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One Drug or 2? Parents See Risk but Also Hope

By ALAN SCHWARZ CONCORD, Calif. — Every time Matthias is kicked out of a school or day camp for defying adults and clashing with other children, his mother, Joelle Kendle, inches closer to a decision she dreads. With each morning of arm-twisting and leg-flailing as she tries to get him dressed and out the door for first grade, the temptation intensifies. Ms. Kendle is torn over whether to have Matthias, just 6 and already taking the stimulant Adderall for attention deficit hyperactivity disorder, go on a second and more potent medication: the antipsychotic Risperdal. Her dilemma is shared by a steadily rising number of American families who are using multiple psychotropic drugs — stimulants, antipsychotics, antidepressants and others — to temper their children’s troublesome behavior, even though many doctors who mix such medications acknowledge that little is known about the overall benefits and risks for children. In 2012 about one in 54 youngsters ages 6 through 17 covered by private insurance was taking at least two psychotropic medications — a rise of 44 percent in four years, according to Express Scripts, which processes prescriptions for 85 million Americans. Academic studies of children covered by Medicaid have also found higher rates and growth. Combined, the data suggest that about one million children are currently taking various combinations of psychotropics. Risks of antipsychotics alone, for example, are known to include substantial weight gain and diabetes. Stimulants can cause appetite suppression, insomnia and, far more infrequently, hallucinations. Some combinations of medication classes, like antipsychotics and antidepressants, have shown improved benefits (for psychotic depression) but also heightened risks (for heart rhythm disturbances). But this knowledge has been derived substantially from studies in adults — children are rarely studied because of concerns about safety and ethics — leaving many experts worried that the use of multiple psychotropics in youngsters has not been explored fully. There is also debate over whether the United States Food and Drug Administration’s database of patients’ adverse drug reactions reliably monitors the hazards of psychotropic drug combinations, primarily because only a small fraction of cases are ever reported. Some clinicians are left somewhat queasy about relying mostly on anecdotal reports of benefit and harm. © 2014 The New York Times Company

Related chapters from BN: Chapter 18: Attention and Higher Cognition; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 14: Attention and Higher Cognition; Chapter 4: Development of the Brain
Link ID: 20314 - Posted: 11.15.2014

Children's Attention Deficit Linked to Air Pollution

|By Lindsey Konkel and Environmental Health News New York City children exposed in the womb to high levels of pollutants in vehicle exhaust had a five times higher risk of attention problems at age 9, according to research by Columbia University scientists published Wednesday. The study adds to earlier evidence that mothers' exposures to polycyclic aromatic hydrocarbons (PAHs), which are emitted by the burning of fossil fuels and other organic materials, are linked to children's behavioral problems associated with Attention Deficit Hyperactivity Disorder (ADHD). “Our research suggests that environmental factors may be contributing to attention problems in a significant way,” said Frederica Perera, an environmental health scientist at Columbia’s Mailman School of Public Health who was the study's lead author. About one in 10 U.S. kids is diagnosed with ADHD, according to the Centers for Disease Control and Prevention. Children with ADHD are at greater risk of poor academic performance, risky behaviors and lower earnings in adulthood, the researchers wrote. “Air pollution has been linked to adverse effects on attention span, behavior and cognitive functioning in research from around the globe. There is little question that air pollutants may pose a variety of potential health risks to children of all ages, possibly beginning in the womb,” said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven & Alexandra Cohen Children’s Medical Center of New York. He did not participate in the new study. © 2014 Scientific American

A Natural Fix for A.D.H.D.

