ADHD

RECENT POSTS

Ritalin Nation: ADHD Drugs Not Studied Enough For Rare Or Late Risks

The ADHD drug Ritalin (Wikimedia Commons)

The ADHD drug Ritalin (Wikimedia Commons)

If we’re going to keep putting millions of American children on ADHD drugs, we really need to study the meds longer and better to pick up rare and late-onset side effects.

That’s my takeaway from a study just out from Boston Children’s Hospital. It found that in many cases, ADHD drugs had not been studied for long enough — really, can a clinical trial of a few weeks be long enough for a drug that’s typically taken for many years? — or in enough people. And drug company promises to keep studying the drugs’ effects even after the FDA approves them have often fallen by the wayside.

From the press release:

Over the last 60 years, the U.S. Food and Drug Administration (FDA) approved 20 medications for attention deficit/hyperactivity disorder (ADHD) based on clinical trials that were not designed to study their long-term efficacy and safety or to detect rare adverse events, researchers at Boston Children’s Hospital report today in PLOS ONE. The study highlights gaps in how the long-term safety of drugs intended for chronic use in children is assessed as part of the FDA approval process.

“This study doesn’t address whether ADHD drugs are safe, though their safety has since been established through years of clinical experience,” says study senior author Kenneth Mandl, MD, MPH, Boston Children’s chair in biomedical informatics and population health and director of the Intelligent Health Laboratory in Boston Children’s Informatics Program. “Instead, we point to the need for an agenda emphasizing improved assessment of rare adverse events and long-term safety through post-marketing trials, comparative effectiveness trials and more active FDA enforcement.”

The numbers: Continue reading

Breastfeeding May Lower Risk Of ADHD, Study Finds

To the long list of health woes breastfeeding might protect your child against, add this one: attention deficit hyperactivity disorder.

vintagebreastfeedingResearchers from Israel report that breastfed children may have a lower risk of developing ADHD, one of the most common neuro-behavioral disorders of childhood.

UPI covered the study, published online earlier this year and just out in the journal Breastfeeding Medicine:

Dr. Aviva Mimouni-Bloch of Tel Aviv University’s Sackler Faculty of Medicine and Loewenstein Hospital and colleagues completed a retrospective study on the breastfeeding habits of parents of three groups of children: a group that had been diagnosed with ADHD; siblings of those diagnosed with ADHD; and a control group of children without ADHD and lacking any genetic ties.

The study…found a clear link between rates of breastfeeding and the likelihood of developing ADHD, even when typical risk factors were taken into consideration.

Children who were bottle-fed at 3 months were found to be three times more likely to have ADHD than those who were breastfed during the same period, the study said. Continue reading

It’s The Carbs: ADHD In Childhood Linked To Adult Obesity, Study Finds

(Tobyotter/flickr)

(Tobyotter/flickr)

Ned Hallowell is a Sudbury, Mass. psychiatrist and expert on ADHD who suffers from the condition himself. Today, he spoke with NPR about a new study in the journal Pediatrics that found boys with ADHD are more likely to become obese men compared to children without the condition. Hallowell is quoted saying the results seem reasonable:

“It makes sense, because they’re self-medicating with carbohydrates. Carbs do the same thing that stimulant medications do — promote dopamine,” says Hallowell, who wasn’t involved in the latest study. “So you get the gallon of ice cream at midnight.”

With impulse control often a problem for people suffering from the disorder, Hallowell also says that nutrition should be part of an ADHD treatment plan. Continue reading

10 Facts You May Not Know About ADHD

By Karen Weintraub
Guest Contributor

When you think about ADHD, what do you imagine? If you’re like most people, it’s probably a stereotypical image of a young boy bouncing off the walls, buzzing with pent-up, unfocused energy.

But many people with ADHD aren’t hyperactive at all, and by the time they reach adulthood, most hyperactive people have calmed down — at least on the outside. This helps explain why Attention Deficit Hyperactivity Disorder, which used to be considered a childhood condition, is now being diagnosed in adults as well.
adhd

There are some who dismiss the condition as massively over-diagnosed, perhaps as a ploy by drug companies to boost business. And maybe there’s some truth to that on the margins. Not everyone who’s got ideas racing through their head should be medicated. (Just ask most of the faculty at MIT.)

