Omega-3 fish oil as effective for attention as ADHD drugs for some children

Omega-3 fish oil as effective for attention as ADHD drugs for some children

‘Our results suggest that fish oil supplements are at least as effective for attention as conventional pharmacological treatments among those children with ADHD who have omega-3 deficiency.

#adhd #omega3 #epa

Chang, J.P., Su, K., Mondelli, V. et al. High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD) and low endogenous EPA levels. Transl Psychiatry 9, 303 (2019) doi:10.1038/s41398-019-0633-0

https://www.nature.com/articles/s41398-019-0633-0#citeas

Saffron as effective as stimulant medicines in treating ADHD

Saffron as effective as stimulant medicines in treating ADHD

Saffron as effective as stimulant medicines in treating ADHD

A new short-term pilot study in children and teens 6-17 years old with attention-deficit hyperactivity disorder (ADHD) has shown saffron to be as effective at controlling symptoms as methylphenidate, the commonly prescribed drug Ritalin.

Sara Baziar et al, Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind Pilot Study, Journal of Child and Adolescent Psychopharmacology (2019). DOI: 10.1089/cap.2018.0146

Study examines acetaminophen use in pregnancy, child behavioral problems

Bottom Line: Children of women who used the pain reliever acetaminophen (paracetamol) during pregnancy appear to be at higher risk for attention-deficit/hyperactivity disorder (ADHD)-like behavioral problems and hyperkinetic disorders (HKDs, a severe form of ADHD).

Open bottles of Extra Strength Tylenol and Ext...

Author: Zeyan Liew, M.P.H., of the University of California, Los Angeles, and colleagues.

Background: Acetaminophen is the most commonly used medication for pain and fever during pregnancy. But some recent studies have suggested that acetaminophen has effects on sex and other hormones, which can in turn affect neurodevelopment and cause behavioral dysfunction. Continue reading “Study examines acetaminophen use in pregnancy, child behavioral problems”

Common plastics chemicals linked to ADHD symptoms – phthalate

Reposted at request:

Public release date: 19-Nov-2009 –

They found a significant positive association between phthalate exposure and ADHD, meaning that the higher the concentration of phthalate metabolites in the urine, the worse the ADHD symptoms and/or test scores.

Disney school supplies loaded with toxic phtha...
Disney school supplies loaded with toxic phthalates, next to petitions signed by 65,000 parents across the country (Photo credit: CHEJ)

 

Are phthalates really safe for children?

Philadelphia, PA, 19 November 2009 – Phthalates are important components of many consumer products, including toys, cleaning materials, plastics, and personal care items. Studies to date on phthalates have been inconsistent, with some linking exposure to these chemicals to hormone disruptions, birth defects, asthma, and reproductive problems, while others have found no significant association between exposure and adverse effects.

A new report by Korean scientists, published by Elsevier in the November 15th issue of Biological Psychiatry, adds to the potentially alarming findings about phthalates. They measured urine phthalate concentrations and evaluated symptoms of attention-deficit/hyperactivity disorder (ADHD) using teacher-reported symptoms and computerized tests that measured attention and impulsivity. Continue reading “Common plastics chemicals linked to ADHD symptoms – phthalate”

Breastfeeding Could Prevent ADHD

Monday, July 22, 2013

TAU research finds that breastfed children are less likely to develop ADHD later in life

We know that breastfeeding has a positive impact on child development and health — including protection against illness. Now researchers from Tel Aviv University have shown that breastfeeding could also help protect against Attention Deficit/Hyperactivity Disorder (ADHD), the most commonly diagnosed neurobehavioral disorder in children and adolescents.

Seeking to determine if the development of ADHD was associated with lower rates of breastfeeding, Dr. Aviva Mimouni-Bloch, of Tel Aviv  University‘s Sackler Faculty of Medicine and Head of the Child Neurodevelopmental Center in Loewenstein Hospital, and her fellow researchers 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 to the disorder.

The researchers 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 three months of age were found to be three times more likely to have ADHD than those who were breastfed during the same period. These results have been published in Breastfeeding Medicine.

Understanding genetics and environment

In their study, the researchers compared breastfeeding histories of children from six to 12 years of age at Schneider’s Children Medical Center in Israel. The ADHD group was comprised of children that had been diagnosed at the hospital, the second group included the siblings of the ADHD patients, and the control group included children without neurobehavioral issues who had been treated at the clinics for unrelated complaints.

In addition to describing their breastfeeding habits during the first year of their child’s life, parents answered a detailed questionnaire on medical and demographic data that might also have an impact on the development of ADHD, including marital status and education of the parents, problems during pregnancy such as hypertension or diabetes, birth weight of the child, and genetic links to ADHD.

Taking all risk factors into account, researchers found that children with ADHD were far less likely to be breastfed in their first year of life than the children in the other groups. At three months, only 43 percent of children in the ADHD group were breastfed compared to 69 percent of the sibling group and 73 percent of the control group. At six months, 29 percent of the ADHD group was breastfed, compared to 50 percent of the sibling group and 57 percent of the control group.

One of the unique elements of the study was the inclusion of the sibling group, says Dr. Mimouni-Bloch. Although a mother will often make the same breastfeeding choices for all her children, this is not always the case. Some children’s temperaments might be more difficult than their siblings’, making it hard for the mother to breastfeed, she suggests.

Added protection

While researchers do not yet know why breastfeeding has an impact on the future development of ADHD — it could be due to the breast milk itself, or the special bond formed between mother and baby during breastfeeding, for example — they believe this research shows that breastfeeding can have a protective effect against the development of the disorder, and can be counted as an additional biological advantage for breastfeeding.