By RICHARD A. FRIEDMAN ATTENTION deficit hyperactivity disorder is now the most prevalent psychiatric illness of young people in America, affecting 11 percent of them at some point between the ages of 4 and 17. The rates of both diagnosis and treatment have increased so much in the past decade that you may wonder whether something that affects so many people can really be a disease. And for a good reason. Recent neuroscience research shows that people with A.D.H.D. are actually hard-wired for novelty-seeking — a trait that had, until relatively recently, a distinct evolutionary advantage. Compared with the rest of us, they have sluggish and underfed brain reward circuits, so much of everyday life feels routine and understimulating. To compensate, they are drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterizes our modern world. In short, people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture. From the standpoint of teachers, parents and the world at large, the problem with people with A.D.H.D. looks like a lack of focus and attention and impulsive behavior. But if you have the “illness,” the real problem is that, to your brain, the world that you live in essentially feels not very interesting. One of my patients, a young woman in her early 20s, is prototypical. “I’ve been on Adderall for years to help me focus,” she told me at our first meeting. Before taking Adderall, she found sitting in lectures unendurable and would lose her concentration within minutes. Like many people with A.D.H.D., she hankered for exciting and varied experiences and also resorted to alcohol to relieve boredom. But when something was new and stimulating, she had laserlike focus. I knew that she loved painting and asked her how long she could maintain her interest in her art. “No problem. I can paint for hours at a stretch.” Rewards like sex, money, drugs and novel situations all cause the release of dopamine in the reward circuit of the brain, a region buried deep beneath the cortex. Aside from generating a sense of pleasure, this dopamine signal tells your brain something like, “Pay attention, this is an important experience that is worth remembering.” © 2014 The New York Times Company

Related chapters from BN: Chapter 18: Attention and Higher Cognition; Chapter 17: Learning and Memory
Related chapters from MM:Chapter 14: Attention and Higher Cognition; Chapter 13: Memory and Learning
Link ID: 20272 - Posted: 11.03.2014

The Creative Gifts of ADHD

By Scott Barry Kaufman “Just because a diagnosis [of ADHD] can be made does not take away from the great traits we love about Calvin and his imaginary tiger friend, Hobbes. In fact, we actually love Calvin BECAUSE of his ADHD traits. Calvin’s imagination, creativity, energy, lack of attention, and view of the world are the gifts that Mr. Watterson gave to this character.” — The Dragonfly Forest In his 2004 book “Creativity is Forever“, Gary Davis reviewed the creativity literature from 1961 to 2003 and identified 22 reoccurring personality traits of creative people. This included 16 “positive” traits (e.g., independent, risk-taking, high energy, curiosity, humor, artistic, emotional) and 6 “negative” traits (e.g., impulsive, hyperactive, argumentative). In her own review of the creativity literature, Bonnie Cramond found that many of these same traits overlap to a substantial degree with behavioral descriptions of Attention Deficit Hyperactive Disorder (ADHD)– including higher levels of spontaneous idea generation, mind wandering, daydreaming, sensation seeking, energy, and impulsivity. Research since then has supported the notion that people with ADHD are more likely to reach higher levels of creative thought and achievement than those without ADHD (see here, here, here, here, here, here, here, here, here, and here). What’s more, recent research by Darya Zabelina and colleagues have found that real-life creative achievement is associated with the ability to broaden attention and have a “leaky” mental filter– something in which people with ADHD excel. Recent work in cognitive neuroscience also suggests a connection between ADHD and creativity (see here and here). Both creative thinkers and people with ADHD show difficulty suppressing brain activity coming from the “Imagination Network“: © 2014 Scientific American

Related chapters from BN: Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 14: Attention and Higher Cognition
Link ID: 20228 - Posted: 10.22.2014

How Exercise Can Boost Young Brains

By Gretchen Reynolds Encourage young boys and girls to run, jump, squeal, hop and chase after each other or after erratically kicked balls, and you substantially improve their ability to think, according to the most ambitious study ever conducted of physical activity and cognitive performance in children. The results underscore, yet again, the importance of physical activity for children’s brain health and development, especially in terms of the particular thinking skills that most affect academic performance. The news that children think better if they move is hardly new. Recent studies have shown that children’s scores on math and reading tests rise if they go for a walk beforehand, even if the children are overweight and unfit. Other studies have found correlations between children’s aerobic fitness and their brain structure, with areas of the brain devoted to thinking and learning being generally larger among youngsters who are more fit. But these studies were short-term or associational, meaning that they could not tease out whether fitness had actually changed the children’s’ brains or if children with well-developed brains just liked exercise. So for the new study, which was published in September in Pediatrics, researchers at the University of Illinois at Urbana-Champaign approached school administrators at public elementary schools in the surrounding communities and asked if they could recruit the school’s 8- and 9-year-old students for an after-school exercise program. This group was of particular interest to the researchers because previous studies had determined that at that age, children typically experience a leap in their brain’s so-called executive functioning, which is the ability to impose order on your thinking. Executive functions help to control mental multitasking, maintain concentration, and inhibit inappropriate responses to mental stimuli. © 2014 The New York Times Company

