RxPG News : Child Psychiatry

Society doing hyperactive kids a disservice

Thu, 18 Jun 2009 11:30:22 PST

( from http://www.rxpgnews.com ) Authors and educators are doing hyperactive children a disservice by insisting that hyperactivity has always existed.

Canadian researcher Matthew Smith said not only is that notion wrong, it misleads patients, their parents and their physicians. Smith, from Edmonton is completing his doctorate at the Centre for Medical History, University of Exeter.

Hyperactivity disorder - is currently the most commonly diagnosed childhood psychiatric disorder, said Smith, and millions of children are prescribed drugs including Ritalin to treat it. Yet prior to the 1950s, it was clinically and culturally insignificant.

He argued in a paper that hyperactivity disorder as we understand it today is a modern construct that was first described in 1957. Before that hyperactive behaviour existed - but it wasn't always thought of as a disorder or pathology worth treating, said Smith.

However, Smith said many today assert that hyperactivity is a universal phenomenon, which can be seen in historical figures like Mozart or Einstein. Smith argues that hyperactivity is rooted in social, cultural, political and economic changes of the last half century.

'When history is extended back beyond 1957, it overlooks all the social factors that contributed to the idea that children were hyperactive - and that that was a problem,' he says.

Smith says that whether you consider hyperactivity a disease worth treating often depends on context - and the context changed in the late 1950s when the US refocussed its education system in response to the space race, said an Exeter release.

'If a child's playing soccer, there's a chance hyperactivity isn't going to be a problem. But if they are stuck in a classroom, it is a problem,' he said.

Inconsistancy in response underlies impaired working memory in ADHD

Wed, 25 Mar 2009 00:41:20 PST

( from http://www.rxpgnews.com ) Children with attention-deficit hyperactivity disorder (ADHD) show more variable or inconsistent responses during on ‘working’ or short-term, memory tasks when compared with typically developing peers, a study by UC Davis M.I.N.D. Institute Julie Schweitzer has found.

“We think poor working memory is a characteristic present in many children and adults with ADHD,” said Schweitzer, an associate professor in the Department of Psychiatry and Behavioral Sciences.

“Our study helps explain why working memory may be fine at one moment and poor at another, just as one day a child with ADHD seems to be able to learn and focus in class and on another day seems distracted and not paying attention,” Schweitzer said.

According to the national Centers for Disease Control and Prevention (CDC), an estimated 4.4 million youth, ages 4 to17, have been diagnosed with ADHD by a healthcare professional. In 2003 nearly 8 percent of school-aged children were reported to have an ADHD diagnosis by their parent. The current study, published online in February in the journal Child Neuropsychology, supports the idea that what underlies impaired working memory is a problem in how consistently a child with ADHD can respond during a working memory task.
“We have known for some time that children with ADHD vary in how fast they are able to complete working memory tasks when compared to normally developing control subjects,” Schweitzer explained .

Previous studies have suggested that children with ADHD might be slower at responding to tasks. The current study took a closer look at their performance using a relatively newer statistical analytical approach, to determine whether the children with ADHD were indeed faster, slower, or if perhaps another, more complicated process was occurring. The hypothesis was that children with ADHD were actually mostly responding at the same rate as healthy children, but with more frequent very slow responses than the control subjects.

To test this hypothesis, the study authors presented 25 children with ADHD and 24 typically developing peers with the Visual Serial Addition Task, a computerized program that presents children with a number on one screen and then asks them to mentally add it to another number shown on a second screen. The children are then asked to decide whether or not a given sum is correct. From session to session, the task is presented at different speeds and at different levels of difficulty.

“We found that the children with ADHD were much less consistent in their response times,” said Wendy Buzy, study lead author and a graduate student when the experiments were conducted.

Schweitzer and Buzy were both at the University of Maryland at the time. Buzy said that the children with ADHD had more frequent longer response times when compared with their typically developing peers, but the responses they did give were just as accurate.
“Once we controlled for omission errors, the accuracy of the two groups was the same,” she said.

Buzy and Schweitzer pointed out that one of the unique things about their study was the way in which their data were analyzed. Previous studies compared only the range of reaction times and average reaction times for children with ADHD and controls. The method used in the current study allowed researchers to compare variation in response times within and between individuals, as well as within and between the two groups. The researchers also showed that working memory variability correlated with ADHD symptoms as scored by parent surveys (using the Conners’ ADHD rating scale) prior to testing.

“We found that higher levels of hyperactivity and restlessness or impulsivity correlated with slower reaction times,” Schweitzer said.

The current results led another Schweitzer laboratory member, postdoctoral fellow Catherine Fassbender, to design a study looking at variability in response time during a working memory task in the brains of children with ADHD using functional magnetic resonance imaging (fMRI).

“This study increases our understanding of what might be happening at a physiological level that underlies the inconsistency in responding in ADHD,” she said.

Schweitzer also hopes to look at whether behavioral interventions and/or medications can help reduce the kind of variability observed in the current study. Variability in working memory, she said, means children cannot generalize what they learn in one situation to another.

“Improving consistency in how children with ADHD respond to the environment should help them generalize what they learn in clinical interventions improving their skills across situations.”

ADHD afflicted may find it difficult to kick the habit

Sat, 22 Nov 2008 13:56:38 PST

( from http://www.rxpgnews.com ) New York, Nov 22 - Smoking is more prevalent among people with Attention Deficit Hyperactivity Disorder - - and they are less likely to quit, according to a new study.

The study found that ADHD smokers with higher levels of hyperactivity and impulsivity, with or without inattention, showed lower quit rates after eight weeks than those without ADHD.

The findings of the study, available online in the journal Nicotine and Tobacco Research, could help smokers and physicians to better tailor cessation treatment for individuals with ADHD.

'Greater understanding of the associations between different kinds of ADHD have important public health consequences for smoking cessation and decreased tobacco-related mortality in this population,' said the study's lead author Lirio Covey of the Columbia University Medical Center.

'The effect of ADHD by itself on smoking cessation has rarely been examined; the effects of the individual ADHD symptoms on smoking cessation, even less so.

'To our knowledge, the effects of inattention or hyperactivity at baseline as separate domains of ADHD on cessation treatment outcome have never been examined,' Covey said.

ADHD is a neuropsychiatric condition that begins in early childhood and, in most cases, persists to adolescence and adulthood. Its core symptoms are inattention and hyperactivity/impulsivity.

The study examined 583 adult smokers, 43 of whom were identified with clinically significant ADHD symptoms. They were treated with the medication buproprion, the nicotine patch and regular cessation counselling.

Compared to smokers without ADHD, smokers of both ADHD subtypes showed lower abstinence rates throughout the study.

'The knowledge gained from further study of how these early onset disorders of nicotine dependency and ADHD are related could lead to early prevention of either one or both of these conditions,' Covey said.

Congenital heart defects increasing among IVF twins

Sun, 03 Feb 2008 13:29:37 PST

( from http://www.rxpgnews.com ) The prevalence of congenital heart disease (CHD) among in vitro fertilization (IVF) pregnancies was similar to that of the general population, but there is an increasing risk of CHD among twins resulting from IVF, according to research by Yale School of Medicine researchers.

Working with the Fetal Cardiovascular Center at Yale University and Yale-New Haven Hospital, a central referral center for the State of Connecticut, Bahtiyar and his colleagues examined almost 2,000 patients using fetal echocardiography. The study lasted from January 1, 2006 through July 31, 2007. Among those patients, 250 women were specifically seen due to pregnancy resulting from in vitro fertilization. They did not have other medical problems that would require echocardiograms. The team conducted 357 fetal echocardiograms for 347 fetuses on these 250 women. Approximately 30 percent had twin pregnancies.

“We found that twin pregnancies conceived through IVF have a higher prevalence of CHD than singletons,” said Bahtiyar, who saw a three-fold increase. “IVF twins are usually fraternal, but past studies of identical twins also showed up to a 13-fold increase in congenital heart defects.”

Bahtiyar said that previous reports of increased CHD risk in pregnancies conceived via IVF may be due, in part, to a higher frequency of multiple pregnancies resulting from this form of conception. “The increased twinning seems to be the cause of the abnormality and not IVF per se.”

Bahtiyar and his team plan to increase the number of study subjects to replicate these preliminary results.

“The next step is to explore why this is happening,” he said. “Knowing about the risk of these defects will help increase the likelihood of survival after birth.”

In utero exposure to smoking increases ADHD risk

Mon, 04 Jun 2007 15:59:37 PST

( from http://www.rxpgnews.com ) Women smokers who become pregnant have long been encouraged to reduce or eliminate their nicotine intake. A new study being published in the June 15th issue of Biological Psychiatry provides further reason to do so, as it presents new evidence that in utero exposure to smoking is associated with attention deficit/hyperactivity disorder (ADHD) problems in genetically susceptible children.

The study investigated male and female twin pairs, aged 7-19 years, to assess the relationship between genetic variations, prenatal substance exposures, and ADHD sub-types. Rosalind Neuman, Ph.D., one of the study's authors, explains the findings: When genetic factors are combined with prenatal cigarette smoke exposure, the ADHD risk rises very significantly. When the child has either or both of two specific forms of dopamine pathway genes (DAT and DRD4), and was exposed to cigarette smoking in utero, the risk for having combined type ADHD (many inattention and hyperactive/impulsive symptoms) increased 3 to 9 fold.