But there are large numbers of people — studies suggest it’s as many as 4 percent of adults – who are profoundly affected by the symptoms of ADHD. Many can’t hold a job or stick with a relationship. They’re chronically late or forgetful. They jump into jobs and purchases and relationships without thinking them through, only to regret their impulsive actions later. They get stuck in self-destructive patterns, fall prey to addiction and depression. And they can’t figure out why they struggle so much more than everyone else.

For this population, a diagnosis can be a huge relief, explaining why they’ve always felt out of step with the world.

Here are a few other things you might not have known about ADHD, drawn from a new book I co-write, Fast Minds, How to Thrive if You Have ADHD (Or Think You Might) published by Berkley Books:

Medication Can’t Fix ADHD
Treating ADHD in adults with medication can be helpful – and it’s often the first suggestion a diagnosing doctor will make. But it’s not enough. Adults with ADHD often need help getting and staying organized, even with their own priorities in life. They may need help at critical moments, making a constructive choice, rather than a destructive one. And they need emotional support to counteract all the negative messages they’ve received all their lives when their actions didn’t meet other people’s expectations.

Not Everyone Who’s High Energy Has ADHD
Our images of ADHD come from celebrities who talk about having it, like singer Adam Levine or actor and game show host Howie Mandel. But many people with the condition struggle to get up off the couch. They were the quiet ones in class who always seemed like they were in their own world. As adults, they may be unsure of what to do, or want to do so many things that they paralyze themselves. On the other hand, there are plenty of people who have some of the traits of ADHD without being impaired by the condition. Some of the same organizational and self-control strategies may help.

People With ADHD Don’t Have Trouble Paying Attention Continue reading

How Doctors Think About ADHD Medication Abuse

By Karen Weintraub
Guest Contributor

Like any other medication, drugs used to treat Attention Deficit Hyperactivity Disorder can be abused.

A story in last Sunday’s New York Times showed the potentially tragic consequences of such abuse, and revealed some of the systemic factors that enabled it.

There is no blood test to diagnose ADHD – no biological marker that says “yes” you have the condition or “no” you don’t. Accurate diagnosis relies on the sophistication and experience of the doctor and the honesty of the patient.

(Adam Crowe/flickr)

(Adam Crowe/flickr)

The New York Times piece suggested that one or both of these factors broke down in the case of Richard Fee, a college graduate who committed suicide at age 24, two weeks after his last prescription for the stimulant Adderall expired.

Drugs like Adderall are far more available now than they used to be, because awareness of ADHD and prescriptions have increased markedly over the last decade, particularly among adults.

Most people tend to see ADHD as a condition of childhood. Research suggests that 5-10 percent of children meet the criteria for ADHD and are impaired by it, while roughly 4 percent of adults do.

Although there has long been discussion about whether ADHD medications are overused in children, this story raised concerns about the drugs in early adulthood, when drug abuse is most common. “We’ve got a lot more drugs out there in that age population,” said Dr. Glen Elliott, chief psychiatrist and medical director at the Children’s Health Council in Palo Alto. “The need to be more alert to possible diversion and misuse and abuse in this population has certainly increased.” Continue reading

ADHD: Girls Get It, Too

Although ADHD is generally associated with males, females have the condition, too. Celebrity Paris Hilton said in a 2007 interview that she has struggled with ADHD since she was 12. (Chesi-Fotos CC/flickr)

By Karen Weintraub
Guest contributor

The stereotypical boy with Attention Deficit Hyperactivity Disorder bounces off the wall of his classroom, unable to sit still or pay attention to lessons. Boys are three times more likely to be diagnosed with ADHD than girls, but a new study suggests that when girls do have the condition, they are likely to have serious challenges.

