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By TARA PARKER-POPE When pediatricians diagnose attention deficit hyperactivity disorder, they often ask their patients whether they know anybody else with the problem. These days, children are likely to reply with a household name: Michael Phelps, the Olympic superstar, who is emerging as an inspirational role model among parents and children whose lives are affected by attention problems. “There is a tremendous, tremendous amount of pride — I got the impression sometimes that some of the kids felt like they owned Michael,” said Dr. Harold S. Koplewicz, director of the Child Study Center at New York University Langone Medical Center. “There is a special feeling when someone belongs to your club and the whole world is adoring him.” But the emergence of a major celebrity with attention deficit has revealed a schism in the community of patients, parents, doctors and educators who deal with the disorder. For years, these people have debated whether it means a lifetime of limitations or whether it can sometimes be a good thing. Children with the disorder typically have trouble sitting still and paying attention. But they may also have boundless energy and a laserlike focus on favorite things — qualities that could be very helpful in, say, an Olympic athlete. Copyright 2008 The New York Times Company

Related chapters from BP6e: Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 13: Memory, Learning, and Development
Link ID: 12269 - Posted: 06.24.2010

Use Ritalin only as last resort for kids with ADHD, guidelines say

Parents of children with ADHD should be trained to help their children cope, and Ritalin should only be prescribed as a last resort, a health watchdog in Britain said Wednesday. The drug shouldn't be used in children under five, and should be prescribed for older children only when they have severe attention deficit hyperactivity disorder, the National Institute for Health and Clinical Excellence said in its guidelines for parents and doctors. Treatment with Ritalin — a brand name for the pharmaceutical methylphenidate — or other drugs "should be reserved for those with severe symptoms and impairment," the guidelines say. Symptoms of ADHD can include a short attention span, a low level of organization, excessive talking, aggressive gestures and irritability. It affects an estimated five to 12 per cent of Canadian children. When drugs for the disorder are prescribed, it should be along with psychological therapy and support for the child to develop problem solving, listening, coping and peer relationship skills, the group said. The guidelines also say parent training and education programs should be offered as a first-line treatment for ADHD in both preschool and school-aged children. © CBC 2008

How smart are 'smart drugs'?

Fleur Britten Is your memory so perforated that you fear early-onset Alzheimer’s? Your attention so centrifugal that you’ve self-diagnosed attention deficit hyperactivity disorder (ADHD)? Perhaps you don’t have time to sleep, or maybe you would just like to function as a super-you. The sci-fi solution we have all been waiting for is already here, and it’s circulating in student unions and school. These days, the kids are all on “smart drugs”. A group of pharmaceuticals designed for sufferers of narcolepsy, Alzheimer’s and ADHD, smart drugs are increasingly being used “off label” (unsupervised, as a lifestyle choice) by healthy people, who procure them from online pharmacies, friendly physicians and illicit prescription sales. “This stuff is being passed around all the time,” says one male A-level student with something of a smart-drug habit — “this stuff” largely being Ritalin, usually prescribed for children with ADHD, and Modafinil, which is used to treat narcolepsy. Students are rejoicing and cramming for exams with smart-drug- fuelled all-nighters. One told me that he buys his from a mate who sells on his larger-than-necessary prescription; another offered to put me in touch with her “very kind doctor”. The government, meanwhile, is sweating. It recently commissioned a report on brain science that concluded more work is needed. What students and the government both know is that in Ritalin improves attention, memory and cognitive flexibility in healthy subjects; Modafinil improves attention, memory, planning and decision- making and leaves you in a state of wakefulness without the wired bit, liability of addiction or “obvious toxic effects”. So what’s not to like? Copyright 2008 Times Newspapers Ltd.

Related chapters from BP6e: Chapter 7: Life-Span Development of the Brain and Behavior; Chapter 17: Learning and Memory
Related chapters from MM:Chapter 13: Memory, Learning, and Development; Chapter 13: Memory, Learning, and Development
Link ID: 11838 - Posted: 06.24.2010

Weighing Nondrug Options for A.D.H.D.