John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, adds, These data highlight a new risk of maternal smoking, increasing the risk for ADHD in their children. ADHD, in turn, increases the risk for substance abuse. Thus, it appears that in utero exposure to nicotine may help to perpetuate a cycle across generations that links addiction and behavioral problems.

Adolescents with high-risk sexual attitudes attract peers with similar attitudes

Mon, 21 May 2007 03:59:37 PST

( from http://www.rxpgnews.com ) High-risk sexual behavior in adolescents appears to be influenced by the sexual attitudes of peers, and young people select friends whose attitudes about sex are consistent with their own attitudes. These are the conclusions of a new study conducted by researchers at the University of Illinois at Chicago and published in the May/June 2007 issue of the journal Child Development.

The study addressed issues of peer influence. Researchers sought to determine how adolescents come to resemble their peers in risky attitudes and behaviors, attempting to learn whether they are encouraged by peers to adopt certain behaviors or gravitate toward others with similar attitudes and behaviors. They also examined the role of peer attitudes in the development of high-risk behaviors.

The study analyzed data on 1,350 15- to 18-year-old male and female students taking part in the National Longitudinal Study of Adolescent Health, a nationwide study of individual, peer, family, school, and community factors related to health. High-risk sexual behavior was defined by the number of partners with whom adolescents had intercourse without a condom, since having multiple sex partners without using condoms puts adolescents at risk for contracting HIV and other sexually transmitted diseases. The researchers also constructed a measure of attitudes about the undesirable consequences of sex. These measures of sexual behavior and attitudes, from individual adolescents and their friends, were compared over time.

Some of the study's findings showed that peers influence adolescent attitudes and behavior. Adolescents whose friends had intercourse without a condom were more likely to have intercourse without a condom the following year. Those whose friends believed that sex had undesirable consequences were likely to change attitudes to be similar to those of their friends, and were less likely to have intercourse without a condom the following year. The effect of friends' attitudes on sexual behavior was stronger for females than for males.

Other findings showed that adolescents choose new friends with attitudes that are similar to their own. Teens who believed that sex had undesirable consequences were likely to choose new friends and retain existing friends with similar attitudes. This occurred to a similar extent in males and females, but occurred less often among Hispanic adolescents than among non-Hispanic white and African American adolescents.

This study has two implications for prevention, according to David B. Henry, associate professor of psychiatry at the University of Illinois at Chicago and the study's lead author. First, it supports the use of adolescent leaders for preventive interventions. Second, it suggests that interventions that use attitude change to change behavior may be more effective among females than among males.

Incredible Years parenting programme effective for child behaviour problems

Sat, 10 Mar 2007 01:37:07 PST

( from http://www.rxpgnews.com ) Research in Wales has demonstrated that the Incredible Years parenting programme, an evidence-based programme developed at the University of Washington, Seattle, is very effective in reducing the likelihood of children going on to develop behavioural problems in the UK.

The study is published on bmj.com and is the first of its kind to demonstrate the effectiveness of the programme in a community setting.

Antisocial behaviour in young people is a growing problem. Around 5-10% of UK and US children aged 5-15 years present with clinically significant conduct disorders and the problem is highest in socially disadvantaged areas. Left untreated, up to 40% of children with early difficulties develop subsequent conduct disorder, including drug misuse, criminal and violent behaviour.

So researchers in North Wales set out to determine whether the Incredible Years programme, which teaches and develops parenting skills, could help prevent a child from developing conduct disorders.

The programme was delivered by existing Sure Start staff across North and Mid Wales. Sure Start is a government strategy aimed at providing parenting support for young children and their families in high-risk communities.

More than 150 parents from socially disadvantaged areas took part. All had children aged 3 and 4 years at risk of conduct disorder. Parents were either placed on the programme (12 weekly group sessions) or were put on a waiting list (controls).

Child behaviour and parenting skill were assessed at the start of the study and six months later both by parent report and by direct blind observation. Parents were also asked to self-rate their own feelings of depression, stress and ability to cope.

Children on the programme showed significantly reduced antisocial and hyperactive behaviour, and increased self-control, compared to control children. Parents reported a reduction in stress and depression levels and improved parenting skills.

The authors say this study holds "important lessons for the UK government because, unlike the disappointing results from the national evaluation of Sure Start, it shows that choosing an evidence-based programme ... can achieve remarkable outcomes in high risk children whose parents generally fail to engage with services."

They conclude: "It is important that Government commission effective services for high-risk conduct disordered children. They deserve evidence-based programmes, as do the public, who pay a high price for services and for the other costs of antisocial behaviour."

In a separate paper, the researchers looked at the cost-effectiveness of the programme. Costs were measured from a public sector perspective including health, special educational and social services, and these were considered against the outcome of improved child behaviour based on parent report using the Eyberg Child Behaviour Index (ECBI), a commonly used measure of child behaviour and the primary outcome measure reported in the main study.

They calculated that it would cost £1344 to bring the average child on the programme to below the clinical cut-off point and £5486 to bring the child with the highest ECBI score to below the clinical cut-off point. The programme also appeared to be more cost effective in children at highest risk of developing conduct disorder.

This parenting programme involves a modest additional cost and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending, they conclude.

Early to bed and later wake times - good for children - Study reports

Wed, 07 Feb 2007 02:28:08 PST

( from http://www.rxpgnews.com ) Research indicates that getting inadequate sleep has negative effects on children's social and emotional well-being and school performance. Now a Northwestern University study finds it also increases their risk of being overweight.

The study -- conducted in two waves of data collection approximately five years apart -- is the first nationally representative, longitudinal investigation of the relationship between sleep, Body Mass Index (BMI) and overweight status in children aged 3 to 18.

"Our study suggests that earlier bedtimes, later wake times and later school start times could be an important and relatively low-cost strategy to help reduce childhood weight problems," says Emily Snell. Snell is co-author of "Sleep and the Body Mass Index and Overweight Status of Children and Adolescents" in the Jan./Feb. issue of Child Development.

"We found even an hour of sleep makes a big difference in weight status," said Snell, a Northwestern doctoral student in human development and social policy. "Sleeping an additional hour reduced young children's chance of being overweight from 36 percent to 30 percent, while it reduced older children's risk from 34 percent to 30 percent."

The Northwestern study not only differs from most other investigations of the effects of sleep on children's weight in its five-year approach. It also helps disentangle the issue of whether sleep actually affects weight or whether children who already are overweight are simply poor sleepers. In addition, it takes into account the possible effects of other variables including race, ethnicity and income.

Snell co-wrote the article with Northwestern's Emma K. Adam and Greg J. Duncan, assistant professor and professor of education and social policy, respectively. Adam and Duncan are fellows at the University's Institute for Policy Research and Center for Social Disparities and Health.

Their findings also suggest that later bedtimes play a greater role in the overweight status of children aged from 3 to 8, while earlier wake times play a greater role in children aged 8 to 13. No significant differences in the effect of sleep on weight was found between boys and girls nor was there evidence that children who slept more grew more in height.

The researchers used time diaries, in which the parents or caregivers of young children or children old enough to keep diaries themselves recorded all activities -- including bedtime, time asleep and wake time -- over the course of a weekday and weekend day. In analyzing the diaries, they found troubling age-related trends in sleep behavior.

By age 7, children were sleeping on average less than 10 hours on weekdays. By age 14, weekday sleep time fell to 8.5 hours. A full 16 percent of adolescents aged 13 to 18 were found to sleep fewer than seven hours on weekday nights. The National Sleep Foundation recommends children aged 5 to 12 years get 10 to 11 hours of sleep and adolescents get eight to nine hours.

"Many American children are simply not getting the sleep they need. Parents, policymakers and health care providers all are concerned about the obesity epidemic among children," says Snell. "Our results suggest that something as simple as helping children sleep more at night could reduce their risk of being overweight."

The 2,182 children examined in the study came from a nationally representative sample called the Child Development Supplement of the Panel Survey of Income Dynamics.

Study reports a rise in autism spectrum disorders

Mon, 05 Feb 2007 14:33:01 PST

( from http://www.rxpgnews.com ) The incidence of three childhood neuropsychiatric disorders, including autism, increased among Danish children between 1990 and 2004, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The findings suggest that recent upward trends in reported autism diagnoses may be part of a broader pattern in childhood mental illness.

Autism is characterized by social and language abnormalities and repetitive patterns of behavior, according to background information in the article. "A public health debate surrounding the prevalence of autism has become a prominent feature in both the public and professional autism literature in the United States and abroad," the authors write. "The debate is fueled by numerous studies reporting marked increases in recent years in the prevalence of autism or its proxy measure, the prevalence of individuals receiving autism services."

Hjördís Ósk Atladóttir, M.B., University of Aarhus, Denmark, and colleagues examined trends in four childhood neuropsychiatric disorders among all 669,995 children born in Denmark between 1990 and 1999. The conditions were autism spectrum disorder, which comprises autism and milder developmental disorders; hyperkinetic disorder, marked by hyperactivity and a tendency to move from one activity to the next without completing any one; Tourette syndrome, characterized by uncontrollable vocal or motor behaviors known as tics; and obsessive-compulsive disorder, in which an individual experiences recurrent obsessive thoughts or performs compulsive acts. Denmark provides free, universal health care coverage, and all psychiatric diagnoses treatments are recorded in a national registry.

