent to approach the subject of A.D.H.D. without feeling like you’re falling prey to the trendiness of the diagnosis. However, I can’t shake the feeling that my just-7-year-old son has some attention challenges that are making his life more difficult. While he gets good grades in a challenging private school, has many friends, and is not at all aggressive, his teachers say he really struggles to maintain focus. When should a parent make the decision that outside intervention/medical consideration is truly warranted — and how do you ensure that the person you consult isn’t overdiagnosing? Such a dilemma for parents these days.
LisaD, Charleston, S.C.

A. Dr. Barkley responds:

Symptoms of A.D.H.D., like distractedness and impulsiveness, can occur to varying degrees within the general population. As symptoms increase in severity, the condition can become more troublesome, eventually impairing a child’s major life activities.

So where does a disorder like A.D.H.D. begin and “normal” behavior — or just high energy levels — leave off?

When a symptom like inattention, as in your child’s case, or hyperactivity or impulsiveness has reached a level at which it becomes excessive and inappropriate for the child’s age, it may be time to seek professional advice. Symptoms that have lasted for at least six months and, most importantly, are interfering with a child’s major life activities, like school, relations with friends or family matters, are particular areas of concern. Another sign that a parent should seek professional help is getting feedback from others that a child may have a problem with any of these symptoms and that it is leading to impairment.

There is no way to know in advance if a particular doctor or other professional is overdiagnosing the disorder in the patients they see. But that would be very unusual, as most clinicians are very conservative in giving a diagnosis. If you think the evaluation is rather short and superficial, then seek a second opinion with a second clinician.

In addition, there may be local support groups in your area. If so, you can ask parents who belong to the group whom they recommend for an expert evaluation of A.D.H.D.

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