Dr. Mimouni-Bloch hopes to conduct a further study on breastfeeding and ADHD, examining children who are at high risk for ADHD from birth and following up in six-month intervals until six years of age, to obtain more data on the phenomenon.


For more news about pediatric medicine research from Tel Aviv University, click here.

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12-months of treatment with ADHD drugs increases dopamine transporters in some brain regions by 24%

Contact: Souri Somphanith onepress@plos.org 415-624-1217 x199 Public Library of Science

Long-term ADHD treatment increases brain dopamine transporter levels, may affect drug efficacy

12-month treatment may impact adult ADHD patients’ response to methylphenidate

Long-term treatment of attention deficit/hyperactivity disorder (ADHD) with certain stimulant medications may alter the density of the dopamine transporter, according to research published May 15 in the open access journal PLOS ONE by Gene-Jack Wang and colleagues from Brookhaven National Laboratory and the intramural program at NIH.

ADHD is commonly treated using drugs to target dysfunctional dopamine signaling in the brain, such as methylphenidate (commonly known as Ritalin). The researchers found that adults with ADHD who had been prescribed the drug methylphenidate for a period of 12 months had a 24% increase in the density of the dopamine transporter in some brain regions, which after treatment was significantly higher than in adults without ADHD who had not been treated with the drug. Prior to the 12-month treatment, there were no significant differences in the two groups’ dopamine transporter levels. The authors conclude that the elevated dopamine transporter density, suggested by some as a biological test for diagnosis of ADHD, may be a consequence of chronic treatment rather than a marker for the disorder. These findings may offer an explanation for discrepancies in the literature describing dopamine transporter levels in ADHD patients, as differences in dopamine transporter levels in the brain may be due to differences in prior treatment.

Many studies have shown that an acute increase in dopamine signaling while on methylphenidate treatment can improve ADHD symptoms in the short term, but this is the first study to analyze the long-term effects of treatment.

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Citation: Wang G-J, Volkow ND, Wigal T, Kollins SH, Newcorn JH, et al. (2013) Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder. PLoS ONE 8(5): e63023. doi:10.1371/journal.pone.0063023

Financial Disclosure: The work was supported by the National Institutes of Health: R01MH66961 to Dr. GJW. The PET study was carried out at Brookhaven National Laboratory with infrastructure support from the U.S. Department of Energy Office of Biological and Environmental Research (DE-ACO2-76CH00016), M01RR10710 (the General Clinical Research Center of Stony Brook University). An Intramural Research Program of the National Institute on Alcohol Abuse and Alcoholism (Z01AA000550) supported Drs. NDV and FT and Mr. MJ. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interest Statement: Dr. GJW received research funding from the Orexigen Therapeutics Inc.; Dr. NDV reports no competing interests; Dr. TW reports no competing interests; Dr. SHK reports no competing interests; Dr. JHN reports no competing interests; Dr. FT reports no competing interests; Dr. JL reports no competing interests; Mr. MJ reports no competing interests; Mr. CTW reports no competing interests; Mr. HH reports no competing interests; Dr. JSF reports no competing interests; Dr. WZ reports no competing interests; Dr. JMS reports no competing interests. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

PLEASE LINK TO THE SCIENTIFIC ARTICLE IN ONLINE VERSIONS OF YOUR REPORT (URL goes live after the embargo ends):  http://dx.plos.org/10.1371/journal.pone.0063023

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90 percent of pediatric specialists not following clinical guidelines when treating preschoolers with ADHD

Contact: Terry Lynam tlynam@nshs.edu 516-465-2600 North Shore-Long Island Jewish (LIJ) Health System

Some prescribe medication too soon; others not even as a second-line treatment

NEW HYDE PARK, NY – A recent study by pediatricians from the Cohen Children’s Medical Center of New York examined to what extent pediatric physicians adhere to American Academy of Pediatrics (AAP) clinical guidelines regarding pharmacotherapy in treating young patients with Attention Deficit Hyperactivity Disorder (ADHD). The results showed that more than 90 percent of medical specialists who diagnose and manage ADHD in preschoolers do not follow treatment guidelines recently published by the AAP.

“It is unclear why so many physicians who specialize in the management of ADHD — child neurologists, psychiatrists and developmental pediatricians —  fail to comply with recently published treatment guidelines,” said Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park.  “With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten.  Primary care physicians and pediatric specialists should recommend behavior therapy as the first line treatment.”

Current clinical guidelines for pediatricians and child psychiatrists associated with the American Academy of Child & Adolescent Psychiatry (AACAP) recommend that behavior therapy be the initial treatment approach for preschoolers with ADHD, and that treatment with medication should only be pursued when counseling in behavior management is not successful.

The study also found that more than one-in-five specialists who diagnose and manage ADHD in preschoolers recommend pharmacotherapy as a first-line treatment alone or in conjunction with behavior therapy.  Although the AAP recommends that pediatricians prescribe methylphenidate when medication is indicated, more than one-third of specialists who prescribe medication for preschool ADHD said they ‘often’ or ‘very often’ choose a medication other than methylphenidate initially (19.4 percent amphetamines; 18.9 percent non-stimulants).

“Although the AAP’s new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines,” said Jaeah Chung, MD, the study’s principal investigator who also practices at Cohen Children’s.  “At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children.”

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To schedule an interview with Dr. Adesman, call 516-232-5229 or email Adesman@lij.edu.

To view the abstract, “Medication Management of Preschool ADHD by Pediatric Sub-Specialists: Non-Compliance with AAP Clinical Guideline, go to http://www.abstracts2view.com/pas/view.php?nu=PAS13L1_1365.5

This study is being presented at the Pediatric Academic Societies in Washington, D.C. on Saturday May 4, 2013 11:30-11:45 a.m. at the Walter E. Washington Convention Center (Rm. 102B).