Through 2004, a total of 4,376 children were given 4,637 diagnoses for these disorders. The incidence of hyperkinetic disorder, Tourette syndrome and autism spectrum disorders all increased significantly over time, while obsessive-compulsive disorder did not. "It is difficult to explain why obsessive-compulsive disorder was the only disorder displaying another pattern; the reason may be etiologic, due to nonetiologic diagnostic differences or due to the relatively short follow-up," the authors write.

"Although the reasons for the observed common pattern of change in reported cumulative incidence in Tourette syndrome, hyperkinetic disorder and autism spectrum disorder cannot be address with these data, it is clear that the number of children with neuropsychiatric disorders and their families in need of support and services has been growing in recent years," the authors conclude. "Furthermore, while the search for causes should proceed unabated, the ultimate value of these data are their contribution to the growing awareness of child neurodevelopment problems in general and understanding of the resources needed to ensure optimal development for all children."

Sodium, prostaglandin may be keys to successful treatment for some bedwetters

Sun, 03 Dec 2006 15:06:05 PST

( from http://www.rxpgnews.com ) Children with a form of bedwetting that does not respond to a common medication have more sodium and urea in their nighttime urine, possibly because of an imbalance of prostaglandin, a hormone-like substance, a new study has found.

The finding helps physiologists understand why about 30% of children who suffer from bedwetting (nocturnal enuresis) do not respond to desmopressin, a drug that successfully treats the other 70%. The findings, made by Danish medical doctors who treat enuresis, could help lead to better treatment for these children.

The study “Nocturnal polyuria in monosymptomatic nocturnal enuresis refractory to desmopressin treatment,” was carried out by Konstantinos Kamperis and Jens Christian Djurhuus of the University of Aarhus, Aarhus, Denmark and Soren Rittig and Kaj Anker Jorgensen of the Aarhus University Hospital. The study appears in the December issue of the American Journal of Physiology-Renal Physiology published by the American Physiological Society.

Urine output is controlled, in part, by our own internal daily clocks, or circadian rhythm. With the transition from day to night, our bodies reduce the amount of excreted water, electrolytes and other metabolic end products in preparation for hours of sleep. We are not born with this circadian rhythm, but it usually develops in early childhood.

Some children take longer to develop this rhythm, which is why about 15% of enuretic children will spontaneously stop bedwetting each year without any intervention or treatment. The condition affects 7-10 percent of 7-year-old children, but some severe cases linger much longer. As many as 2 percent of young adults have the problem, which may persist for life.

In a psychological sense, enuresis takes a severe toll, and is among the conditions children worry about most, Rittig said. When asked to imagine the worst things that could happen to them, children rated bedwetting in the top 10, he said.

Rittig published a study in 1989 showing that the hormone vasopressin plays a role in enuresis. This research helped lead to the use of desmopressin to stop bedwetting in many enuretic children. But he and others have remained puzzled as to why some children do not respond to desmopressin. In this study, the researchers set out to understand the physiological mechanisms behind the 30% of desmopressin nonresponders.

The researchers examined 46 enuretic children, ages 7-14, who were outpatients at the Center for Child Incontinence at Aarhus University Hospital and whose enuresis had failed to respond to desmopressin. The enuretic children were subdivided into a “polyuric” group (average nocturnal output on wet nights exceeded 130% of expected bladder capacity) and nonpolyuric (output on wet nights less than 130% of expected capacity). The study also included an age-matched control group of 15 non-enuretic children.

The children spent two nights at Aarhus University Hospital. The first night was to acclimate the children to the hospital environment while the second night was the experimental period. The researchers collected blood and urine from the children during the second night, without waking them. This gave the researchers a more complete picture of physiological changes that occur through the course of an entire night.

Fluid and sodium intake was standardized for all children, based on their weight, to eliminate the possibility that enuretic episodes were related either to excess sodium or fluid intake. All children had adequate bladder capacity and were healthy. None experienced daytime incontinence.

Some enuretic children (five polyurics and four nonpolyurics) did not have a wet night during their stay. This is not unusual for enuretic children, many of whom get through some nights without an episode. The enuretic children who were dry provided one more opportunity to find the physiological difference between them on dry and wet nights, Kamperis said.

Circadian variations in urine output were evident for all groups. However, polyuric children excreted twice as much urine during the night, compared to the nonpolyuric children and the controls. The researchers found that the urine of the polyuric children who wet their beds during the experiment contained more:

* sodium
* urea
* prostaglandin

Interestingly, the children who wet the bed did not excrete a greater volume of water: It was the sodium and urea content that made the difference. Sodium and urea excretion was much higher among children who wet the bed, and these substances expand the volume of urine in the bladder, leading to enuresis.

The study also found that urine from enuretic episodes in the first hours of sleep is quite different from the urine the researchers collected in the morning. “When we look at what happens in the last hours of the night, we couldn’t find any differences,” Kamperis said. “The first hours are most important.”

The study looked at a variety of other factors that could play a role in bedwetting, including mean arterial pressure, heart rate, atrial natriuretic peptide, angiotensin II, aldosterone and renin levels, but found no differences among the groups. Also, there was no difference in the amount of vasopressin between the two enuretic groups.

“We found enuresis-related polyuria to be largely due to an abnormal nocturnal renal handling of solutes and in particular, sodium,” the authors wrote. While the study suggests that sodium is the main culprit among this subpopulation of enuretic children, there is much still to be done to understand how the process works.

The increased prostaglandin production of the polyurics could account for the difference in excretion of sodium, the authors noted. Prostaglandins counteract the actions of vasopressin and influence of how much sodium we excrete.

The researchers have begun treating children who do not respond to desmopressin with indomethacin, a prostaglandin inhibitor. Those trials, which include a placebo, are expected to be completed within a year, Rittig said.

Many adults with psychiatric disorders may also have undiagnosed ADHD

Sat, 28 Oct 2006 05:37:37 PST

( from http://www.rxpgnews.com ) Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ) announced today that many adults with a depressive disorder, Bipolar Disorder (BPD), or an anxiety disorder may also have undiagnosed Attention-Deficit/Hyperactivity Disorder (ADHD), according to a longitudinal retrospective medical claims analysis presented today at a major medical meeting of child and adolescent psychiatrists.

According to an analysis of medical claims derived from a large managed care database in the United States, approximately 2.5 percent of adults initially diagnosed with a depressive disorder, BPD or an anxiety disorder were also diagnosed with ADHD within the 12-month analysis period spanning January 1, 2005 through December 31, 2005. However, recent findings from the National Comorbidity Survey (NCS) showed that among adult patients surveyed ADHD existed comorbidly in 32.0 percent of those with a depressive disorder, 21.2 percent of those with BPD, and 9.5 percent of those with an anxiety disorder. When compared with these high overall levels of psychiatric comorbidity detected in the NCS, the low comorbid diagnosis rates of the medical claims analysis suggest that many adult patients with psychiatric disorders such as a depressive disorder, BPD or an anxiety disorder may also have undiagnosed ADHD.

"The large discrepancy between the known rates of ADHD comorbidity and the number of patients actually being diagnosed with comorbid ADHD clearly demonstrates that there is still a strong need for increased awareness of adult ADHD, and that physicians treating the adult population may benefit from additional training in evaluating and diagnosing this disorder," said Lenard A. Adler, M.D., lead researcher and director of the Adult ADHD Program in the Departments of Psychiatry and Neurology at New York University (NYU) School of Medicine and author of Scattered Minds: Hope and Help for Adults with ADHD (Putnam).

There are potentially serious consequences of ADHD in adults, including lower educational and occupational achievement, challenges with relationships, anti-social thoughts and poor self-esteem. "The NCS data show us that a fairly high proportion of adults with depressive, bipolar, or anxiety disorders may also suffer from ADHD, and evaluating adult patients for the symptoms of this disorder must become standard practice in the healthcare community," says Dr. Adler.

Researchers conducted a retrospective analysis on data from a 12-month period spanning January 1, 2005 through December 31, 2005 using medical claims derived from a large managed care database in the United States. All claims used in the analysis were from adult patients 18 years and older and no claims with the same diagnosis in the 6 months preceding the index date were used.

Throughout the period analyzed, patients were tracked for claims citing one or more of the other targeted conditions with a total of 900,897 new diagnoses of ADHD; 12,036,905 new diagnoses of a depressive disorder; 1,148,175 new diagnoses of BPD and 6,573,576 new diagnoses of anxiety disorders. Of those patients initially diagnosed with BPD, 2.5 percent were also diagnosed with ADHD and of those patients initially diagnosed with a depressive or anxiety disorder, 1.7 percent were also diagnosed with comorbid ADHD.

Lisdexamfetamine dimesylate (NRP104/LDX) is generally well-tolerated.

Sat, 28 Oct 2006 05:33:37 PST

( from http://www.rxpgnews.com ) Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ) and its collaborative partner New River Pharmaceuticals Inc. (NASDAQ: NRPH) announced today that their investigational ADHD treatment, lisdexamfetamine dimesylate (also known as NRP104 or LDX), yielded a 60 percent improvement in the primary rating scale scores for symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children aged 6 to 12 years who received six months of treatment in an open-label phase III study. Results also demonstrated that at 6 months, 95 percent of children taking lisdexamfetamine dimesylate (NRP104/LDX) produced a "much improved" or "very much improved" rating on the Clinical Global Impressions Improvement score. These results were presented last weekend at a national meeting of child and adolescent psychiatrists.