By TARA PARKER-POPE About 2.5 million children in the United States take stimulant drugs for attention and hyperactivity problems. But concerns about side effects have prompted many parents to look elsewhere: as many as two-thirds of children with attention deficit hyperactivity disorder, or A.D.H.D., have used some form of alternative treatment. The most common strategy involves diet changes, like giving up processed foods, sugars and food additives. About 20 percent of children with the disorder have been given some form of herbal therapy; others have tried supplements like vitamins and fish oil or have used biofeedback, massage and yoga. While some studies of alternative treatments show promise, there is little solid research to guide parents. That is unfortunate, because for some children, prescription drugs aren’t an option. The drugs have been life-changing for many children. But nearly one-third experience worrisome side effects, and a 2001 report in The Canadian Medical Association Journal found that for more than 10 percent, the effects could be severe — including decreased appetite and weight loss, insomnia, abdominal pain and personality changes. Although the drugs are widely viewed as safe, many parents were alarmed when the Food and Drug Administration ordered in 2006 that stimulants like Adderall, Ritalin and Concerta carry warnings of risk for sudden death, heart attacks and hallucinations in some patients. Copyright 2008 The New York Times Company

Heart test urged before kids get ADHD drugs

NEW YORK - Children should be screened for heart problems with an electrocardiogram before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder, the American Heart Association recommended Monday. Stimulant drugs can increase blood pressure and heart rate. For most children, that isn't a problem. But in those with heart conditions, it could make them more vulnerable to sudden cardiac arrest — an erratic heartbeat that causes the heart to stop pumping blood through the body — and other heart problems. About 2.5 million American children and 1.5 million adults take medication for attention-deficit hyperactivity disorder, or ADHD, according to government estimates. Stimulant drugs, like Ritalin, Adderall and Concerta, help children with ADHD to stay focused and control their behavior. The medications already carry warnings of possible heart risks in those with heart defects or other heart problems, which some critics said were driven more by concerns of overuse of the drugs than their safety. The heart group is now recommending a thorough exam, including a family history and an EKG, before children are put on the drugs to make sure that they don't have any undiagnosed heart issues. Copyright 2008 The Associated Press.

Attention Deficits That May Linger Well Past Childhood

By ALIYAH BARUCHIN A recent groundbreaking brain-imaging study found that children with attention-deficit hyperactivity disorder experience a development delay with a distinct biological basis. Investigators at the National Institute of Mental Health discovered that areas of the brain’s cortex undergo a thinning maturation process about three years later in children with A.D.H.D. than in those without the condition. Areas that integrate sensory information with executive functions like focused attention, remembering things from moment to moment and controlling movement — functions that are often compromised in people with A.D.H.D. — showed the longest lag time. The results of the study support the belief that A.D.H.D. is a delay in a normal pattern of development, rather than a deficit that completely derails development — a longstanding debate in A.D.H.D. research. Yet despite M.R.I. images showing biological brain differences in children with A.D.H.D., news of the findings immediately tapped into a wellspring of skepticism about the legitimacy of the condition. Web sites were inundated with postings that A.D.H.D. is “just a delay,” that kids diagnosed with the condition are actually “normal” after all, that it’s perverse to medicate children for something that “most” will outgrow. Estimated to affect millions of Americans — 3 percent to 7 percent of children and more than 4 percent of adults — A.D.H.D. has traveled an extraordinary arc of clinical and public opinion over the last four decades. What began as a relatively unknown disorder became broadly recognized as one of the most common psychiatric problems in children and an increasingly major consideration in adult psychiatric diagnoses as well. Copyright 2008 The New York Times Company

Faulty memory may explain kids' bad grades

CHICAGO - Defects in working memory — the brain's temporary storage bin — may explain why one child cannot read her history book and another gets lost in algebra, new research suggests. As many as 10 percent of school age children may suffer from poor working memory, British researchers said in a report last week, yet the problem remains rarely identified. "You can think of working memory as a pure measure of your child's potential," Dr. Tracey Alloway of Britain's Durham University said in a telephone interview. "Some psychologists consider working memory to be the new IQ because we find that working memory is the single most important predictor of learning," Alloway said. Many children with poor working memory are considered lazy or dim. But Alloway said with early identification and memory training, many of these underachievers can improve. Working memory allows people to hold and manipulate a few items in their minds, such as a telephone number. Alloway compares working memory to a box. Copyright 2008 Reuters.