ADHD symptoms persist for most young children despite treatment

Contact: Ekaterina Pesheva epeshv1@jhmi.edu 410-502-9433 Johns Hopkins Medicine

Nine out of 10 young children with moderate to severe attention-deficit hyperactivity disorder (ADHD) continue to experience serious, often severe symptoms and impairment long after their original diagnoses and, in many cases, despite treatment, according to a federally funded multi-center study led by investigators at Johns Hopkins Children’s Center.

The study, published online Feb. 11 in the Journal of the American Academy of Child & Adolescent Psychiatry, is the largest long-term analysis to date of preschoolers with ADHD, the investigators say, and sheds much-needed light on the natural course of a condition that is being diagnosed at an increasingly earlier age.

“ADHD is becoming a more common diagnosis in early childhood, so understanding how the disorder progresses in this age group is critical,” says lead investigator Mark Riddle, M.D., a pediatric psychiatrist at Johns Hopkins Children’s Center. “We found that ADHD in preschoolers is a chronic and rather persistent condition, one that requires better long-term behavioral and pharmacological treatments than we currently have.”

The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found.

Children with ADHD, ages 3 to 5, were enrolled in the study, treated for several months, after which they were referred to community pediatricians for ongoing care. Over the next six years, the researchers used detailed reports from parents and teachers to track the children’s behavior, school performance and the frequency and severity of three of ADHD’s hallmark symptoms—inattention, hyperactivity and impulsivity. The children also had full diagnostic workups by the study’s clinicians at the beginning, halfway through and at the end of the research.

Symptom severity scores did not differ significantly between the more than two-thirds of children on medication and those off medication, the study showed. Specifically, 62 percent of children taking anti-ADHD drugs had clinically significant hyperactivity and impulsivity, compared with 58 percent of those not taking medicines. And 65 percent of children on medication had clinically significant inattention, compared with 62 percent of their medication-free counterparts. The investigators caution that it remains unclear whether the lack of medication effectiveness was due to suboptimal drug choice or dosage, poor adherence, medication ineffectiveness per se or some other reason.

“Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better,” Riddle says.

Children who had oppositional defiant disorder or conduct disorder in addition to ADHD were 30 percent more likely to experience persistent ADHD symptoms six years after diagnosis, compared with children whose sole diagnosis was ADHD.

ADHD is considered a neurobehavioral condition and is marked by inability to concentrate, restlessness, hyperactivity and impulsive behavior. It can have profound and long-lasting effects on a child’s intellectual and emotional development, Riddle says. It can impair learning, academic performance, peer and family relationships and even physical safety. Past research has found that children with ADHD are at higher risk for injuries and hospitalizations.

More than 7 percent of U.S. children are currently treated for ADHD, the investigators say. The annual economic burden of the condition is estimated to be between $36 billion and $52 billion, according to researchers.

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Other Johns Hopkins investigators on the research included Elizabeth Kastelic, M.D., and Gayane Yenokyan, Ph.D.

The other institutions involved in the research were Columbia University Medical Center, Duke University, the Nathan Kline Institute, University of California—Irvine and University of California—Los Angeles.

The research was funded by the National Institute of Mental Health under grant numbers: U01 MH60642 (Johns Hopkins), U01MH60848 (Duke University Medical Center), U01MH60943 (New York University Child Study Center), U01MH60903 (Columbia University), U01 MH60833 (University of California–Irvine) and U01H60900 (University of California—Los Angeles).

Related

Journal of the American Academy of Child & Adolescent Psychiatry http://www.jaacap.com/article/S0890-8567%2812%2900993-8/abstract

Popular ADHD Drug Safe and Effective for Preschoolers http://www.hopkinschildrens.org/Popular-ADHD-Drug-Safe-and-Effective-for-Pre-Schoolers.aspx

Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children — United States, 2003 and 2007 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm?s_cid=mm5944a3_w

Founded in 1912 as the children’s hospital at Johns Hopkins, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children’s is consistently ranked among the top children’s hospitals in the nation. Hopkins Children’s is Maryland’s largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, please visit

Medication cuts crime rate among ADHD sufferers: results suggested that encouraging more ADHD sufferers to take medication could help to reduce crime and re-offending rates

Wed, 21 Nov 2012 22:00 GMT

Reuters

* Study of 25,000 people found ADHD drugs cut crime rates

* Ritalin and other stimulants can help patients to focus

* Experts say medication decisions must be personal choice

By Kate Kelland

LONDON, Nov 21 (Reuters) – Criminal behaviour in adults with attention deficit hyperactivity disorder (ADHD) drops sharply when they take stimulant drugs like Ritalin to help them to control impulses, scientists said on Wednesday.

A study of more than 25,000 people with ADHD found the number of crimes committed was about a third or more lower in those taking medication, suggesting that encouraging ADHD patients to stay on the pills could cut the risk of crime.

Past international studies show up to two-thirds of young offenders and half the adult prison population screen positively for childhood ADHD, and many may still have symptoms as adults.

British and Swedish researchers who conducted the new study found that patients who went through periods on and off ADHD drugs had a significantly reduced risk of engaging in criminal activity when they were medicated.

“The bottom line is that medication led to a 32 percent reduction in crime rates in men and a 41 percent reduction in crime rates in women,” said Seena Fazel, a forensic psychiatrist at Britain’s Oxford University who presented the findings at a briefing in London

Paul Lichtenstein of Sweden’s Karolinska Institute, who worked with Fazel and colleagues, said the results suggested that encouraging more ADHD sufferers to take medication could help to reduce crime and re-offending rates.