Related chapters from BN: Chapter 18: Attention and Higher Cognition; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 14: Attention and Higher Cognition; Chapter 5: The Sensorimotor System
Link ID: 20174 - Posted: 10.08.2014

Exercise Is ADHD Medication

James Hamblin Mental exercises to build (or rebuild) attention span have shown promise recently as adjuncts or alternatives to amphetamines in addressing symptoms common to Attention Deficit Hyperactivity Disorder (ADHD). Building cognitive control, to be better able to focus on just one thing, or single-task, might involve regular practice with a specialized video game that reinforces "top-down" cognitive modulation, as was the case in a popular paper in Nature last year. Cool but still notional. More insipid but also more clearly critical to addressing what's being called the ADHD epidemic is plain old physical activity. This morning the medical journal Pediatrics published research that found kids who took part in a regular physical activity program showed important enhancement of cognitive performance and brain function. The findings, according to University of Illinois professor Charles Hillman and colleagues, "demonstrate a causal effect of a physical program on executive control, and provide support for physical activity for improving childhood cognition and brain health." If it seems odd that this is something that still needs support, that's because it is odd, yes. Physical activity is clearly a high, high-yield investment for all kids, but especially those attentive or hyperactive. This brand of research is still published and written about as though it were a novel finding, in part because exercise programs for kids remain underfunded and underprioritized in many school curricula, even though exercise is clearly integral to maximizing the utility of time spent in class. The improvements in this case came in executive control, which consists of inhibition (resisting distraction, maintaining focus), working memory, and cognitive flexibility (switching between tasks). The images above show the brain activity in the group of kids who did the program as opposed to the group that didn't. It's the kind of difference that's so dramatic it's a little unsettling. The study only lasted nine months, but when you're only seven years old, nine months is a long time to be sitting in class with a blue head. © 2014 by The Atlantic Monthly Group.

Could Schools Combat Rise in ADHD With More Exercise?

By Megan Allison Diagnoses of Attention Hyperactivity Disorder are on the rise. The Centers for Disease Control and Prevention calculated that by 2011, 11 percent of children had been diagnosed with ADHD, and 6.1 percent of all US children were taking an ADHD medication. But could a solution be as simple as exercise? A study published this month in the Journal of Abnormal Child Psychology found that aerobic activity sessions before school helped children with ADHD with their moods and attention spans. The study involved a group of just over 200 students in kindergarten through second grade at schools in Indiana and Vermont. For 12 weeks, the students did 31 minutes of physical activity. The control group participated in classroom activities during this time. Although the results showed that all students showed improvement, authors noted that the exercise especially helped kids with ADHD. “It benefits all the kids, but I definitely see where it helps the kids with ADHD a lot,” said Jill Fritz, a fourth-grade teacher in Jacksonville, Fla. in an interview with The Wall Street Journal. “It really helps them get back on track and get focused.” In the Boston area, Dr. Sarah Sparrow Benes, Program Director of Physical and Health Education Programs at Boston University, teaches elementary and special educators how to use movement as a strategy in their classroom for learning. She finds that all students can benefit from exercise.

The truth about smart drugs

By Marek Kohn “You know how they say that we can only access 20% of our brain?” says the man who offers stressed-out writer Eddie Morra a fateful pill in the 2011 film Limitless. “Well, what this does, it lets you access all of it.” Morra is instantly transformed into a superhuman by the fictitious drug NZT-48. Granted access to all cognitive areas, he learns to play the piano in three days, finishes writing his book in four, and swiftly makes himself a millionaire. Limitless is what you get when you flatter yourself that your head houses the most complex known object in the universe, and you run away with the notion that it must have powers to match. A number of so-called ‘smart drugs’ or cognitive enhancers have captured attention recently, from stimulants such as modafinil, to amphetamines (often prescribed under the name Adderall) and methylphenidate (also known by its brand name Ritalin). According to widespread news reports, students have begun using these drugs to enhance their performance in school and college, and are continuing to do so in their professional lives. Yet are these smart drugs all they are cracked up to be? Can they really make all of us more intelligent or learn more? Should we be asking deeper questions about what these pharmaceuticals can and can’t do? BBC © 2014

Related chapters from BN: Chapter 18: Attention and Higher Cognition; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 14: Attention and Higher Cognition; Chapter 3: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 19897 - Posted: 07.30.2014

ADHD: A Matter of Drugs Now--Or Later?