Girls diagnosed with ADHD in childhood were more likely to attempt suicide, cutting and other self-harming behaviors as teenagers than those without the condition, according to the study, by Stephen P. Hinshaw, of the University of California, Berkeley, among others.

It is well established that people diagnosed with ADHD are also more likely than others to have other conditions, like depression, bipolar and eating disorders. It’s as if their brains are more vulnerable to all sorts of hits, not just ADHD. But Hinshaw said he’s particularly worried about girls.

It’s not clear whether the girls who are diagnosed with ADHD have more problems than boys with the condition, or whether girls with milder forms of ADHD are just missed by clinicians, because they don’t fit the stereotype. Or, perhaps, the trauma of growing up as a girl with ADHD scars these girls so much that they resort to self-harm, Hinshaw said.

The old assumption that children will grow out of ADHD is wrong, with roughly 60 percent continuing to have symptoms into adulthood, research shows. Continue reading

Deep Murk On Cause Of ADHD Drug Shortage

When I wrote about the rising shortage of ADHD drugs earlier this month, I felt like a failure for my inability to offer a clear explanation for what lies behind it. I ran into a sort of hall of mirrors, with conflicting accounts from federal officials and drug companies, some of it frustratingly off the record — and I threw up my hands, hoping some more investigative type with more time would ferret out the truth.

So I’m a little comforted that in his excellent report today for NPR on the national ADHD drug shortage, Dick Knox, a veteran health and science reporter whom I respect maximally, seems to have run into the same thing. He says that the ADHD drug Adderall has become hard to get in recent months “for reasons that are unclear.”

And in the Web version of his story, he writes, near the end, “For one version of what really may be going on behind the scenes to cause (or exacerbate) the shortages – or market distortions, as the DEA would have it – read this.”

“This” is a long and fascinating piece on “the fix,” a Website on addiction and recovery. It has “The Great American Adderall Drought” in the headline, and in the sub-head, “Naturally, it’s all about Big Pharma profits.”

Please forgive my prudishness, but I’m going to delete a profane gerund in this quote: Continue reading

Voices: The Hunt For Elusive ADHD Drugs

Some attention deficit disorder drugs are running short around the country, and Massachusetts is no exception. In our report on the shortage and its possible causes, a leading ADHD expert, Dr. Edward Hallowell, says that the recent deficit of the drug Adderall “seems crazy.” He can prescribe substitutes, but otherwise, he doesn’t know what to tell his patients other than, “I guess, ‘Go shopping.’

Around the state, people are indeed going shopping — or perhaps “hunting” is a better word for the quest that many must undertake for the stimulants prescribed to offset Attention Deficit Hyperactivity Disorder.

Some need the medications for themselves, some for their children. Our initial post describes the oddly patchy shortages that one shopper encountered when calling around to various pharmacies in Brookline and Newton. In search of the bigger picture, I turned to Lisa Lambert, executive director of the Parent/Professional Advocacy League, which advocates for children with mental illness. She could teach Facebook a thing or two about social networking, and she kindly sent out our query to listservs run by Mass Family Voices and MassPAC. Nearly a dozen responses immediately rolled in from people struggling to find ADHD medications. Here’s a sampling:

From a Mansfield father of two daughters with attention deficit disorders:
“Just recently, I was getting the prescription filled for one of my daughters, and the doctor had written the usual prescription plus one that was faster-acting, and CVS didn’t have that one in stock — they’ve been backlogged for quite a while.
I pulled up to the drive-through window and the lady told me that for that particular Adderall, they were on back-order; they didn’t have any and they’re finding it’s universal, I probably wouldn’t find it at another drugstore either. I drove away thinking, ‘My God, why would it be a universal drop in that availability?’ There
is an incredible demand for this stuff. How, or in what way, or if at all that plays a role in the lack of its availability I don’t know.”

[Note: His experience jibes with the FDA list of drug shortages, which shows the current crunch largely in immediate-release stimulants rather than longer-acting ones.]