“It’s said that roughly 30 to 40 percent of long-serving criminals have ADHD. If their chances of recidivism can be reduced by 30 percent, it would clearly affect total crime numbers in many societies, he said in a statement.

Some 5 percent of school-age children and around half as many adults worldwide have ADHD, a disorder characterised by distractedness and impulsive and sometimes violent behaviour.

In the United States, it is one of the most common childhood disorders with an average of 9 percent of children between the ages of five and 17 are diagnosed with it each year.

Previous studies have shown that people with ADHD have on average less education and lower incomes, higher rates of unemployment, divorce and substance abuse, and are more likely to enter a life of crime. But until now health experts were not clear how medication might be affecting the crime risk.

“We’ve shown that ADHD medication very probably reduces the risk of crime,” said Henrik Larsson of the Karolinska Institute. “However … most medical treatments can have adverse side effects, so risks must be weighed up against benefits.”

Ritalin, known generically as methylphenidate, is sold by the Swiss drugmaker Novartis and is widely used in developed countries to help people with ADHD to concentrate better and control impulsiveness. Other ADHD drugs include Johnson & Johnson’s Concerta, Shire’s Adderall and Vyvanse and Eli Lilly’s Strattera.

Philip Asherson, an ADHD expert from Britain’s Institute of Psychiatry who was not involved in this research but was speaking at the London briefing, said the findings could point to a cost-effective way to help patients stay out of trouble.

In Britain for example, a month’s supply of ADHD medication costs around 300 pounds per patient, he said – a fraction of the cost to society of keeping someone in prison.

Asherson stressed however that decisions about medication should be a personal choice.

The study was published in the New England Journal of Medicine on Wednesday.

http://www.trust.org/alertnet/news/medication-cuts-crime-rate-among-adhd-sufferers/

Did the gene for ADHD help our nomadic ancestors?

Re-Post 2008

Contact: Ben Campbell
campbelb@uwm.edu
414-229-6250
University of Wisconsin – Milwaukee

An ADHD-associated version of the human gene DRD4 is linked to better health among nomadic tribesmen, but may cause malnourishment in their settled cousins, according to new research by a team directed by an anthropologist at the University of Wisconsin-Milwaukee (UWM).

A study by UWM assistant professor Ben Campbell and colleagues from Northwestern University, Boston University and UNLV shows that a particular version of the gene DRD4, appears to have completely different effects, depending on one’s environment.

The DRD4 gene codes for a receptor for dopamine, one of the chemical messengers used in the brain. Previous research has linked the gene with Attention Deficit Hyperactivity Disorder-type behavior in young men – risk-taking, reward-seeking and impulsivity, says Campbell.

But people can have different versions of the gene. One variant, called the 7R allele, is associated with novelty-seeking in addition to ADHD.

The researchers conducted the study among the Ariaal population in northern Kenya – some of whom still live as nomads, while others have recently settled. The research team analyzed the body mass index (BMI) and height of the two groups, nomadic and non-nomadic Ariaal men, who had the variant gene.

They found that those with the 7R allele in the nomadic population were better nourished than their non-nomadic brethren who carried 7R allele.

The results underscore, says Campbell, the complexity of genotype on the expression of behavior. Different environments can determine whether behaviors associated with the gene, such as ADHD, are more or less effective.

“We may have difficulty understanding ADHD in part because we are considering the behaviors associated with it in only one environment – the present one,” he says. “The thinking used to be one gene, one outcome. Now we know that one gene with different environments yields different outcomes.”

Campbell says the results have implications for the relationship between a sedentary lifestyle and aging.

“This suggests that this particular allele may be beneficial in a traditional setting with high levels of habitual physical activity, but carries with it longer term costs in a more sedentary setting.”

Although the effects of different versions of dopamine genes have already been studied in industrialized countries, very little research has been carried out in non-industrial settings, says Campbell. And yet, subsistence environments are more similar to those where much of human genetic evolution took place, he points out.

 

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The research, co-authored by T.A. Eisenberg, Peter B. Gray, and Michael D. Sorenson, is published this month in the open access journal BMC Evolutionary Biology

A trial of removing food additives should be considered for hyperactive children

Re-Post for Filing 2008

Contact: Rachael Davies
rdavies@bma.org.uk
44-020-738-36529
BMJ-British Medical Journal

A properly supervised trial eliminating colours and preservatives from the diet of hyperactive children should considered a part of the standard treatment, says an editorial in this week’s BMJ.

Although a substantial body of evidence shows a link between attention deficit hyperactivity disorder (ADHD) and artificial food colourings and preservatives, removing them is still considered as an alternative rather than a standard treatment for ADHD, writes Professor Andrew Kemp from the University of Sydney.

In contrast, despite a lack of evidence for its effectiveness, the use of alternative medicine is widespread—up to 50% of children attending tertiary children’s hospitals in the UK and Australia have used it in the past year.

Of the three main treatments for ADHD in children—drugs, behavioural therapy, and dietary modification—only drugs and dietary modification are supported by data from several trials. Yet, behavioural therapy, which has no scientific evidence base, is still thought of as necessary for “adequate treatment”, he says.

So why, despite evidence to the contrary, does the removal of food additives remain an alternative rather than a standard part of treatment for ADHD, asks Kemp”

Data published in 2007 showed that normal (not hyperactive) children were significantly more hyperactive after they ate a mixture of food colourings and a preservative (sodium benzoate), with obvious implications for children with ADHD.

In light of these findings, the European Food Safety Authority (EFSA) reviewed the evidence linking preservatives and colourings with hyperactive behaviours from 22 studies between 1975 and 1994 and two additional meta-analyses.