Claire McCarthy I have many patients with ADHD (Attention Deficit Hyperactivity Disorder) and it seems like I have the same conversation over and over again with their parents: to medicate or not to medicate. I completely understand the hesitation I hear from so many parents. I have to admit, I'm not entirely happy myself about prescribing a medication that has side effects and can be abused or misused, and one for which there is a black market. I also worry that too often when a child is on medication and so learning and behaving better, parents and teachers lose the incentive to help the child learn the organizational and other skills that could make all the difference later in life. Since ADHD often persists into adulthood, we have to have the long view with these kids. But....the long view works the other way, too. Not treating ADHD with medication can lead to problems. Like drug abuse. ADHD is really common. It affects 8 percent of children and youth--that's about 2 in every classroom of 20. Kids with ADHD can have real problems with both learning and behavior, problems that can haunt them for a lifetime (if you end up dropping out of high school because of poor grades or behavior, or end up getting arrested, it has a way of interfering with your future income and quality of life). But another thing we know is that kids with ADHD have a higher risk of drug abuse. We don't know exactly why this is the case. Some of it is likely the impulsivity that is so common in people with ADHD; they don't always make the best decisions. It may also be that people with ADHD are more prone to addiction. Whatever it is, the risk is very real. Not only are kids with ADHD 2.5 times more likely to abuse drugs, they are more likely to start earlier, use more types of drugs, and continue into adulthood. ©2014 Boston Globe Media Partners, LLC

Insel of NIMH Misses the Mark: Medication as Social Control

Claudia M. Gold Tom Insel, director of the National Institute of Mental Health (NIMH,) in his recent blog post "Are Children Overmedicated?" seems to suggest that perhaps more psychiatric medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase medication prescribing patterns. In his view, these explanations are: Blaming psychiatrists who are too busy to provide therapy, parents who are too busy to provide a stable home environment, drug companies for marketing their products, and schools for lack of recess. By concluding that perhaps the explanation for the increase in prescribing of psychiatric medication to children is a greater number of children with serious psychiatric illness, Insel shows a lack of recognition of the complexity of the situation. When a recent New York Times article, that Insel makes reference to, reported on the rise in prescribing of psychiatric medication for toddlers diagnosed with ADHD, with a disproportionate number coming from families of poverty, one clinician remarked that if this is an attempt to medicate social and economic issues, then we have a huge problem. He was on to something. In conversations with pediatricians (the main prescribers of these medications) and child psychiatrists on the front lines, I find many in a reactive stance. When people feel overwhelmed, they go into survival mode, with their immediate aim just to get through the day. They find themselves prescribing medication because they have no other options.

Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries

By ALAN SCHWARZ ATLANTA — More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention. The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young. The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. “It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. “People are just feeling around in the dark. We obviously don’t have our act together for little children.” Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.” Friday’s report was the latest to raise concerns about A.D.H.D. diagnoses and medications for American children beyond what many experts consider medically justified. Last year, a nationwide C.D.C. survey found that 11 percent of children ages 4 to 17 have received a diagnosis of the disorder, and that about one in five boys will get one during childhood. A vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines like Adderall, which often calm a child’s hyperactivity and impulsivity but also carry risks for growth suppression, insomnia and hallucinations. Only Adderall is approved by the Food and Drug Administration for children below age 6. However, because off-label use of methylphenidate in preschool children had produced some encouraging results, the most recent American Academy of Pediatrics guidelines authorized it in 4- and 5-year-olds — but only after formal training for parents and teachers to improve the child’s environment were unsuccessful. © 2014 The New York Times Company