"This study further demonstrates the potential of lisdexamfetamine dimesylate to be an effective treatment option for children with ADHD," said Ann Childress, M.D., study investigator and president at the Center for Psychiatry and Behavioral Medicine, Inc. in Las Vegas, Nev. "Lisdexamfetamine dimesylate was designed to offer the effectiveness of a stimulant with a novel prodrug formulation that is inactive until metabolized in the body."

New River Pharmaceuticals designed lisdexamfetamine dimesylate as a new ADHD medication in which d-amphetamine is covalently linked to l-lysine, a naturally occurring amino acid. Designed to provide efficacy throughout the day through 6 p.m., lisdexamfetamine dimesylate (NRP104/LDX) remains inactive until converted in the body and the active drug is released. In January 2005, New River signed a collaborative agreement with Shire to develop and commercialize lisdexamfetamine dimesylate (NRP104/LDX). New River received an approvable letter from the U.S. Food and Drug Administration (FDA) for lisdexamfetamine dimesylate (NRP104/LDX) on October 6, 2006. According to the FDA's letter, marketing approval is contingent upon final scheduling by the U.S. Drug Enforcement Administration (DEA). The FDA has not requested any additional studies. Shire and New River are preparing for a product launch in Q2 2007, pending final labeling and scheduling discussions.

Interim Results of Open Label Phase III Study

The subjects in this study had previously participated in either of two blinded clinical trials of lisdexamfetamine dimesylate (NRP104/LDX). All patients in the current trial received lisdexamfetamine dimesylate (NRP104/LDX) 30 mg in the first week. Investigators titrated patients' daily dosage by 20 mg at weekly intervals during subsequent visits to achieve optimal efficacy and tolerability. The maximum daily dose was 70 mg.

In this study of 269 children with ADHD, six months of treatment with lisdexamfetamine dimesylate (NRP104/LDX) resulted in significant reductions in the participants' average total scores on the Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS-IV). Specifically, the children had an average reduction of 26.9 points which represents an average improvement of more than 60 percent. ADHD-RS-IV, the primary efficacy measurement tool for the study, is a standard test for assessing symptoms of ADHD. The scale, which contains 18 items, is based on the ADHD diagnostic criteria as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision®, a publication of the American Psychiatric Association.

Investigators also measured the efficacy of lisdexamfetamine dimesylate (NRP104/LDX) with the Clinical Global Impressions - Improvement (CGI-I) scale, in which 95 percent of patients' symptoms were rated as "much improved" or "very much improved" after six months of treatment. The CGI is a standard assessment tool used to rate the severity of illness, change of improvement over time and efficacy of medication.

Preschoolers with ADHD improve with low doses of medication

Tue, 17 Oct 2006 02:42:37 PST

( from http://www.rxpgnews.com ) The first long-term, large-scale study designed to determine the safety and effectiveness of treating preschoolers who have attention deficit/hyperactivity disorder (ADHD) with methylphenidate (Ritalin) has found that overall, low doses of this medication are effective and safe. However, the study found that children this age are more sensitive than older children to the medication's side effects and therefore should be closely monitored. The 70-week, six-site study was funded by the National Institutes of Health's National Institute of Mental Health (NIMH) and was described in several articles in the November 2006 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"The Preschool ADHD Treatment Study, or PATS, provides us with the best information to date about treating very young children diagnosed with ADHD," said NIMH Director Thomas R. Insel, MD. "The results show that preschoolers may benefit from low doses of medication when it is closely monitored, but the positive effects are less evident and side-effects are somewhat greater than previous reports in older children."

Methylphenidate is the most commonly prescribed medication to treat children diagnosed with ADHD. But its use for children younger than 6 years has not been approved by the Food and Drug Administration. And until PATS, very few studies--and no large-scale ones--have been conducted to collect reliable, consistent data to help guide practitioners treating preschoolers with ADHD.

The 303 preschoolers enrolled in the study ranged in age from 3 to 5 years. The children and their parents participated in a pre-trial, 10-week behavioral therapy and training course. Only those children with the most extreme ADHD symptoms who did not improve after the behavioral therapy course and whose parents agreed to have them treated with medication were included in the medication study. In the first part of the medication study, the children took a range of doses from a very low amount of 3.75 mg daily of methylphenidate, administered in three equal doses, up to 22.5 mg/day. By comparison, doses for school-aged children usually range from 15 to 50 mg total daily.

The study then compared the effectiveness of methylphenidate to placebo. It found that the children taking methylphenidate had a more marked reduction of their ADHD symptoms compared to children taking a placebo, and that different children responded best to different doses.

"The best dose to reduce ADHD symptoms varied substantially among the children, but the average across the whole group was as low as 14 mg per day," said lead author Laurence Greenhill, M.D., of Columbia University/New York State Psychiatric Institute. "Preschoolers with ADHD may need only a low dose of methylphenidate initially, but they may need to take a higher dose later on to maintain the drug's effectiveness."

To ensure the safety of the very young children involved, the study was governed by a strict set of ethical standards and additional review boards. The children's health was monitored carefully and repeatedly throughout the study's duration. Their parents were repeatedly consulted for consent prior to every step of the program. The researchers also reviewed the teacher ratings of the children who attended preschool at various stages in the study.

Similar to 1999 results found in NIMH's Multimodal Treatment Study of Children with ADHD (MTA study), and other studies on school-aged children, the medication did appear to slow the preschoolers' growth rates. Throughout the duration of the study, the children grew about half an inch less in height and weighed about 3 pounds less than expected, based on average growth rates established prior to the study.

Currently, no data exist that track long-term growth rate changes among preschoolers with ADHD who are medicated with methylphenidate. However, a five-year-long follow-up study is underway to track the children's physical, cognitive, and behavioral development, as well as health care services the family is using to care for the child. Those data will be available in two to three years.

Finally, 89 percent of the children tolerated the drug well, but 11 percent--about 1 in 10 children--had to drop out of the study as a result of intolerable side effects. For example, while some children lost weight, weight loss of 10 percent or more of the child's baseline weight was considered a severe enough side effect for the investigators to discontinue the medication. Other side effects included insomnia, loss of appetite, mood disturbances such as feeling nervous or worried, and skin-picking behaviors. Despite concerns that stimulants may increase blood pressure or pulse, any changes seen in the children's blood pressure or pulse were minimal.

"The study shows that preschoolers with severe ADHD symptoms can benefit from the medication, but doctors should weigh that benefit against the potential for these very young children to be more sensitive than older children to the medication's side effects, and monitor use closely," concluded Dr. Greenhill.

Controlling behavior of children with tourette and tic disorders

Wed, 27 Sep 2006 00:18:37 PST

( from http://www.rxpgnews.com ) A program to train parents how to manage the disruptive behavior of children with Tourette syndrome (TS) and tic disorders works well, according to a pilot study conducted by Yale School of Nursing and the Yale Child Study Center.

"A new approach is needed because the relationship between tics and disruptive behavior is unclear and this can be confusing for parents and teachers," said the lead author, Lawrence Scahill, professor at Yale School of Nursing and the Yale Child Study Center. "Tics are involuntary, but not all of the disruptive behavior seen in children with TS is involuntary. This can lead to uncertainty about what behaviors to accept and what behaviors to limit."

TS is a neurological disorder that begins in childhood and is defined by an enduring pattern of motor and phonic tics. Children with only motor or only phonic tics are diagnosed with chronic tic disorder. The current primary treatment is medication to control tics or to treat the commonly associated conditions of attention deficit hyperactivity disorder or obsessive-compulsive disorder.

This is the first study to use Parent Management Training (PMT) for children with TS. Of the 24 children in the study, 18 had TS and six had chronic tic disorder. The children were ages six to 12.

The 10-week program included positive reinforcement for appropriate behavior, communicating directions effectively, and being consistent with consequences for disruptive behaviors. Parenting skills were taught through modeling, role-play, and corrective feedback provided by a therapist. Half of the children were randomly assigned to PMT and were allowed to continue with ongoing treatments such as medication or psychotherapy. The other half of the subjects continued with only their original treatment.

The results showed PMT was successful in controlling moderate to severe levels of oppositional behavior. As rated by the parents, there was a 51 percent decline in disruptive behavior in the PMT group and a 19 percent decrease in the control group. Without knowing ahead of time which treatment the children received, the clinicians rated 64 percent of the children in the PMT group as much improved or very improved compared to 17 percent of the children in the control group.

OROS methylphenidate is best for teenage drivers with ADHD

Wed, 06 Sep 2006 01:04:37 PST

( from http://www.rxpgnews.com ) Researchers at the University of Virginia Health System have found that teenage drivers with attention deficit hyper activity disorder (ADHD) drive better when they took OROS methylphenidate (OROS MPH), a controlled-release stimulant, rather than extended release amphetamine salts (se-AMPH ER). The findings, which reinforce the use of OROS MPH to improve driving performance in teens with ADHD, will appear in the Sept. issue of Pediatrics.

"Car collisions are two to four times more likely to occur among teens with ADHD. Past studies have shown that stimulants commonly used to treat ADHD can help improve driving performance among this group," said Daniel Cox, Ph.d., lead author and professor of psychiatric medicine at the University of Virginia Health System. "However, there are many different formulations of stimulant drugs to treat ADHD and parents need to know which ones will have the best positive effect."

In previous studies, Cox and his team set out to determine whether immediate-release and extended release drug formulations influence driving performance throughout the day. They found that OROS MPH (Concerta) compared with immediate-release methylphenidate (Ritalin) was better at improving driving performance. The OROS technology uses osmotic pressure to deliver the drug at a controlled rate.