Hyper kid? Sleep apnea may be the culprit

By Roni Caryn Rabin When Benjamin Kidd was in pre-K last year, his teachers marveled at how bright, attentive and well-behaved he was — in the morning. Later in the day, Ben was a different child. He was fidgety and he couldn’t focus. He couldn’t sit still for a story. And he burst into tears and temper tantrums at the slightest provocation. After taking him to one specialist after another, his mother, Michelle Kidd, who lives in Hillsborough N.J., finally figured out what the problem was: 5-year-old Ben was exhausted. Doctors who ran an overnight sleep study on him last fall said he was suffering from obstructive sleep apnea, a sleep disorder associated with middle age but not uncommon in preschoolers, where it can lead to behavior easily mistaken for hyperactivity — even though it’s actually caused by fatigue. “You know how it is when you let your kid stay up too late, and they’re bouncing off the walls and don’t listen?” says Kidd, who had consulted physicians at the Somerset Medical Center’s Sleep for Life Center in Hillsborough. “It was a lot of that.” © 2008 Microsoft

Related chapters from BP6e: Chapter 7: Life-Span Development of the Brain and Behavior; Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 13: Memory, Learning, and Development; Chapter 10: Biological Rhythms and Sleep
Link ID: 11290 - Posted: 06.24.2010

Short Attention Spans Serve Purpose

Malcolm Ritter, Associated Press — Mainstream psychology hasn't paid much attention to distractability. But a spate of new studies is chipping away at its mysteries and scientists say the topic is beginning to gain visibility. Someday, such research may turn up ways to help students keep their focus on textbooks and lectures, and drivers to keep their minds on the road. It may reveal ways to reap payoffs from the habit. And it might shed light on attention deficit hyperactivity disorder, which can include an unusually severe inability to focus that causes trouble in multiple areas of life. More generally, scientists say, mind-wandering is worth studying because it's just too common to ignore. Michael Kane, a psychologist at the University of North Carolina at Greensboro, sampled the thoughts of students at eight random times a day for a week. He found that on average, they were not thinking about what they were doing 30 percent of the time. For some students it was between 80 and 90 percent of the time. Out of the 126 participants, only one denied any mind-wandering at the sampled moments. © 2007 Discovery Communications Inc.

Related chapters from BP6e: Chapter 7: Life-Span Development of the Brain and Behavior; Chapter 19: Language and Hemispheric Asymmetry
Related chapters from MM:Chapter 13: Memory, Learning, and Development; Chapter 15: Language and Our Divided Brain
Link ID: 10102 - Posted: 06.24.2010

Panel Advises Disclosure of Drugs' Psychotic Effects

By GARDINER HARRIS GAITHERSBURG, Md., — Stimulants like Ritalin lead a small number of children to suffer hallucinations that usually feature insects, snakes or worms, according to federal drug officials, and a panel of experts said on Wednesday that physicians and parents needed to be warned of the risk. The panel members said they hoped the warning would prevent physicians from prescribing a second drug to treat the hallucinations caused by the stimulants, which one expert estimated affect 2 to 5 of every 100 children taking them. Instead, they said, the right thing to do in such cases was to stop prescribing the stimulants. On Feb. 9, a different advisory committee voted 8 to 7 to recommend that the Food and Drug Administration place its most serious warning label, a so-called black box, on the labels of stimulants to warn that they could have dangerous effects on the heart, particularly in adults. That recommendation grew out of reports that 25 people, mostly children, had died suddenly while taking the drugs. The twin conclusions come more than 50 years after Ritalin was first approved to treat attention deficit disorder and hyperactivity. Since then, stimulants have become among the most widely prescribed medicines in the world. In the United States alone, about 2.5 million children and 1.5 million adults take them; as many as 10 percent of boys ages 10 to 12 do. Copyright 2006 The New York Times Company