Exercising the Mind to Treat Attention Deficits

By DANIEL GOLEMAN Which will it be — the berries or the chocolate dessert? Homework or the Xbox? Finish that memo, or roam Facebook? Such quotidian decisions test a mental ability called cognitive control, the capacity to maintain focus on an important choice while ignoring other impulses. Poor planning, wandering attention and trouble inhibiting impulses all signify lapses in cognitive control. Now a growing stream of research suggests that strengthening this mental muscle, usually with exercises in so-called mindfulness, may help children and adults cope with attention deficit hyperactivity disorder and its adult equivalent, attention deficit disorder. The studies come amid growing disenchantment with the first-line treatment for these conditions: drugs. In 2007, researchers at the University of California, Los Angeles, published a study finding that the incidence of A.D.H.D. among teenagers in Finland, along with difficulties in cognitive functioning and related emotional disorders like depression, were virtually identical to rates among teenagers in the United States. The real difference? Most adolescents with A.D.H.D. in the United States were taking medication; most in Finland were not. “It raises questions about using medication as a first line of treatment,” said Susan Smalley, a behavior geneticist at U.C.L.A. and the lead author. In a large study published last year in The Journal of the American Academy of Child & Adolescent Psychiatry, researchers reported that while most young people with A.D.H.D. benefit from medications in the first year, these effects generally wane by the third year, if not sooner. “There are no long-term, lasting benefits from taking A.D.H.D. medications,” said James M. Swanson, a psychologist at the University of California, Irvine, and an author of the study. “But mindfulness seems to be training the same areas of the brain that have reduced activity in A.D.H.D.” © 2014 The New York Times Company

Idea of New Attention Disorder Spurs Research, and Debate

By ALAN SCHWARZ With more than six million American children having received a diagnosis of attention deficit hyperactivity disorder, concern has been rising that the condition is being significantly misdiagnosed and overtreated with prescription medications. Yet now some powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children. Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship A.D.H.D. drug might treat it. The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming that the question of its existence “seems to be laid to rest as of this issue.” The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.” In an interview, Keith McBurnett, a professor of psychiatry at the University of California, San Francisco, and co-author of several papers on sluggish cognitive tempo, said: “When you start talking about things like daydreaming, mind-wandering, those types of behaviors, someone who has a son or daughter who does this excessively says, ‘I know about this from my own experience.’ They know what you’re talking about.” © 2014 The New York Times Company

Related chapters from BN: Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 14: Attention and Higher Cognition
Link ID: 19479 - Posted: 04.12.2014

ADHD treatment may be tied to obesity, study suggests

Linda Carroll TODAY contributor The stimulants used to treat ADHD might be making kids fat, a new study suggests. A study of more than 160,000 youngsters found that kids with Attention Deficit and Hyperactivity Disorder who received stimulants were at increased risk of becoming obese as they hit their teens. In contrast, kids with ADHD who took non-stimulant medications or got no therapy were very comparable, in terms of weight gain, to kids who didn’t have the disorder. “Our data suggest that stimulant use during childhood might have lifelong effects,” said Dr. Brian Schwartz, the study’s lead author and a professor of environmental health sciences, epidemiology, and medicine at the Johns Hopkins Bloomberg School of Public Health and senior investigator at the Geisinger Center for Health Research. “They might reset all sorts of physical properties and appetite parameters.” The new research may have uncovered a growing public health issue, Schwartz said. “Our data would seem to offer a lot of cause for concern with respect to prescribing stimulants,” he explained. Schwartz and his colleagues started the study because they were perplexed by the apparent paradox of hyperactive kids being prone to obesity. They scrutinized 12 years-worth of medical information from 163,820 Pennsylvania children, 13,427 of whom received an ADHD diagnosis.

Related chapters from BN: Chapter 18: Attention and Higher Cognition; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 14: Attention and Higher Cognition; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 19368 - Posted: 03.17.2014

Expand Pre-K, Not A.D.H.D.