In this study, researchers compared Concerta to se-AMPH ER (Adderall XR). Both are long-acting stimulants used to treat ADHD. Using a driving simulator, teen drivers between 16 and 19 years of age, displayed their driving skills after taking Concerta, Adderall XR or placebo. Study participants took their medications at 8 a.m. They came to the driving simulator laboratory and completed 15-minute simulated drives at 5 p.m., 8 p.m. and 11p.m. Driving performance was determined by sophisticated computer algorithms.

Researchers found that treatments with Concerta led to fewer inattentive driving errors and less hyperactive or impulsive driving errors, such as speeding and inappropriate braking, compared with Adderall XR and placebo.

"This was the first study of its kind to demonstrate that OROS methylphenidate has therapeutic benefits among teens for up to 15 hours," said Cox. "We hope these results encourage teens to be vigilant in taking their medication as prescribed to help contribute to their driving safety and help them appreciate the benefits of stimulant therapy."

"The study suggests that Concerta should be the initial treatment of choice for teen drivers with ADHD, though teens already on Adderall XR should not necessarily switch medications if they demonstrate a robust therapeutic response", according to Cox.

In addition, accidents occur most frequently in the evenings and on weekends, meaning parents should not necessarily limit medication use to school days.

Almost half of kids with ADHD are not being treated

Mon, 07 Aug 2006 13:48:37 PST

( from http://www.rxpgnews.com ) In contrast to claims that children are being overmedicated for attention-deficit/hyperactivity disorder (ADHD), a team of researchers at Washington University School of Medicine in St. Louis has found that a high percentage of kids with ADHD are not receiving treatment. In fact, almost half of the children who might benefit from ADHD drugs were not getting them.

"What we found was somewhat surprising," says Richard D. Todd, M.D., Ph.D., the Blanche F. Ittleson Professor of Psychiatry and professor of genetics. "Only about 58 percent of boys and about 45 percent of girls who had a diagnosis of full-scale ADHD got any medication at all."

Much has been written about the increasing number of children taking drugs for ADHD. One study found that the percentage of elementary school children taking medication for ADHD more than tripled, rising from 0.6 percent in 1975 to 3 percent by 1987. Another study reported that the number of adolescents taking ADHD drugs increased 2.5 fold between 1990 and 1995. And many reports have noted a rapid increase in the U.S. manufacture of the stimulant drug methylphenidate -- usually sold under the brand names Ritalin or Concerta.

The researchers studied 1,610 twins between the ages of 7 and 17. Of those, 359 met full criteria for ADHD: 302 boys and 57 girls. The total number of boys in the sample was 1,006, and 604 girls were included.

"From a clinical point of view, this study affirms that for whatever reason, many children who could benefit from treatment are not receiving it," says first author Wendy Reich, Ph.D., research professor of psychiatry in the William Greenleaf Eliot Division of Child Psychiatry.

It's possible those children aren't being identified at schools or pediatrician's offices or that their parents are choosing not to put their children on stimulant medication, according to Reich.

"It may be that mental health professionals need to do a better job of explaining the risks and benefits of treatment," Todd says. "The vast majority of parents whose children were involved in this study reported that their kids improved with medication, and when used properly these drugs have been shown to be very safe."

Todd, who also is the chief of child psychiatry, says among the 1,251 kids in the study who did not have ADHD, some did take stimulant medications, but it was a very small percentage, only 3.6 percent of the boys and 2.6 percent of the girls.

He says, however, that in many cases, there's an understandable reason those children have sought treatment. The study found that most of the children without ADHD who took medication did have some symptoms of ADHD -- some hyperactivity or problems with inattention -- but not enough symptoms to meet formal diagnostic criteria as defined by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV). The study also found that most of the kids who took medication without an ADHD diagnosis had a twin who did have the disorder.

"These children have what we might call subsyndromal, or mild, forms of ADHD, and they seemed to come from families where other children had full-blown ADHD," Todd explains. "We didn't find that children got these drugs because they had other problems, such as conduct disorder or a learning disability."

Reich says the eventual goal of studying twins is to learn what elements of ADHD are passed down in families. She says some aspects of the disorder are certainly genetic. Others may be related to environmental factors, and studying twins allows the researchers to tease out those influences. Todd says the hope is to identify genes that contribute to the disorder, or rather, the disorders.

"It's becoming clearer that ADHD is not a single problem but a group of disorders that have different causes but similar clinical expressions," he explains. "There also can be lots of reasons why you become diabetic or hypertensive. The end result is high blood sugar or elevated blood pressure, but how that happens can differ greatly from individual to individual. It's the same thing for ADHD."

Todd believes that as genes are identified, it may become possible to intervene in new ways -- with psychotherapies, environmental interventions or medications that affect biological pathways that haven't yet been identified. But he says a potential stumbling block in the future, as now, will involve getting children into treatment.

"That's especially true for girls because for whatever reason, less than half of the girls who had ADHD in this sample ever received treatment," Todd says. "As genes are discovered and treatments developed, they won't be able to solve problems unless they are used."

How ADHD drugs work in brain

Tue, 27 Jun 2006 01:24:37 PST

( from http://www.rxpgnews.com ) Although millions depend on medications such as Ritalin to quell symptoms of attention deficit hyperactivity disorder (ADHD), scientists have struggled to pinpoint how the drugs work in the brain.

But new work at the University of Wisconsin-Madison is now starting to clear up some of the mystery. Writing in the journal Biological Psychiatry, UW-Madison researchers report that ADHD drugs primarily target the prefrontal cortex (PFC), a region of the brain that is associated with attention, decision-making and an individual's expression of personality.

The finding could prove invaluable in the search for new ADHD treatments, and comes amidst deep public concern over the widespread abuse of existing ADHD medicines.

"There's been a lot of concern over giving a potentially addictive drug to a child [with ADHD]," says lead author Craig Berridge, a UW-Madison professor of psychology. "But in order to come up with a better drug we must first know what the existing drugs do."

A behavioral disorder that afflicts both children and adults, ADHD is marked by hyperactivity, impulsivity and an inability to concentrate. The National Institute of Mental Health estimates that 2 million children in the U.S. suffer from the condition, with between 30 to 70 percent of them continuing to exhibit symptoms in their adult years.

Despite public anxiety over the treatment of a behavioral condition with pharmacological drugs, doctors have continued to prescribe meds like Adderall, Ritalin and Dexedrine because - quite simply - they work better than anything else.

ADHD drugs fall into a class of medications known as stimulants. ADHD stimulants boost levels of two neurotransmitters, or chemical messengers in the brain, known as dopamine and norepinephrine. Dopamine is thought to play a role in memory formation and the onset of addictive behaviors, while norepinephrine has been linked with arousal and attentiveness.

Berridge notes that scientists have learned little about how ADHD drugs work because past studies have primarily examined the effects of the medicines at high doses. High-dose stimulants can cause dramatic spikes in neurotransmitter levels in the brain, which can in turn impair attention and heighten the risk of developing addiction.

"It is surprising that no one was looking at low-dose [ADHD] drugs because we know that the drugs are most effective only at low doses," says Berridge. "So we asked the natural question: what are these drugs doing at clinically relevant doses?"

To answer that question, Berridge and his team monitored neurotransmitter levels in three different brain regions thought to be targeted by ADHD drugs: the PFC and two smaller brain areas known as the accumbens which has been linked with processing "rewards," and the medial septum, which has been implicated in arousal and movement.

Working with rats, the researchers conducted laboratory and behavioral tests to ensure that animal drug doses were functionally equivalent to doses prescribed in humans. Then, using a type of brain probe - a process known as microdialysis - the UW-Madison team measured concentrations of dopamine and norepinephrine in the three different brain areas, both in the presence and absence of low-dose ADHD stimulants.

Under the influence of ADHD drugs, dopamine and norepinephrine levels increased in the rats' PFC. Levels in the accumbens and medial septum, however, remained much the same, the scientists found.

"Our work provides pretty important information on the importance of targeting the PFC when treating ADHD," says Berridge, "In particular it tells us that if we want to produce new ADHD drugs, we need to target [neurotransmitter] transmission in the PFC."

In the future, Berridge and his colleagues plan to look deeper within the PFC to gain more detailed insights into how ADHD meds act on nerves to enhance cognitive ability.

Other researchers who contributed to the study include UW-Madison co-authors David Devilbiss, Matthew Andrzejewski, Ann Kelley, Brooke Schmeichel, Christina Hamilton and Robert Spencer, and Yale Medical School researcher Amy Arnsten.

Pycnogenol reduces hyperactivity, increases concentration in ADHD

Sat, 17 Jun 2006 20:19:37 PST

( from http://www.rxpgnews.com ) A new study to be published in the June 17 edition of the journal of European Child & Adolescent Psychiatry shows a significant reduction of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in children after supplementing with Pycnogenol® (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, everyday for one month.

In the randomized, double-blind placebo-controlled study, Pycnogenol helped reduce hyperactivity and improve attention, concentration and motor-visual coordination in children with ADHD.

"These findings are especially notable for parents who are concerned about overmedicating children diagnosed with ADHD. Many families are seeking natural options to avoid the potentially dangerous side effects of prescription drugs," said Dr. Peter Rohdewald, Institute of Pharmaceutical Chemistry at Germany's University of Munster and one of the authors of the study.