Attention Surplus? Re-examining a Disorder

By PAUL STEINBERG, M.D. The recent recommendation that Ritalin and other medications for attention-deficit disorder carry the most serious allowable warning will certainly slow the explosive growth in the use of those drugs. That was the intention of some members of the Food and Drug Administration advisory committee that called for the packaging alert, known as a black-box warning. But the recommendation and concerns about growth in the use of these drugs may force us to think about the disorder, known as A.D.H.D., in new and different ways, from an evolutionary and contextual standpoint. Every generation likes to believe that it is witnessing the most dramatic epoch in history. In the case of the current Western world, that belief may indeed be accurate, particularly in light of the striking changes of the last 30 years. As the business writer and consultant Peter Drucker pointed out, most people in the United States, Japan and parts of Europe are "knowledge workers." We live in an information age, in a knowledge-based economy. For those of us who have "attention-surplus disorder" — a term coined by Dr. Ned Hallowell, a psychiatrist in Boston who has A.D.H.D. — this knowledge-based economy has been a godsend. We thrive. Copyright 2006 The New York Times Company

Deaths Cited in Reports on Stimulant Drugs, but Their Cause Is Uncertain

By GARDINER HARRIS WASHINGTON, Feb. 8 — Twenty-five people died suddenly and 54 others suffered serious unexplained heart problems while taking stimulant drugs like Ritalin from 1999 through 2003, according to reports sent to federal drug regulators. It is impossible to determine whether the deaths and injuries resulted from the drugs or from other factors, federal drug regulators wrote in a 2004 report released publicly Wednesday. But stimulant drugs are among the most widely prescribed medicines in the world, and so any hint that they may cause health problems leads to intense concern. Few mental health experts believe that the drugs are dangerous. "Controlled trials have never found anything" suggesting that drugs to treat hyperactivity injure the heart, said Dr. Tom Insel, director of the National Institute of Mental Health. Children accounted for 19 of the deaths noted in the 2004 report and 26 of the serious heart problems, and the report, using the abbreviation for attention-deficit hyperactivity disorder, said, "The rare occurrence of pediatric sudden death during stimulant therapy of A.D.H.D. is an issue that warrants close monitoring." An advisory committee for the Food and Drug Administration will meet Thursday to discuss the report and recommend ways to research whether the drugs are to blame for the deaths. Copyright 2006 The New York Times Company

New Research in Animals Reveals Possible Long-Term Effects of Stimulants on Brain and Behavior

Three new studies conducted in animals, published in the December issue of the journal Biological Psychiatry, provide evidence that misuse of the stimulant methylphenidate (Ritalin) may have long-term effects on the brain and behavior. While methylphenidate and other stimulant medications are the recommended treatments for Attention Deficit Hyperactivity Disorder (ADHD), based on the more than 150 controlled studies demonstrating their safety and efficacy when used as prescribed, these three studies showed changes in the brains of young (adolescent or pre-adolescent) animals that persisted into adulthood. In both animals and humans, the brain continues to develop throughout adolescence. If the current studies are applicable to humans, they could have important implications for young people who use stimulants for recreational purposes. In the first study, Dr. Cindy Brandon and her colleagues at the Finch University of Health Sciences/The Chicago Medical School examined how low doses of methylphenidate affect dopamine cells in the brains of adolescent rats. Dopamine is a brain chemical that has been implicated in natural rewards, such as food and sex, as well as in drug abuse and addiction. The study showed that the rats experienced brain cell changes that subsequently made them more sensitive to the rewarding effects of cocaine. In the second study, Dr. William Carlezon, Jr., and his colleagues at Harvard Medical School and McLean Hospital in Belmont, Massachusetts, looked at how pre-adolescent exposure to methylphenidate affected certain behaviors in rats when they reached adulthood. They found that early exposure to twice-daily injections of methylphenidate actually reduced the sensitivity to cocaine reward, but increased other behaviors that could indicate depression. The timing of exposure to methylphenidate may be important — in this study the rats were exposed at an age corresponding to childhood, whereas in the study by Dr. Brandon et al., the rats were slightly older, more akin to adolescence.