By STEPHEN P. HINSHAW and RICHARD M. SCHEFFLER BERKELEY, Calif. — THE writing is on the chalkboard. Over the next few years, America can count on a major expansion of early childhood education. We embrace this trend, but as health policy researchers, we want to raise a major caveat: Unless we’re careful, today’s preschool bandwagon could lead straight to an epidemic of 4- and 5-year-olds wrongfully being told that they have attention deficit hyperactivity disorder. Introducing millions of 3- to 5-year-olds to classrooms and preacademic demands means that many more distracted kids will undoubtedly catch the attention of their teachers. Sure, many children this age are already in preschool, but making the movement universal and embedding transitional-K programs in public schools is bound to increase the pressure. We’re all for high standards, but danger lurks. The American Academy of Pediatrics now endorses the idea that the diagnosis of A.D.H.D. can and should begin at age 4, before problems accumulate. In fact, Adderall and other stimulants are approved for treatment of attentional issues in children as young as 3. Early intervention for children with A.D.H.D. could provide great relief. Children who go untreated have major difficulties in school and with their peers, and they have higher-than-normal rates of accidents and physical injuries. The problem is that millions of American children have been labeled with A.D.H.D. when they don’t truly have it. Our research has revealed a worrisome parallel between our nation’s increasing push for academic achievement and increased school accountability — and skyrocketing A.D.H.D. diagnoses, particularly for the nation’s poorest children. © 2014 The New York Times Company

Acetaminophen use in pregnancy linked to kids’ slightly higher risk of ADHD

by Nathan Seppa Women who take acetaminophen during pregnancy are more likely to have a child with attention-deficit/hyperactivity disorder than are women who don’t, according to an analysis of nearly 41,000 pairs of mothers and children in a Danish birth registry. Researchers found that more than half of the women, who gave birth between 1996 and 2002, had used the pain reliever during pregnancy. Calls to the women when the children were 7 years old revealed that children whose moms used any acetaminophen during pregnancy were 37 percent more apt to be diagnosed with ADHD or a related disorder than children whose moms didn’t use the drug. If the women used it in all three trimesters, the apparent risk for offspring was 61 percent higher than for children whose mothers didn’t use the drug. Out of nearly 41,000 children, fewer than 1,000 were diagnosed with ADHD and related disorders. The data establish an association and not cause and effect. But the researchers note that acetaminophen, also sold as Tylenol or Panadol, can cross the placental barrier and may affect hormones in a fetus. Citations Z. Liew et al. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. Online February 24, 2014. doi:10.1001/jamapediatrics.2013.4914. © Society for Science & the Public 2000 - 2013.

Doctors Train to Spot Signs of A.D.H.D. in Children

By ALAN SCHWARZ Jerry, 9 years old, dissolved into his Game Boy while his father described his attentional difficulties to the family pediatrician. The child began flitting around the room distractedly, ignoring the doctor’s questions and squirming in his chair — but then he leapt up and yelled: “Freeze! What do you think is the problem here?” Nine-year-old Jerry was in fact being played by Dr. Peter Jensen, one of the nation’s most prominent child psychiatrists. On this Sunday in January in New York, Dr. Jensen was on a cross-country tour, teaching pediatricians and other medical providers how to properly evaluate children’s mental health issues — especially attention deficit hyperactivity disorder, which some doctors diagnose despite having little professional training. One in seven children in the United States — and almost 20 percent of all boys — receives a diagnosis of A.D.H.D. by the time they turn 18, according to the Centers for Disease Control and Prevention. It narrowly trails asthma as the most common long-term medical condition in children. Increasing concern about the handling of the disorder has raised questions about the training doctors receive before diagnosing the condition and prescribing stimulants like Adderall or Concerta, sometimes with little understanding of the risks. The medications can cause sleep problems, loss of appetite and, in rare cases, delusions. Because the disorder became a widespread national health concern only in the past few decades, many current pediatricians received little formal instruction on it, sometimes only several hours, during their seven years of medical school and residency. But the national scarcity of child psychiatrists has placed much of the burden for evaluating children’s behavioral problems on general pediatricians and family doctors, a reality that Dr. Jensen and others are trying to address through classes that emphasize role-playing exercises and spirited debate. © 2014 The New York Times Company