"The results of this study show Pycnogenol may serve as a safe, effective treatment for children diagnosed with ADHD. French maritime pine bark extract reduced hyperactivity among study participants, while improving attention and visual-motor coordination and concentration of these children," said Rohdewald.

The study sampled 61 out-patients with ADHD with an average age of 9 ½ years, from the Department of Child Psychology at the Children University Hospital in Slovakia.

Forty-one patients received Pycnogenol and 16 received placebo. Patients were not supplemented with any other drugs or with vitamins E or C during the study. The placebo contained lactose (58 mg) and cellulose (65 mg). Participants in the Pycnogenol group received 1 mg of Pycnogenol or placebo for every kilogram of body weight, on a daily basis each morning, for one month.

Participants were given a basic psychiatric examination; an evaluation by teachers and parents using the Child Attention Problems scale (CAP), the Connor's Teacher Rating Scale (CTRS) and Connor's Parent Rating Scale (CPRS) and a psychological investigation before treatment, one month after the study began and one month after the end of the study.

After one month of Pycnogenol treatment, the participants' teachers compared the pre-test CAP and CTRS results with those scores after one month of treatment with either Pycnogenol or placebo. There was a significant drop in hyperactivity and inattention compared to start of the study and placebo.

The CPRS results, evaluated by parents after one month of treatment, showed a decrease in hyperactivity compared to the scores at the start of the study. The results for motor-visual coordination and concentration showed a significant increase for participants who took Pycnogenol after one month of the study period compared to before the study started. Participants who took placebo showed no significant improvement in these scores.

The researchers also found that, one month after termination of treatment, symptoms returned to their levels as measured before the study started in the Pycnogenol group, strongly suggesting the antioxidant's effect on reducing ADHD symptoms.

According to the U.S. Centers for Disease Control and Prevention (CDC), 7.8% of American Children are diagnosed with ADHD and 4.3% of children are taking medication for this disorder.

Most types of medications used to treat ADHD can be addictive and may have major side effects. Stimulant medications such as Ritalin, Dexedrine and Adderall are the most common treatments for ADHD and side effects often include depression, anxiety and irritability.

The CDC estimated nearly 3,100 people are admitted to emergency rooms each year due to stimulant drugs. An estimated 3.3 million Americans under the age of 19 and 1.5 million Americans over the age of 20 take ADHD medications. Pycnogenol was chosen for the study because it continues to scientifically demonstrate health benefits without serious side effects or addictive properties. Published findings have demonstrated Pycnogenol's beneficial effects in heart, circulatory, skin and cognitive function, among others.

"ADHD is affecting the quality of life for so many children and their families. It is imperative that science explores natural means to provide expanded treatment options. We look forward to advancing this promising research," said Rohdewald.

Severe body image concerns under-recognized in teens

Thu, 08 Jun 2006 06:15:37 PST

( from http://www.rxpgnews.com ) Adolescents with negative body image concerns are more likely to be depressed, anxious, and suicidal than those without intense dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses, according to a new study by researchers at Bradley Hospital, Butler Hospital and Brown Medical School.

Researchers assessed the prevalence and clinical correlates of body image concerns including: body dysmorphic disorder (BDD), eating disorders (ED) (such as bulimia or anorexia), and other clinically significant concerns over shape/weight in adolescent inpatients at Bradley Hospital, the nation's first psychiatric hospital for children and adolescents. Classic BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect, like a crooked nose or imperfect complexion. Weight-related BDD, however, is classified as distressing and impairing preoccupations with one's weight and shape ie: thinking one's thighs are too fat or one's waist is too big.

The study found that one third of inpatient adolescents had problematic body image concerns, and that these patients were more severely ill than other adolescent inpatients in a number of important domains. Specifically, those with BDD and shape/weight preoccupations had significantly higher levels of depression, anxiety, and suicidality than other patients with no body image concerns. Those with eating disorders had significantly higher rates of depression than those without body image concerns.

"These findings underscore just how central feelings about one's appearance tend to be in the world of teenagers and how impairing these concerns can be," says lead author, Jennifer Dyl, PhD, with Bradley Hospital and Brown Medical School.

This is the first study to show that adolescents with BDD and with shape/weight preoccupations display higher levels of symptoms in areas like depression, anxiety and suicidality, as compared to other adolescents presenting with psychiatric disorders such as behavioral, psychotic, or mood and anxiety disorders who do not have body image concerns.

"This is important because distressing and impairing body image concerns appear to be very prevalent among adolescents with psychiatric illnesses, and are related to a higher degree of distress and impairment," says author Jennifer Kittler, PhD with Bradley Hospital and Brown Medical School.

An additional finding revealed that in addition to higher levels of depression, anxiety and suicidality, patients with shape/weight preoccupations expressed higher levels of dissociation (a coping style characterized by blocking out emotions), sexual preoccupation/distress, and post-traumatic stress disorder (PTSD), suggesting that such concerns may be related to the experience of past physical or sexual abuse.

Interestingly, the authors found that the majority of the adolescents in the study were not actually overweight.

Two hundred and eight consecutively admitted patients (ages 12 to 17) on the adolescent inpatient unit of Bradley Hospital completed the Body Dyspmorphic Disorder Questionnaire (BDDQ) as part of their admission evaluation. The questionnaire assesses the presence of BDD by asking whether respondents are very worried about how they look, think about their appearance problems a lot, and wish they could think about them less, and whether their main appearance concern is that they are not thin enough, or might become too fat. It also asks for the amount of time that they spend focusing on appearance concerns.

"We found that 6.7 percent of patients on the adolescent inpatient unit at Bradley Hospital met criteria for classic (non-weight-related) BDD, but that a much higher percentage (22.1 percent) exhibited distressing and impairing concerns with their weight and shape," says Kittler.

These findings are especially concerning for treatment providers and parents, the authors say, because the majority of adolescents in this study were not receiving psychiatric treatment specifically targeted towards their body image problems. They were most commonly being treated for mood disorders, anxiety disorders, and posttraumatic stress disorder and these body image preoccupations may well have been contributing to the events leading to their hospitalization.

"We have indeed seen a number of teens entering the hospital whose negative feelings about their appearance is a major influence on suicidal thoughts and even suicide attempts, a fact which is often initially not recognized by parents and even professionals," says Dyl.

The authors looked at whether individuals determined to have BDD via a self-report measure were diagnosed with BDD by their clinician. They found that only 1 of 14 participants with definite or probable BDD was diagnosed with BDD in the clinical record.

"This is likely due to clinicians' lack of systematic questioning about BDD, as well as patients' embarrassment and reluctance to reveal their symptoms, which may be particularly characteristic of adolescents," they write.

The authors conclude that severe body image disturbances among adolescents are likely to be under-recognized and under-treated, and may be related to other forms of psychological distress (including depression and suicidality). They also note that since many adults presenting in psychiatric settings often report that preoccupation with their appearance first began in adolescence, it is all the more important to recognize and begin to treat body dysmorphic disorder and other body image concerns in the teenage years, to prevent the problem from becoming a more chronic condition.

Even in the absence of an eating disorder, the study finds that body image concerns can be impairing, preoccupying and distressing for teens, taking up a great deal of mental energy and detracting from their quality of life

"Helping teens verbalize their negative feelings and concerns about their appearance is the first step in getting them to value themselves as individuals and recognize the importance of other non-weight, or non-appearance-based qualities and activities as contributors to their self-esteem and self-worth," Dyl explains.

Prematurity and low birth weight increase risk of hyperkinetic disorder

Mon, 05 Jun 2006 16:47:37 PST

( from http://www.rxpgnews.com ) Premature or low birthweight babies are up to three times as likely to become hyperactive, with low attention spans, suggests research published ahead of print in the Archives of Disease in Childhood.

Hyperactivity, low attention span, and impulsive behaviour characterise the syndrome known as hyperkinetic disorder, or HKD for short. It is one of the most common mental disorders diagnosed among children, say the authors.

The Danish research team compared the birth records of 834 children with confirmed HKD with those of 20,100 children with no mental disorders. All the children were born between 1980 and 1994.

Children born at between 34 and 36 weeks were around 70% more likely to develop the disorder than children born at term. Babies at born below 34 completed weeks were almost three times as likely to develop the disorder.

Low birthweight babies born at term were also at risk, the study showed.

Babies born at term, but weighing 1500 to 2499 g at birth were 90% more likely to develop HKD, while those weighing between 2500 and 2999 g were 50% more likely to develop the disorder than babies weighing over 2999 g at birth.

Of the 834 children with confirmed HKD, nine out of 10 were boys. The age at which the children were diagnosed ranged from 2 to 18 years.

Single parenthood, social and economic deprivation, and young age at parenthood were all risk factors for HKD, but the results still held true even after these had been taken into account and the figures adjusted accordingly.

Ritalin, from whiskers to brain

Wed, 31 May 2006 17:02:37 PST

( from http://www.rxpgnews.com ) Methylphenidate (Ritalin) elevates norepinephrine levels in the brains of rats to help focus attention while suppressing nerve signal transmissions in the sensory pathways to make it easier to block out extraneous stimuli, a Philadelphia research team has found.

Their report in the Journal of Neurophysiology helps explain how a stimulant aids people with attention deficit and hyperactivity disorders to improve their focus without increasing their motor activity. Methylphenidate, prescribed under the brand name Ritalin, has been used for more than 20 years, mostly in children, to treat attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). The drug can also help people who don't suffer either disorder to attend better to a cognitive task.