Imaging children with ADHD

MRI technology reveals differences in neuro-signaling NEW YORK— Children with attention deficit-hyperactivity disorder (ADHD) may have significantly altered levels of important neurotransmitters (biochemicals that carry signals to and from cells) in the frontal region of the brain, according to a study publishing in the December issue of the Journal of Neuropsychiatry and Clinical Neurosciences. "Our data show children with ADHD had a two-and-half-fold increased level of glutamate, an excitatory brain chemical that can be toxic to nerve cells," said lead author Helen Courvoisie, M.D., assistant professor, division of child and adolescent psychiatry, department of psychiatry and behavioral sciences at the Johns Hopkins Medical Institutions, Baltimore. "The data also suggest a decreased level of GABA, a neuro-inhibitor. This combination may explain the behavior of children with poor impulse control." Dr. Courvoisie spoke today at an American Medical Association media briefing on advances in neurology in New York. "Children with ADHD have problems that are associated with the part of the brain called the frontal lobes," said Dr. Courvoisie. "The frontal lobes are like the 'boss of the brain,' responsible for what we call executive functioning — telling the brain and body what to do." This area regulates impulse control, attention, movement and elaborating on thoughts.

Brain Shrinkage in ADHD Not Caused by Medications

A 10-year study by National Institute of Mental Health (NIMH) scientists has found that brains of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) are 3-4 percent smaller than those of children who don't have the disorder — and that medication treatment is not the cause. Indeed, in this first major study to scan previously never-medicated patients, they found "strikingly smaller" white matter volumes in children who had not taken stimulant drugs. Still, the course of brain development in the ADHD patients paralleled that of normal subjects, suggesting that whatever caused the disorder happened earlier. Drs. Xavier Castellanos, Judith Rapoport, NIMH Child Psychiatry Branch, and colleagues, report on their magnetic resonance imaging (MRI) study of 152 boys and girls with ADHD in the October 9, 2002 Journal of the American Medical Association. Affecting 3-5 percent of school-age children, ADHD is characterized by over-activity, distractibility and impulsiveness. The disorder affects two to three times as many boys as girls, with as many as 20 percent of boys taking stimulant medication in some school systems. The new study strengthens the validity of the diagnosis by helping to put to rest criticism that structural brain abnormalities seen in ADHD might be drug-induced.

A Courtroom Champion for 4-Legged Creatures

By CLAUDIA DREIFUS CAMBRIDGE, Mass. — Among the high-flying lawyers who roam the halls of Harvard Law School, Steven M. Wise, 51, is an oddity. Instead of devoting himself to the fine points of torts or contracts, he teaches the school's first ever course in animal rights law. Moreover, Mr. Wise, who runs a small law firm that litigates for the interests of animals, has written two well-reviewed books on the subject, "Rattling the Cage: Toward Legal Rights for Animals" and the recently released "Drawing the Line: Science and the Case for Animal Rights." Mr. Wise spends much of his time trying to develop legal theories to advance his cause. "Almost all my work is directed toward breaching the legal wall that separates humans from nonhumans," he said over coffee at the Charles Hotel. "I'm interested in getting the first nonhuman animals their rights because I think once that happens the paradigm will shift. I'm very practical about this. It's going to take a while." Copyright The New York Times Company

Related chapters from BP6e: Chapter 1: Biological Psychology: Scope and Outlook
Related chapters from MM:Chapter 1: An Introduction to Brain and Behavior
Link ID: 2744 - Posted: 06.24.2010

Attention-deficit hyperactivity disorder related to advantageous gene

More genetic links found; disorder may have arisen recently Irvine, Calif., — A variant form of a gene associated with attention-deficit hyperactivity disorder (ADHD) indicates that the disorder is a recent affliction and may once have helped humans thrive and survive, according to a UCI College of Medicine study. The human gene study, which appears in the Jan. 8 issue of Proceedings of the National Academy of Science, suggests that behavior now considered inappropriate in a classroom may be related to behavior that once helped humans overcome their environment. Robert Moyzis, professor of biological chemistry, and his colleagues studied genes from 600 individuals worldwide. Among numerous new genetic variations of the receptor for the dopamine neurotransmitter, they found one linked strongly to both ADHD and a behavior trait called "novelty seeking," a condition often underlying addiction. Their analysis of the genetic variations also suggests that this variation occurred recently in human evolution between 10,000 and 40,000 years ago. © copyright 2001 UC Regents