16 of the studies reported positive effects in at least some of the children. However, the EFSA pointed out that hyperactivity has a wide range of social and biological causes, and exclusively focusing on food additives may “detract from the provision of adequate treatment” for children with the disorder. But, argues Kemp, to discount the accumulating evidence of dietary factors may also do this.

Increasing numbers of children are taking drugs for hyperactivity—2.4% of children in the state of Western Australia. Removing colours and preservatives is a relatively harmless intervention, so a properly supervised and evaluated trial period of eliminating them should be considered as part of the standard treatment, he concludes.

More Children Being Prescribed – Quote “Lobotomizing” Antipsychotics Than Adults Now.

More Kids Taking Antipsychotics for ADHD: Study

HealthDayBy By Steven Reinberg HealthDay Reporter | HealthDay – 2 hrs 17 mins ago

TUESDAY, Aug. 7 (HealthDay News) — Use of powerful antipsychotic  medications such as Abilify and  Risperdal to control youngsters with  attention-deficit/hyperactivity disorder (ADHD) and other behavior  problems has skyrocketed in recent years, a new study finds.

Antipsychotics are approved to treat bipolar disorder, schizophrenia,  other serious mental problems and irritability related to autism. But they  don’t have U.S. Food and Drug Administration approval for ADHD or other  childhood behavior problems, and their use for this purpose is considered  “off label.”

“Only a small proportion of antipsychotic treatment of children (6  percent) and adolescents (13 percent) is for FDA-approved clinical  indications,” said lead researcher Dr. Mark Olfson, a professor of  clinical psychiatry at Columbia University Medical Center in New York  City.

“These national trends focus attention on the substantial  and growing  extent to which children diagnosed with ADHD and other disruptive  behavioral disorders are being treated with antipsychotic medications,”  said Olfson.

The researchers found that doctor visits between 1993-1998 and  2005-2009 that involved a prescription of antipsychotic medication for  children jumped sevenfold — from 0.24 to 1.83 per 100 people. For teens,  14 to 20 years old, the rate rose from 0.78 to 3.76 per 100 people, and  for adults, it just about doubled, from 3.25 to 6.18 per 100 people.

Many of the prescriptions for children were ordered by doctors who are  not psychiatrists, the researchers found.

Although these drugs can deliver rapid improvement in children with  severe conduct problems and aggressive behaviors, it is not clear whether  they are helpful for the larger group of children with ADHD, he said. Nor  has their long-term effect on children’s developing brains been studied.

Olfson said most children and adolescents treated with antipsychotics  are not receiving psychotherapy. “This suggests that more needs to be done  to increase access and availability of psychosocial interventions,” he  said.

“Parent management training and cognitive problem-solving skills  training are examples of effective but underused treatments for young  people with disruptive behavioral problems,” he said.

The study, published in the Aug. 6 online edition of the Archives of  General Psychiatry, used data from the National Ambulatory Medical  Care Surveys from 1993 to 2009. More than 484,000 people were included in  total.

The researchers found prescriptions for antipsychotics increased for  children and adults. But doctors prescribed more antipsychotics to  children and adolescents (68 percent and 72 percent, respectively) than to  adults (50 percent).

For children 13 and younger, the most prescribed drug was risperidone  (Risperdal). Other drugs included aripiprazole (Abilify), quetiapine  (Seroquel) and olanzapine (Zyprexa). Of these drugs, Abilify was most  commonly prescribed to adolescents, aged 14 to 20, the study found.

All of these antipsychotics, developed since the 1990s, are considered  “atypical” or second-generation  antipsychotics.

For elderly patients, the FDA recently issued a Public Health Advisory  about  atypical antipsychotic medications after determining that death  rates are higher for elderly people with dementia when taking atypical  antipsychotics.

Dr. Peter Breggin, a psychiatrist from Ithaca, N.Y.,  and an outspoken  critic of widespread antipsychotic use in children, said these drugs  damage developing brains.

“We have a national catastrophe,” said Breggin. “This is a situation  where we have ruined the brains of millions of children.”

In controlling behavior, antipsychotics act on the frontal lobes of the  brain — the same area of the brain targeted by a lobotomy, Breggin  said.

“These are lobotomizing drugs,” he added. “Of course, they will reduce  all behavior, including irritability,” he said.

Olfson’s team found that most children treated with antipsychotic  medications are diagnosed with ADHD, oppositional behavior and unspecified  disruptive behavioral disorders.

Between 2005 and 2009, controlling “disruptive behavior” accounted for  63 percent of the reason antipsychotics were given to children and almost  34 percent for adolescents, the researchers found.

In contrast, bipolar disorder and depression were the most common  reasons these drugs were prescribed to adults during that time period.

Simon Rego, director of psychology training at Montefiore Medical  Center/Albert Einstein College of Medicine in New York City, said these  drugs have serious side effects, including weight gain, diabetes and heart  problems.

“But, perhaps even more important is the finding that a substantial  majority of the child antipsychotic visits were for young people diagnosed  with disruptive behavior disorders, for which there are currently no  FDA-approved antipsychotic medications,” he said.

Given the uncertain effects that antipsychotic medications have on  cognitive (brain), social and physical development in children and  adolescents, it may be necessary to reevaluate clinical practice patterns,  Rego said.

Efforts to educate physicians about the safety and effectiveness of  antipsychotic medications are also needed, he said.

More information

For more information on antipsychotics, visit the U.S. National Institute of Mental Health

Harvard psychologist Jerome Kagan, offers a scathing critique of the mental-health establishment and pharmaceutical companies, accusing them of incorrectly classifying millions as mentally ill out of self-interest and greed.