Despite its wide use, little is known about how the drug, a chemical cousin of amphetamines, produces its therapeutic effects. Researchers want to unlock the mystery of why the drug has the paradoxical effect of decreasing hyperactive behavior and increasing the ability to focus, even though it is a stimulant, said Barry Waterhouse, the study's senior author.

"We're developing a series of behavioral and electrophysiological assays for examining the actions of drugs like methylphenidate," Waterhouse said. "If we can show exactly how methylphenidate works, we may be able to produce even more effective drugs and provide a better understanding of the physiology underlying ADHD."

The study, using rats, is the first to document the increase in norepinephrine and suppression of the neuronal response in this sensory pathway of the brain. "Methylphenidate enhances noradrenergic transmission and suppresses mid- and long-latency sensory responses in the primary somatosensory cortex of awake rats," by Philadelphia-based researchers Candice Drouin, University of Pennsylvania; Michelle Page, Thomas Jefferson University; and Barry Waterhouse, Drexel University College of Medicine appears online in the Journal of Neurophysiology, published by The American Physiological Society.

The researchers stimulated rats' whiskers while recording the activity of the neurons in the sensory pathways that convey this sensation from the whiskers to the cerebral cortex. They compared the rat's sensory pathway response to the whisker stimulation when receiving two different doses of methylphenidate. They found that both the low and moderate doses of methylphenidate:

* Elevated norepinephrine in the area of the brain that processes information related to whisker movement. Norepinephrine helps transmit sensory information from the periphery to the brain.
* Suppressed the long latency phase of the brain's neuronal response to whisker-related sensory stimuli. Suppression of the sensory neuronal response in this way is believed to help filter extraneous stimuli, Waterhouse explained. With the extraneous stimuli out of the way, the individual is better able to attend to the important stimuli.

In addition, the researchers found that the higher dose caused the rats to increase motor activity, while the lower dose did not.

Scientists still have much to learn about methylphenidate, which has an impact on neural circuits throughout the entire brain, not just the sensory pathway studied in this paper, Waterhouse noted. The changes that occur in this sensory pathway may affect other areas of the brain and changes in other areas of the brain may affect this pathway. In addition to sensory pathways, other scientists are studying how the drug affects cognitive and emotional areas of brain.

"This experiment adds to our knowledge of what the drug is doing at the cellular level and gives us a springboard to other studies," Waterhouse said. "One question now is, how does the individual's perception of what is an important stimulus factor into the equation?"

Researchers in this area keep in touch and share their results, Waterhouse said. One group, for example, is looking at the drug's effects on dopamine and norepinephrine in the prefrontal cortex, he noted. These results will eventually have to be combined, as changes in one area of the brain are likely to affect other areas.

"We've been thinking about this for a long time," Waterhouse said of his research. "We hope to have a good idea of the drug's action when we put it all together."

One broad question that intrigues researchers is whether ADHD traces back to the same area of the brain as attention deficit disorder, a similar condition but one in which hyperactivity isn't a symptom.

They also want to know whether Ritalin has any toxic or long-lasting effects, not only for ADHD patients, but also for individuals taking the drug who do not suffer from ADHD or ADD. Methylphenidate use is on the rise among college students who solicit prescriptions from friends or siblings diagnosed with ADHD and use the drug to postpone fatigue and stay alert and focused while studying for exams or completing projects, Waterhouse said.

NRP104 significantly reduced symptoms of attention deficit hyperactivity disorder in children

Thu, 25 May 2006 13:19:37 PST

( from http://www.rxpgnews.com ) Treatment with the investigational drug, lisdexamfetamine dimesylate (NRP104), demonstrated statistically significant reduction in the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children aged 6 to 12 years according to the results of a phase III trial presented today at the American Psychiatric Association (APA) annual meeting.

A phase II trial of lisdexamfetamine dimesylate (NRP104), also presented at APA today, demonstrated a statistically significant reduction in ADHD symptoms comparable to mixed amphetamine salts extended-release (MAS XR). Both products were studied versus placebo in children aged 6 to 12 years with ADHD.

These studies showed that NRP104 significantly reduced ADHD symptoms and was well-tolerated, said Joseph Biederman, M.D., professor of psychiatry at Harvard Medical School and director of Pediatric Psychopharmacology at Massachusetts General Hospital. Dr. Biederman led both of the NRP104 studies presented at the APA meeting.

New River Pharmaceuticals Inc. developed NRP104 and on January 31, 2005, signed a collaborative agreement with Shire to develop and commercialize the product. On December 6, 2005 New River filed a New Drug Application with U.S. Food and Drug Administration to evaluate NRP104 for the treatment of ADHD. This application is currently under review.

In the phase III study, 30-milligram (mg), 50 mg, and 70 mg QD doses of lisdexamfetamine dimesylate (NRP104) demonstrated significant improvements in average ADHD symptoms compared with placebo (P less than 0.0001) after four weeks of once-daily treatment, as measured by 230 children's scores on the ADHD Rating Scale (ADHD-RS). ADHD-RS is a standard test for diagnosing ADHD in children and adolescents and for assessing their response to treatment. The scale, which contains 18 items, is based on the ADHD diagnosis criteria as defined in the APA¡¦s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.

Average reductions in ADHD-RS scores were 51 percent (21.8 points), 54 percent (23.4 points) and 59 percent (26.7 points) for the 30 mg, 50 mg, and 70 mg dosage strengths, respectively, compared to baseline. All three NRP104 doses produced significant average differences in the scores during the first week of treatment (P less than 0.0001 versus placebo for each dose). Of the participants, 36 percent had previously received treatment for ADHD.

Each of the three dosage strengths (30 mg, 50 mg and 70 mg per day) demonstrated efficacy in the morning (~10:00 am); afternoon (~2:00 pm); and into evening (~6:00 pm), compared to placebo, as demonstrated by the Conners ADHD Rating Scale V Parent (CPRS).

Most adverse events were mild to moderate and occurred in the first week. The most common adverse events were decreased appetite, insomnia, headache and upper abdominal pain.

In a phase II three-way double-blind cross-over analog classroom study, investigators optimized 50 children aged 6 to 12 years to their MAS XR dose during a three-week period. The researchers then randomized the participants to receive one week each of lisdexamfetamine dimesylate (NRP104) (approximate equivalent dose to the child's optimal MAS XR dose), MAS XR (subject's optimal dose) or a placebo for a total of three weeks.

The results demonstrated consistently improved behavior when receiving either NRP104 or MAS XR as measured by the Swanson, Kotkin, Agler, M-Flynn and Pelham (SKAMP) deportment rating scale, which is a standard, validated classroom assessment tool used for testing ADHD treatment. Both NRP104 and MAS XR treatments resulted in significant and equivalent improved deportment (0.8 for both), versus placebo (1.7) (P less than 0.0001, for both).

The results also demonstrated that children¡¦s academic productivity significantly improved with both NRP104 and MAS XR treatments, compared to placebo, as measured by PERMP, an age-adjusted collection of math problems that provides an accurate measure of a child's ability to pay attention and stay on task correlated by an increase in number of successfully completed problems. Average scores on PERMP-attempted were NRP104, 133.3, and MAS XR, 133.6, compared to placebo, 88.2, (P less than 0.0001, for both) and on PERMP-correct, NRP104, 129.6, and MAS XR, 129.4, compared to placebo, 84.1 (P less than 0.0001).

Adverse events were mild to moderate. The most common adverse events for NRP104 were insomnia (8 percent), decreased appetite (6 percent) and anorexia (4 percent); for MAS XR were decreased appetite (4 percent), upper abdominal pain (4 percent), insomnia (2 percent), and vomiting (2 percent).

Extreme personality poses risk of ADHD, conduct disorder

Wed, 22 Mar 2006 07:57:37 PST

( from http://www.rxpgnews.com ) Children with personalities marked by aggressiveness, mood swings, a sense of alienation and a need for excitement may be at greater risk for attention deficit hyperactivity disorder or conduct disorder, according to a new Florida State University study.

FSU psychology professors Jeanette Taylor and Chris Schatschneider, FSU doctoral student Kelly Cukrowicz and University of Minnesota Professor William Iacono found that children with ADHD or conduct disorder had more negative emotions - aggressiveness, tension and feelings of being exploited, unlucky or poorly treated - and lower constraints - a tendency to break rules and engage in thrill-seeking behavior - than children with neither of the disorders. Not surprisingly, those children who have both ADHD and conduct disorder had the most extreme personality profiles.

"This helps us to understand that personality is part of the bigger picture of these disorders," Taylor said. "That could help with initial assessments or lead to unexpected discoveries or potential interventions. We're saying to researchers and clinicians, 'Think about personality when you look at these issues.' "

The study, published in the Journal of Child Psychology and Psychiatry, is the first to investigate personality trait patterns among children who have ADHD, conduct disorder or a combination of both. It is important to learn more about the co-occurrence of ADHD and conduct disorder because the consequences are so severe, Taylor said.

"It's more than the sum of its parts," she said, explaining that children and adolescents with a combination of the two disorders are at much higher risk of school failure, criminal activity, substance abuse and depression. Previous studies have indicated that between 15 to 35 percent of children with ADHD also have conduct disorder.

Between 3 percent and 5 percent of U.S. school age children are estimated to have ADHD, a disorder that encompasses symptoms of hyperactivity, inattention or impulsivity. Conduct disorder affects about 13 percent of children and adolescents and is characterized by severe misbehavior including chronic lying, setting fires, destroying property or hurting animals.

