Thursday, November 7th, 2013
A new, broader definition of attention deficit hyperactivity disorder (ADHD) is leading to over-diagnosis and unnecessary medication of many children, a new report published in the British Medical Journal says. The rise also amounts to a $500 million bump in health care costs associated with ADHD in the U.S. alone. More from Reuters:
Less restrictive diagnostic criteria have contributed to a steep rise in diagnoses for the behavioral brain condition -particularly among children – the researchers said, and in the use of stimulant drugs to manage it.
The broader definition also “devalues the diagnosis in those with serious problems”, said Rae Thomas, a senior researcher at Australia’s Bond University who led an analysis of the problem and has published it in the British Medical Journal.
“The broadening of the diagnostic criteria is likely to increase what is already a significant concern about overdiagnosis,” he said. “It risks resulting in a diagnosis of ADHD being regarded with skepticism, to the harm of those with severe problems who unquestionably need sensitive, skilled specialist help and support.”
People with the ADHD are excessively restless, impulsive and easily distracted, and children with the condition often have trouble in school. It is most often diagnosed in children, mainly boys, but it is also known to persist into adulthood.
There is no cure, but the symptoms can be kept in check by a combination of behavioral therapy and medications such as Ritalin or a newer drug called Vyvanse.
Image: Hyper boy, via Shutterstock
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Friday, May 31st, 2013
Stimulant medications that are prescribed for attention deficit hyperactivity disorder (ADHD) are not predictors of later drug abuse by children, a new report based on more than 20 years of previous research has found. The news will come as a relief to parents who might have concerns about their pediatricians’ ADHD treatment plan. The New York Times has more:
The paper, written by three researchers at the University of California, Los Angeles, examined data from 15 previous studies on the subject and determined that, on average, medications like Adderall and Ritalin had no effect one way or the other on whether children abused alcohol, marijuana, nicotine or cocaine later in life.
A 2003 study in the journal Pediatrics had concluded that the introduction of stimulant medication to children with A.D.H.D. reduced the risk of such abuse later in life, a finding that has been repeated by doctors and pharmaceutical companies not only to assuage parents’ fears of medication but also to suggest that the pills would protect their children from later harm.
“I always doubted the whole ‘protection’ argument, and I wasn’t the only one, but that message was really out there,” said Liz Jorgensen, an adolescent addiction specialist at Insight Counseling in Ridgefield, Conn. “Hopefully, this message will be heard loud and clear.”
The study comes amid growing concern about the persistent rise in A.D.H.D. diagnoses and prescriptions for medication among children. A recent New York Times analysis of data collected by the Centers for Disease Control and Prevention found that 11 percent of all children ages 4 through 17 — 6.4 million over all — had received a diagnosis of A.D.H.D. from a medical professional. The diagnosis rate rose to 19 percent for boys of high school age.
Stimulant medication is by far the most prevalent treatment for childhood A.D.H.D., with the vast majority of children at least trying medication and about 60 percent of them staying on it long term. Stimulants can drastically improve the lives of children with severe A.D.H.D. but are also increasingly abused by high school and college students for their jolts of focus toward schoolwork.
Side effects can include appetite and growth suppression, sleep disturbance and occasionally psychosis, especially when the stimulants are abused.
The paper released Wednesday in the journal JAMA Psychiatry analyzed data from studies conducted from 1980 to 2012, and included more than 2,500 children with A.D.H.D. from the United States, Canada and Germany. They were followed from an average age of 8 into young adulthood.
Image: Prescription medications, via Shutterstock
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Wednesday, May 22nd, 2013
A boy who is diagnosed during childhood with attention deficit hyperactivity disorder (ADHD) has a greater risk of developing obesity as an adult, twice the risk of a child without ADHD, according to a new study published in the journal Pediatrics. The findings are, at first glance, counter-intuitive because children with ADHD are known for being active–overly so. But the study identifies a number of factors that contribute to the elevated obesity risk. More from NBC News:
These findings, published in Pediatrics, may be surprising to parents because drugs such as Ritalin or Adderall used to treat ADHD can suppress appetite, said Dr. F. Xavier Castellanos, the study co-author and a professor of child and adolescent psychiatry at New York University.