Kids With ADHD Can Train Their Brains

Kids with ADHD may be able to learn better focus through a computer game that trains the brain to pay attention, a new study suggests. The game was part of a neurofeedback system that used bicycle helmets wired to measure brain waves and gave immediate feedback when kids were paying attention, researchers reported Monday in Pediatrics. Giving kids feedback on what their brains are doing is "like turning on a light switch," said Dr. Naomi Steiner, the study's lead author and a developmental and behavioral pediatrician at the Floating Hospital for Children at Tufts Medical Center. "Kids said 'Oh, this is what people mean when they tell me to pay attention.'" To test the system, Steiner and her colleagues randomly assigned 104 Boston area elementary school children to one of three groups: no treatment, 40 half-hour sessions of neurofeedback or 40 sessions of cognitive therapy. The kids getting neurofeedback wore standard bicycle helmets fitted with brain wave sensors while they performed a variety of exercises on the computer. In one exercise, kids were told to focus on a cartoon dolphin. When people pay attention, theta wave activity goes down while beta waves increase, Steiner explained. If the kids' brains showed they were paying attention, the dolphin would dive to the bottom of the sea. Parents' reports on ADHD symptoms six months later showed a lasting improvement in kids who had done neurofeedback.

Medication: The smart-pill oversell

Katherine Sharpe Ben Harkless could not sit still. At home, the athletic ten-year-old preferred doing three activities at once: playing with his iPad, say, while watching television and rolling on an exercise ball. Sometimes he kicked the walls; other times, he literally bounced off them. School was another story, however. Ben sat in class most days with his head down on his desk, “a defeated heap”, remembers his mother, Suzanne Harkless, a social worker in Berkeley, California. His grades were poor, and his teacher was at a loss for what to do. Harkless took Ben to a therapist who diagnosed him with attention deficit hyperactivity disorder (ADHD). He was prescribed methylphenidate, a stimulant used to improve focus in people with the condition. Harkless was reluctant to medicate her child, so she gave him a dose on a morning when she could visit the school to observe. “He didn't whip through his work, but he finished his work,” she says. “And then he went on and helped his classmate next to him. My jaw dropped.” ADHD diagnoses are rising rapidly around the world and especially in the United States, where 11% of children aged between 4 and 17 years old have been diagnosed with the disorder. Between half and two-thirds of those are put on medication, a decision often influenced by a child's difficulties at school. And there are numerous reports of adolescents and young adults without ADHD using the drugs as study aids. © 2014 Nature Publishing Group,

ADHD: About 1 in 20 adults may have a disorder usually associated with grade school

By Suzanne Allard Levingston, Chris Ecarius had so much difficulty filling out his Social Security application online that the 62-year-old went to a doctor to find out why his brain didn’t seem to work properly. Over the years, he’d seen other doctors about similar struggles. He’d been told that he was depressed, but he didn’t feel depressed. This time, Ecarius got a different diagnosis: attention deficit hyperactivity disorder, a conclusion that seemed more appropriate for a child in grade school than an adult in retirement. When Ecarius, who lives in Houghton Lake, Mich., was young, he had trouble paying attention. He’d dropped out of school and left several jobs, had several traffic accidents and had never quite gotten on track. “I could have been a doctor,” he said. “I could have been a pharmacist, I could have been anything I wanted to be,” had someone diagnosed his ADHD when he was a child. With the help of his wife, Ecarius was able to settle into a skilled trade job with General Motors, a position he held until age 58, when, he says, he became overwhelmed by the computers at work. Ecarius is not alone. While ADHD — a condition marked by inattention, hyperactivity and impulsivity — is one of the most common brain disorders in children, it also occurs in approximately one in 20 adults, according to a 2006 study. A 2012 study based on interviews with almost 1,500 people by researchers in the Netherlands found that 2.8 percent of adults older than 60 have ADHD, with 4.2 percent of people in that age group reporting several ADHD symptoms and some impairment. But just being forgetful or scatterbrained doesn’t mean you have ADHD. Of course, many people, especially those older than 60, have these problems, but they could be a sign of something else — or nothing at all. © 1996-2013 The Washington Post

Related chapters from BN: Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 14: Attention and Higher Cognition
Link ID: 19042 - Posted: 12.17.2013

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