SPIEGEL Interview with Jerome Kagan 2 AUG 2012

Harvard psychologist Jerome Kagan is one of the world’s leading experts in child development. In a SPIEGEL interview, he offers a scathing critique of the mental-health establishment and pharmaceutical companies, accusing them of incorrectly classifying millions as mentally ill out of self-interest and greed.

Jerome Kagan can look back on a brilliant career as a researcher in psychology. Still, when he contemplates his field today, he is overcome with melancholy and unease. He compares it with a wonderful antique wooden chest: Once, as a student, he had taken it upon himself to restore the chest with his colleagues.

He took one of its drawers home himself and spent his entire professional life whittling, shaping and sanding it. Finally, he wanted to return the drawer to the chest, only to realize that the piece of furniture had rotted in the meantime.

If anyone has the professional expertise and moral authority to compare psychology to a rotten piece of furniture, it is Kagan. A ranking of the 100 most eminent psychologists of the 20th century published by a group of US academics in 2002 put Kagan in 22nd place, even above Carl Jung (23rd), the founder of analytical psychology, and Ivan Pavlov (24th), who discovered the reflex bearing his name.

Kagan has been studying developmental psychology at Harvard University for his entire professional career. He has spent decades observing how babies and small children grow, measuring them, testing their reactions and, later, once they’ve learned to speak, questioning them over and over again. For him, the major questions are: How does personality emerge? What traits are we born with, and which ones develop over time? What determines whether someone will be happy or mentally ill over the course of his or her life?

In his research, Kagan has determined that how we are shaped in our early childhood is not as irreversible as has long been assumed. He says that even children who suffer from massive privations in the first months of life can develop normally as long as they are later raised in a more favorable environment. Likewise, he has studied how people become human in a certain programmatic way in the second year of life: Their vocabulary suddenly grows in leaps and bounds, and they develop a sense of empathy, a moral sensibility and an awareness of the self.

But Kagan’s most significant contribution to developmental research has come through his examination of innate temperaments. As early as four months old, he has found, some 20 percent of all babies already have skittish reactions to new situations, objects and individuals. He calls these babies “high reactives” and says they tend to develop into anxious children and adults. Forty percent of babies, or what he calls the “low reactives,” behave in the opposite manner: They are relaxed, easy to care for and curious. In later life, they are also not so easily ruffled.

Kagan could have reacted to his finding in a “low-reactive” way by kicking back and letting subsequent generations of researchers marvel at his findings. Instead, he has attacked his own profession in his recently published book “Psychology’s Ghost: The Crisis in the Profession and the Way Back.” In it, he warns that this crisis has had disastrous consequences for millions of people who have been incorrectly diagnosed as suffering from mental illness.


SPIEGEL: Professor Kagan, you’ve been studying the development of children for more than 50 years. During this period, has their mental health gotten better or worse?

Kagan: Let’s say it has changed. Particularly in poorer families, among immigrants and minorities, mental health issues have increased. Objectively speaking, adolescents in these groups have more opportunities today than they did 50 years ago, but they are still anxious and frustrated because inequality in society has increased. The number of diagnosed cases of attention-deficit disorders and depression has increased among the poor…

SPIEGEL: … you could also say skyrocketed. In the 1960s, mental disorders were virtually unknown among children. Today, official sources claim that one child in eight in the United States is mentally ill.

Kagan: That’s true, but it is primarily due to fuzzy diagnostic practices. Let’s go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). That’s why the numbers have soared.

SPIEGEL: Experts speak of 5.4 million American children who display the symptoms typical of ADHD. Are you saying that this mental disorder is just an invention?

Kagan: That’s correct; it is an invention. Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.

SPIEGEL: So the alleged health crisis among children is actually nothing but a bugaboo?

Kagan: We could get philosophical and ask ourselves: “What does mental illness mean?” If you do interviews with children and adolescents aged 12 to 19, then 40 percent can be categorized as anxious or depressed. But if you take a closer look and ask how many of them are seriously impaired by this, the number shrinks to 8 percent. Describing every child who is depressed or anxious as being mentally ill is ridiculous. Adolescents are anxious, that’s normal. They don’t know what college to go to. Their boyfriend or girlfriend just stood them up. Being sad or anxious is just as much a part of life as anger or sexual frustration.

SPIEGEL: What does it mean if millions of American children are wrongly being declared mentally ill?

Kagan: Well, most of all, it means more money for the pharmaceutical industry and more money for psychiatrists and people doing research.

SPIEGEL: And what does it mean for the children concerned?

Kagan: For them, it is a sign that something is wrong with them — and that can be debilitating. I’m not the only psychologist to say this. But we’re up against an enormously powerful alliance: pharmaceutical companies that are making billions, and a profession that is self-interested.

SPIEGEL: You once wrote that you yourself often suffered from inner restlessness as a child. If you were born again in the present era, would you belong to the 13 percent of all children who are said to be mentally ill?

Kagan: Probably. When I was five, I started stuttering. But my mother said: “There’s nothing wrong with you. Your mind is working faster than your tongue.” And I thought: “Gee, that’s great, I’m only stuttering because I’m so smart.”

SPIEGEL: In addition to ADHD, a second epidemic is rampant among children: depression. In 1987, one in 400 American adolescents was treated with anti-depressants; by 2002, it was already one on 40. Starting at what age is it possible to speak of depression in children?

Kagan: That’s not an easy question to answer. In adults, depression either implies a serious loss, a sense of guilt or a feeling that you are unable to achieve a goal that you really wanted to reach. Infants are obviously not yet capable of these emotions. But, after the age of three or four, a child can develop something like a feeling of guilt, and if it loses its mother at that age, it will be sad for a while. So, from then on, mild depression can occur. But the feeling of not being able to achieve a vital goal in life and seeing no alternative only starts becoming important from puberty on. And that is also the age at which the incidence of depression increases dramatically.