From a mother in Bridgewater, whose daughter takes a 40-milligram dose of long-acting Ritalin — no supply problems with that one — and then in the afternoon, a 20-milligram dose of immediate-release Ritalin. Continue reading

Daily Rounds: ADHD Nears 10%; Being A ‘Best Doc’; Medicaid Managed Care; WHO on BPA; FSA’s Get Less Flexible

Medical News: ADHD Rates Are Increasing – in Pediatrics, ADHD/ADD from MedPage Today “The percentage of children and teens ages 4 to 17 with a parent-reported ADHD diagnosis increased from 7.8% in 2003 to 9.5% in 2007, researchers from the agency’s National Center on Birth Defects and Developmental Disabilities and from the National Center for Health Statistics reported in the Nov. 12 issue of Morbidity and Mortality Weekly Report.” (medpagetoday.com)

Best Doc in a magazine, the inside story” It’s hard to judge doctors. Even good doctors get sued, and have medical board complaints against them. I have a lot of patients who love me. And some who hate me and think I’m incompetent. You can’t predict the vagaries of human chemistry.” (Kevin, M.D.)

Medicaid managed care programs grow; so do issues – USATODAY.com “Medicaid health plans without exception are seeing reform as a tremendous business opportunity, and they are preparing for the expansion as a chance to grow and expand,” says Vernon Smith, a principal at consulting firm Health Management Associates. But the coming boom is sparking debate about whether Medicaid managed care is best for patients. In traditional fee-for-service Medicaid, enrollees can go to any doctor willing to participate, although finding a specialist can be a challenge in some areas. In managed care, enrollees must see providers in their plans’ networks.” (USA Today)

bisphenol A restrictions premature, said WHO – latimes.com “An expert panel convened last week by the World Health Organization recommended that public health officials hold off on regulations limiting or banning the use of bisphenol A.” (Los Angeles Times)

Flexible Spending Accounts Get Less Flexible : NPR“If you’re one of the 20 million or so Americans with a flexible spending account for health care, get ready for some changes. Paul Sakuma/AP Tylenol drugs on display at Costco in Mountain View, Calif. To get reimbursed for these over-the-counter drugs by flexible spending accounts, consumers will need a prescription. Starting Jan. 1, you’ll no longer be able to set aside pretax dollars in that account to use for medicines bought without a doctor’s prescription.” (npr.org)

Daily Rounds: Stop Texting Now! Mammogram Mixed Messages; Innovation Chief Snapshot; The ADHD Gene; A New Nurturing Planet?

Mass. texting while driving ban begins Thursday – BostonHerald.com “The new law also prohibits scanning the Internet on a phone or mobile device while driving and bans anyone under 18 from talking on a cell phone while driving. Violators will face fines ranging from $100 for a first offense and up to $500 for repeat offenses. The ban still applies when drivers are at a stoplight.” (bostonherald.com)

Mammogram Benefit Is Seen for Women in Their 40s – NYTimes.com “The study’s conclusions contrast with those of a report last year by the United States Preventive Services Task Force, an independent group that issues guidelines on cancer screening, questioning the benefit of screening women younger than 50.” (The New York Times)

New 'Innovation' Chief Comes From 'Model' Health Care System – Kaiser Health News Dr. Richard Gilfillan was just appointed the new acting director of the Center for Medicare and Medicaid Innovation. "It is one of the most important positions in HHS because almost all of the reform of the delivery system potential hinges on this innovation center. It is as key a position as there is," said Gail Wilensky, who ran the Health Care Financing Administration — now CMS — from 1990 to 1992.” (kaiserhealthnews.org)

Kids with ADHD more likely to have missing DNA – Boston.com “Children with attention deficit hyperactivity disorder are twice as likely to have missing or extra chromosomes than other children — the first evidence that the disorder is genetic, a new study says.” (Boston Globe)

New Planet May Be Able to Nurture Organisms – NYTimes.com It might be a place that only a lichen or pond scum could love, but astronomers said Wednesday that they had found a very distant planet capable of harboring water on its surface, thus potentially making it a home for plant or animal life.” (The New York Times)