A.D.H.D. Drugs Linked to Higher Test Scores

Children with attention deficit problems make bigger academic gains if they are taking stimulant medications compared to similar kids who aren’t receiving drug therapy, a new study shows. The findings, from a five year study of nearly 600 schoolchildren from across the country, are believed to be the first to offer an objective measure of the effect of drug therapy on a child’s long-term academic achievement. Earlier studies have shown that children who receive medication for attention-deficit hyperactivity disorder behave better in class and can complete more homework. But it hasn’t been clear whether treating A.D.H.D. results in any measurable improvement in long-term academic gains. The latest study, conducted by researchers at the University of California, Berkeley, and published in Pediatrics, tracked standardized math and reading scores among a nationally-representative sample of 600 children from kindergarten through the fifth grade, all of whom had been diagnosed with A.D.H.D. The researchers compared the scores of the students who were on A.D.H.D. medications with similarly diagnosed students who weren’t receiving drug therapy. In the study, taking A.D.H.D. medication was associated with gains in math scores that equated to about a fifth of a school year in extra learning. In reading, the gains were even greater, equating to progress of about a third of a school year. “I think the findings are important because this is the first time that we’ve had objective educational performance measures, to look at whether kids who are taking medications for A.D.H.D. compared to kids who are not, that actually show that they are doing better,” said Richard Scheffler, distinguished professor of health economics and public policy at the University of California, Berkeley’s School of Public Health. Copyright 2009 The New York Times Company

Good mood gone bad

By Bruce Bower A burst of happiness may impair children’s attention to detailA new study of how mood affects thinking styles presented children with problems such as the one shown above. Participants searched for a houselike shape, left, in the larger drawing of a vehicle, right.Schnall Happy children learn especially well, unless they have to focus on details rather than the big picture. That’s the implication of a new study in which school-age youngsters induced to feel happy lagged behind their sad- or neutral-feeling peers in finding shapes embedded within larger images. This two-part investigation shows for the first time that an experimentally induced good mood undermines children’s ability to perform detail-oriented tasks, report psychologist Simone Schnall of the University of Plymouth in England and her colleagues online and in an upcoming Developmental Science. Earlier studies had indicated that a surge of happiness draws adults’ attention away from the details of a problem but increases both adults’ and children’s creativity and mental flexibility. Schnall hypothesized that positive and negative feelings evolved, in part, to trigger contrasting thinking styles. Happiness signals a sense of personal safety that encourages a relaxed, broad focus on one’s immediate situation. Sadness reflects awareness of a difficult problem or situation, prompting caution and a detailed surveillance of one’s surroundings. © Society for Science & the Public 2000 - 2008

Related chapters from BP6e: Chapter 19: Language and Hemispheric Asymmetry; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 15: Language and Our Divided Brain; Chapter 11: Emotions, Aggression, and Stress
Link ID: 11834 - Posted: 06.24.2010

Scientists find key brain circuits for attention

LONDON - Scientists have identified the brain circuits that play a key role in helping us pay attention, a finding that may help explain why things go wrong in diseases such as Alzheimer’s and attention deficit disorders. The finding published in the journal Nature could provide a new target for potential drugs to treat some neurodegenerative conditions and attention deficit hyperactivity disorder or ADHD, the researchers said. “What we have identified is the way this works in one particular area of the brain,” said Alex Thiele, a neuroscientist at Newcastle University, who led the study. “If we ever want to have a smart drug for diseases like Alzheimer’s, we need to understand this level of detail.” Alzheimer’s is a degenerative condition for which there is no cure. An estimated 24 million people worldwide suffer from the memory loss and problems with orientation that signal Alzheimer’s and other, less common forms of dementia. Existing drugs such as Aricept from Pfizer and Eisai, Exelon by Novartis and Razadyne or Reminyl from Johnson & Johnson and Shire can ease symptoms but do not stop the disease. Copyright 2008 Reuters

Related chapters from BP6e: Chapter 19: Language and Hemispheric Asymmetry; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 15: Language and Our Divided Brain; Chapter 13: Memory, Learning, and Development
Link ID: 11830 - Posted: 06.24.2010

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