“It’s not uncommon for kids treated with ADHD medications to be fairly thin,” Castellanos said. Because parents often worry that thinner boys won’t grow as tall, “sometimes [they] will encourage their boys to eat more.”
Instead, to help avert weight problems down the road, parents should be alert to poor eating habits. “If anything, you have to pay attention to how many times they’re having fast food, how many times they’re having fried food, whether they’re getting meals supersized,” Castellanos said.
The study comes at a time when ADHD rates are rising. A new report from the Centers for Disease Control and Prevention found that ADHD is the most common mental health issue in children ages 3-17, with nearly 7 percent of kids receiving a diagnosis.
The NYU researchers followed 222 boys — 111 with ADHD and 111 without, for an average of 33 years — hoping to better understand the disorder’s effects on the brain. The boys with ADHD, all from middle-class, white families, were diagnosed between the ages of 6 and 12.
Decades later, when some of the men returned for brain scans, many of the now 40-something adults who had ADHD as children had gained so much weight they barely fit into the fMRI machine, Castellanos said.
Image: Boy eating, via Shutterstock
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Tuesday, April 2nd, 2013
Over the past decade, diagnoses of attention deficit hyperactivity disorder (ADHD) have grown exponentially, with 11 percent of school age children–and 1 in 5 boys–having a diagnosis. The New York Times reports on the new numbers, which come from research by the Centers for Disease Control and Prevention:
The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.
“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”
And even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment. A.D.H.D. is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.
While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates — diversion long tolerated in college settings and gaining traction in high-achieving high schools — are particularly dangerous, doctors say, because of their health risks when abused.
Image: ADHD, via Shutterstock
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Tuesday, January 10th, 2012
Medications commonly used to treat attention deficit hyperactivity disorder are in short supply because tight regulations by the US Drug Enforcement Agency are limiting the manufacture of the drugs, The Boston Globe reports. Parents whose children are on medications including Ritalin, Adderall, and their generic equivalents are more and more often having to jump through logistical hoops to get their kids’ prescriptions filled.
From the Globe:
Often, parents must come back to his office after an appointment to request a new prescription for a different dose pill, replacing a 30 milligram pill, for example, with three 10 milligram pills to be taken in the morning, since pharmacies aren’t allowed to make these replacements on their own to handle shortages.
The drug that seems to be in the shortest supply? Adderall XR (extended release), said [Children's Hospital Boston's psychopharmacology director Dr. Joseph] Gonzalez-Heydrich, which is made by Shire and lost its patent two years ago. (The drug appears on this FDA list of drug shortages.)
Shire has instead been promoting and steadily producing its newer and more expensive drug Vyvanse — which is in plentiful supply and works similarly to Adderall XR; the DEA allows manufacturers to decide how they will divvy up their restricted production among expensive brand names and lower-priced generics.
“I’ve switched a lot of my patients to Vyvanse since it’s more in stock and has a similar action,” said Gonzalez-Heydrich. But many are forced to pay more for the prescription as a result.
Gonzalez-Heydrich offered advice to parents who are struggling with this issue:
Those expecting to get a new prescription for their recently diagnosed child should be aware of the shortage and ask the doctor to call their local pharmacy to see what’s in stock before walking out with a script.
Those bringing their child in for a prescription refill should call their pharmacy before their child’s appointment — even in the doctor’s waiting room — to find out whether the store has their child’s prescription in stock and, if so, in what dosage.
“If they have the drug in stock, ask if the pharmacy can set aside some pills for a prescription that’s about to be filled,” if their stock is running low, advised Gonzalez-Heydrich. Doctors can’t call in prescriptions, so pharmacies can sometimes run out during the time it takes to bring the script in to be filled.
Parents may also want to call around to other pharmacies to see what they have in stock, also before the doctor’s appointment. That way, said Gonzalez-Heydrich, doctors can tailor the dose and number of pills based on what’s in stock.
Image: Prescription medication, via Shutterstock.
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