SPIEGEL: The fact is that younger children are also increasingly being treated with antidepressants.

Kagan: Yes, simply because the pills are available.

SPIEGEL: So would you completely abolish the diagnosis of depression among children?

Kagan: No, I wouldn’t go as far as that. But if a mother sees a doctor with her young daughter and says the girl used to be much more cheerful, the doctor should first of all find out what the problem is. He should see the girl on her own, perhaps carry out a few tests before prescribing drugs (and) certainly order an EEG. From studies, we know that people with greater activity in the right frontal lobe respond poorly to antidepressants.

Part 2: ‘Psychiatrists Should Ask What the Causes Are’

SPIEGEL: Should one just wait to see whether depression will go away by itself?

Kagan: That depends on the circumstances. Take my own case: About 35 years ago, I was working on a book summarizing a major research project. I wanted to say something truly important, but I wasn’t being very successful. So I went into a textbook-type depression. I was unable to sleep, and I met all the other clinical criteria, too. But I knew what the cause was, so I didn’t see a psychiatrist. And what do you know? Six months later, the depression had gone.

SPIEGEL: In a case like that, does it even make sense to speak of mental illness?

Kagan: Psychiatrists would say I was mentally ill. But what had happened? I had set myself a standard that was too high and failed to meet that standard. So I did what most people would do in this situation: I went into a depression for a while. Most depressions like that blow over. But there are also people with a genetic vulnerability to depression in whom the symptoms do not pass by themselves. These people are chronically depressed; they are mentally ill. So it is important to look not just at the symptoms, but also at the causes. Psychiatry is the only medical profession in which the illnesses are only based on symptoms …

SPIEGEL: … and it seems to discover more and more new disorders in the process. Bipolar disorders, for example, virtually never used to occur among children. Today, almost a million Americans under the age of 19 are said to suffer from it.

Kagan: We seem to have passed the cusp of that wave. A group of doctors at Massachusetts General Hospital just started calling kids who had temper tantrums bipolar. They shouldn’t have done that. But the drug companies loved it because drugs against bipolar disorders are expensive. That’s how the trend was started. It’s a little like in the 15th century, when people started thinking someone could be possessed by the devil or hexed by a witch.

SPIEGEL: Are you comparing modern psychiatry to fighting witches’ hexes in the Middle Ages?

Kagan: Doctors are making mistakes all the time — despite their best intentions. They are not evil; they are fallible. Take Egas Moniz, who cut the frontal lobes of schizophrenics because he thought that would cure them …

SPIEGEL: … and received a Nobel Prize for it in 1949.

Kagan: Yes, indeed. Within a few years, thousands of schizophrenics had their frontal lobes cut — until it turned out that it was a terrible mistake. If you think of all the people who had their frontal lobes cut, being called bipolar is comparatively harmless.

SPIEGEL: It’s not entirely harmless either, though. After all, children with this diagnosis are being subjected to a systematic change in their brain chemistry through psychoactive substances.

Kagan: I share your unhappiness. But that is the history of humanity: Those in authority believe they’re doing the right thing, and they harm those who have no power.

SPIEGEL: That sounds very cynical. Are there any alternatives to giving psychoactive drugs to children with behavioral abnormalities?

Kagan: Certainly. Tutoring, for example. Who’s being diagnosed with ADHD? Children who aren’t doing well in school. It never happens to children who are doing well in school. So what about tutoring instead of pills?

SPIEGEL: Listening to you, one might get the impression that mental illnesses are simply an invention of the pharmaceutical industry.

Kagan: No, that would be a crazy assertion. Of course there are people who suffer from schizophrenia, who hear their great-grandfather’s voice, for example, or who believe the Russians are shooting laser beams into their eyes. These are mentally ill people who need help. A person who buys two cars in a single day and the next day is unable to get out of bed has a bipolar disorder. And someone who cannot eat a bite in a restaurant because strangers could be watching them has a social phobia. There are people who, either for prenatal or inherited reasons, have serious vulnerabilities in their central nervous system that predispose them to schizophrenia, bipolar disease, social anxiety or obsessive-compulsive disorders. We should distinguish these people from all the others who are anxious or depressed because of poverty, rejection, loss or failure. The symptoms may look similar, but the causes are completely different.

SPIEGEL: But how are you going to distinguish between them in a concrete case?

Kagan: Psychiatrists should begin to make diagnoses the way other doctors do: They should ask what the causes are.

SPIEGEL: The problems you describe are not new. Why do you believe psychiatry is in a crisis at this specific time?

Kagan: It’s a matter of the degree. Epidemiological studies are saying that one person in four is mentally ill. The Centers for Disease Control and Prevention in Atlanta recently announced that one in 88 American children has autism. That’s absurd. It means that psychiatrists are calling any child who is socially awkward autistic. If you claim that anyone who can’t walk a mile in 10 minutes has a serious locomotor disability, then you will trigger an epidemic of serious locomotor disabilities among older people. It may sound funny, but that’s exactly what’s going on in psychiatry today.

SPIEGEL: Do you sometimes feel ashamed of belonging to a profession that you think wrongly declares large parts of society to be mentally ill?

Kagan: I feel sad, not ashamed … but maybe a little ashamed, too.

SPIEGEL: Over 60 years ago, when you decided to become a psychologist, you wanted “to improve social conditions so that fewer people might experience the shame of school failure … and the psychic pain of depression,” as you once put it. How far did you get?

Kagan: Not very far, unfortunately, because I had the wrong idea. I thought family circumstances were crucial to being successful in life. I thought that, if we could help parents do a better job, we could solve all these problems. That’s why I chose to be a child psychologist. I didn’t recognize the bigger forces: culture, social standing, but also neurobiology. I really thought that everything was decided in the family, and that biology was irrelevant.

SPIEGEL: Over time, you’ve come to realize that the bond between a mother and her child is not so important after all.

Kagan: That’s right, though one must remember that the mother’s role was not emphasized until quite recently. Sixteenth-century commentators even wrote that mothers were not suited to looking after children: too emotional, overprotective. But when the bourgeoisie increased in the 19th century, women didn’t have to go out and work anymore. They had a lot of time on their hands. So society gave them an assignment and said: “You are now the sculptress of this child.” At the same time, middle-class children didn’t have to contribute to their family the way peasants’ children did. They were not needed and therefore ran the risk of feeling worthless. But when a child doesn’t feel needed, it needs another sign. So love suddenly became important. And who gives love? Women. Eventually, John Bowlby came along and romanticized maternal attachment.

SPIEGEL: Bowlby, the British psychiatrist, was one of the fathers of attachment theory. Do you consider his hypotheses to be wrong?

Kagan: People wanted simple answers, and they longed for a gentler conception of humanity, especially after the horrors of World War II. This fit the idea that only children who are able to trust their mothers from birth are able to lead a happy life.

SPIEGEL: Anxieties over whether raising children in day care centers could harm them persist to this day.

Kagan: Unfortunately, even though we already disproved this in the 1970s. Nixon was president at the time, and Congress was toying with the idea of national day care centers. Along with two colleagues, I got a big grant to study the effect of day care on a group of infants. The children in the control group were looked after at home by their mothers. At the end of 30 months, we found that there was no difference between the two groups. Nonetheless, to this day, 40 years later, people are still claiming that day care centers are bad for children. In 2012.

SPIEGEL: Professor Kagan, we thank you for this conversation.

Interview conducted by Johann Grolle and Samiha Shafy

Study pinpoints effects of different doses of an ADHD drug; Finds higher doses may harm learning

MADISON – New research with monkeys sheds light on how the drug methylphenidate may affect learning and memory in children with attention deficit hyperactivity disorder.

The results parallel a 1977 finding that a low dose of the drug boosted cognitive performance of children with ADHD, but a higher dose that reduced their hyperactivity also impaired their performance on a memory test.

“Many people were intrigued by that result, but their attempts to repeat the study did not yield clear-cut results,” says Luis Populin, an associate professor of neuroscience at the University of Wisconsin-Madison School of Medicine and Public Health.

Populin was senior author of the new study exploring the same topic, now available in the early access section of the Journal of Cognitive Neuroscience, published last week. In the study, three monkeys were taught to focus on a central dot on a screen, while a “target” dot flashed nearby. The monkeys were taught that they could earn a sip of water by waiting until the central dot switched off, and then looking at the location of the now-vanished target dot.

The system tests working (short-term) memory, impulsiveness and willingness to stick with the task, as the monkeys could quit “working” at any time, says Populin. The study used different doses of methylphenidate — the generic name for Ritalin — that were comparable to the range of clinical prescriptions for ADHD.

According to the Centers for Disease Control, almost 5 percent of American children are taking medications for ADHD.

Strikingly, dosage had a major and unexpected impact. “At a low dose, the performance scores improved because the monkeys could control their impulses and wait long enough to focus their eyes on the target. All three were calmer and could complete a significantly larger number of trials,” says Populin, who collaborated with Jeffrey Henriques and graduate student Abigail Rajala on the study.

At the higher dose, “performance on the task is impaired,” Populin says,  “but the subjects don’t seem to care, all three monkeys continued making the same errors over and over.” The monkeys stayed on task more than twice as long at the higher dose, even though they had much more trouble performing the task.

Although ADHD drugs are commonly thought to improve memory, “If we take the accuracy of their eye movements as a gauge of working memory, memory was not helped by either dose,” says Populin. “It did not get better at the lower dose, and there actually was a small negative effect at the higher dose.”

Memory is at the root of many intellectual abilities, but it can be affected by many factors, says Bradley Postle, a professor of psychology at UW-Madison.

Postle, an expert on working memory who was not involved in the study, says methylphenidate affects the brain’s executive function, “which can create an internal environment that, depending on the dose, is either more or less amenable to memory formation and/or retention. If you can concentrate, and are able to process information without being interrupted by distracting thoughts or distractions in your environment, you will perform much better on a memory test. Apparently, the lower dose of methylphenidate helped create the conditions for success without actually improving memory itself.”

Monkeys are not people, but monkeys in the study still reminded him of school children, Populin says.

“They made premature movements, could not wait to look at the target before they could be rewarded for doing so. It’s like a kid where the teacher says, ‘When you complete the task, raise your hand.’ But he can’t wait, even if he knows that by responding prematurely he will not get rewarded,” he says.

The study results had another parallel with daily life, Populin says. Drug dosages may be set high enough to reduce the characteristic hyperactivity of ADHD, “but some children say that makes them feel less creative and spontaneous; more like a robot. If learning drops off as it did in our study, that dose may not be best for them. Our monkeys actually did act like robots at the higher doses, keeping at it for up to seven hours even though their performance was so low.”

The logical way forward would involve a similar study with people diagnosed with ADHD, Populin says. With millions of children, and an increasing number of adults, taking medicines for the condition, “We have to be very careful about finding the right spot on the dose curve, or we may get changes in behavior that we don’t want.  People think these drugs help improve memory, but our data say, ‘No, your memory is not getting better.’ At the higher dose, you get a behavioral improvement at a price, and that price is cognitive ability.”