The researchers analyzed personality data from 1,438 sets of same-sex, reared-together 11-year-old and 17-year-old male and female twins who participated in the Minnesota Twin Family Study. The rate of ADHD, conduct disorder and the co-occurrence of both was about the same as is found in the general population, Taylor said. Those who did not have symptoms of the disorders served as the control group.

The connection between personality and the disorders is clear, but more research will have to be done to determine whether the personality traits are shaped by the psychological disorders or vice versa.

"Developmentally, it makes sense that the personality comes first," she said. "But to say that one causes the other is too simplistic. I think they become intertwined."

Increased cognitive control in Tourette's syndrome

Tue, 21 Mar 2006 02:22:37 PST

( from http://www.rxpgnews.com ) Though the repetitive vocal and motor tics characteristic of Tourette's syndrome may suggest an inability to control involuntary actions at the cognitive level, researchers have now found evidence that young people with Tourette's syndrome actually exhibit a greater level of cognitive control over their movements than their non-affected peers do.

The research findings are consistent with a greater need for cognitive control of actions in individuals with Tourette's syndrome, and they offer clues to which regions of the brain may be involved in the generation of the syndrome's characteristic behavioral tics.

The findings are reported by Dr. Georgina Jackson and colleagues at the University of Nottingham, UK in the March 21st issue of Current Biology.

Tourette's syndrome is a developmental disorder that typically occurs during late childhood and is characterized by the presence of chronic vocal and motor tics. Tics are involuntary, repetitive, highly stereotyped behaviors that occur with a limited duration, typically occur many times during a single day, and occur on most days. Motor tics can be simple or complex in appearance, ranging from simple repetitive movements to coordinated action sequences. Verbal tics may involve repeating words or utterances (palilalia), producing inappropriate or obscene utterances (coprolalia), or the repetition of another's words (echolalia). Understanding the psychological processes and neural mechanisms that give rise to the execution of tics is of considerable clinical importance. A widely held view is that the inability to suppress unwanted movements in Tourette's syndrome results from a failure of cognitive control mechanisms.

In the new work, Dr. Jackson and colleagues studied cognitive control mechanisms in a group of young people with Tourette's syndrome (TS) by assessing the performance of individuals on a goal-oriented eye-movement task. The task demanded high levels of voluntary control and the active inhibition of automatic eye movements. The researchers found that in performing the task, TS individuals are not in fact impaired in cognitive control. Instead, the study showed that, paradoxically, TS individuals make fewer error responses than their age-matched and neurologically normal peers do, while responding just as fast to the task's demands. According to the authors, this finding most likely reflects a compensatory change in TS individuals whereby the chronic suppression of tics results in a generalized suppression of reflexive behavior in favor of increased cognitive control.

TV viewing may not increase chances of ADHD

Wed, 08 Mar 2006 04:37:37 PST

( from http://www.rxpgnews.com ) Children who watch television are no more likely to develop attention disorders, say scientists rejecting earlier studies that linked kids' television exposure to such problems.

Earlier studies found that children who watch TV more often could face several health problems such as loss of sleep, poor academic performances and symptoms of attention deficit-hyperactivity disorder (ADHD), a mental condition.

In the latest study, Texas Tech University scientists failed to find a connection between ADHD and TV viewing habits, reported the health portal HealthCentral.

Tara Stevens and other researchers randomly selected two samples of 2,500 children. The study includes 22,000 youngsters who started kindergarten during the 1998-1999 school year.

They found no association between television exposure and symptoms of ADHD. They also found that parental involvement -- such as the amount of time parents spent in children's activities that didn't involve TV -- didn't have a link to ADHD symptoms.

"TV is designed to capture our attention and move us quickly from one subject to the next. The question is, does the young brain become different because of this?" asked Stevens.

He said that from this study, it appeared that was not the case. And, as far as ADHD symptoms were concerned, "It was clear that the relationship with TV viewing was close to zero".

She was quick to point out that the researchers weren't advocating TV viewing in children; however she added, "I think these findings take a little bit of the pressure off parents."

Jess Shatkin, director of education and training at the New York University Child Study Center, said he wasn't prepared to fully accept the new findings.

"This is a thoughtful and interesting study, but there's not enough data to support the idea that we shouldn't be cautious about kids' exposure to all media. This doesn't change anything I would tell parents."

The bottom line for parents, he said, is "all things in moderation".

Parental Conflict Produces More Than Fleeting Distress for Children

Sun, 12 Feb 2006 18:35:37 PST

( from http://www.rxpgnews.com ) Six-year-olds whose parents displayed frequent disagreements in their relationship responded to subsequent parental conflicts with elevated distress and negative thoughts, according to a team of researchers from the University of Rochester and the University of Notre Dame.

In the latest issue of the journal Child Development, the team reported examining 223 children twice during a one-year period for their reactions to conflicts between their parents. First, their mothers and fathers participated alone in an exercise in which they attempted to manage and resolve a common point of disagreement. The researchers rated the parents' level of hostility or indifference to capture the characteristic ways that parents managed their conflicts. Then the children observed their parents working through two simulated telephone conversations: a short conflict and a resolution.

Researchers found that the ways parents managed conflicts in the exercise predicted how children responded to the simulated phone conflictâboth within a two-week period and one year later. Parents who displayed high levels of discord had children who responded with greater than expected distress to the simulated phone conflict.

"The stressfulness of witnessing several different types of conflict may have long-term implications for children's functioning by directly altering their patterns of responding to those conflicts," says Patrick T. Davies, lead author and professor of psychology at the University of Rochester. "Our results highlight the possibility that several different types of conflict between parents may negatively affect the well-being of children over time," he says.

According to the authors, prior experiences with parental conflicts can alter the way children cope with later conflicts. "Conflict between parents may have distinct meanings and implications for the child and family system even after considering the effects of parenting difficulties," Davies points out.

Although previous work has shown that children don't get used to their parents discord but, instead, become more sensitive to it, Davies and his colleagues wondered if different forms of destructive conflict between parents played different roles in children's reactions. It didn't matter whether the adults disagreed in openly hostile ways or appeared indifferent during the arguments. Both ways of managing conflict were linked with higher than expected distress in children that lasted even one year later.

The primary purpose of the study was to chart stability and change in children's responses to a conflict in the context of interparental and family interactions in the early elementary years. The authors believe that the study lays the foundation for new testing on how children adapt when dealing with interparental conflict.

Teasing contributes to children's eating disorder

Sun, 12 Feb 2006 17:57:37 PST

( from http://www.rxpgnews.com ) Distress over being teased about their weight and rejection by peers could lead to eating disorders in children, says a study.

Researchers at the University of Minnesota studied more than 2,500 children and found that weight teasing results in negative outcomes.

The research published in the recent issue of journal Pediatrics shows that children who had been teased about their weight could resort to unhealthy method in a bid to stop the taunts. They are more likely to try fasting, skipping meals, vomiting or using laxatives.

Dianne Neumark-Sztainer and other researchers surveyed the children twice, five years apart. At the initial survey, 23 percent of girls and 21 percent of boys said they had been teased about their weight "at least a few times a year".

Among girls, those who were teased were 80 percent more likely to report frequent dieting five years later. However, it was the boys who were likely to turn to unhealthy methods of losing weight, they said.

The researchers suggest that teasing may have a greater impact on boys because they are not used to facing a negative reaction to their weight.

Girls, in comparison, are constantly bombarded with a variety of media messages and images hammering home the need to stay slim.

Neumark-Sztainer said: "The great danger is that in starting an inappropriate diet a child may develop an eating disorder which has serious, or even fatal medical consequences."

Methylphenidate transdermal system showed promise

Sat, 12 Nov 2005 20:23:38 PST

( from http://www.rxpgnews.com ) Shire announced at the US Psychiatric and Mental Health Congress in Las Vegas, Nevada, that its investigational methylphenidate transdermal system (MTS) demonstrated statistically significant reductions in the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and was generally well tolerated in patients aged 6 to 12 in two clinical trials.

"Children who have ADHD must cope with symptoms throughout the day and in a number of environments, including in the classroom, during extra-curricular activities, or while at home," explained Frank Lopez, MD, developmental pediatrician at the Children's Developmental Center, Maitland, Florida. "While oral methylphenidate has long been a first-line treatment for patients with ADHD symptoms, if approved, this transdermal patch formulation would provide parents and health care professionals the first and only non-oral medication for children with ADHD."

The MTS patch was developed by Noven Pharmaceuticals, Inc. and combines the active ingredient of methylphenidate with transdermal technology. This transdermal deliveryäNoven's patented DOT Matrix system was designed to provide continuous medication release throughout the day. The transdermal system releases medication that passes through the skin and directly into the blood stream. The patch is water-resistant.

Data from phase II and phase III clinical trials presented this week in Las Vegas demonstrated statistically significant improvements in the primary and secondary endpoints analyzed for children treated with MTS compared to children treated with placebo.

The phase II analog classroom study included 79 children with ADHD. The patch was worn for nine hours, and efficacy was assessed throughout the day for twelve hours. MTS demonstrated statistically significant improvement over placebo on the measures tested. Behavior, which was measured using the Swanson, Kotkin, Agler, M-Flynn, and Pelham Deportment (SKAMP-D) scale, was improved with MTS overall (mean score 3.2 for MTS versus 8.0 for placebo) and at all time points throughout the day (P < 0.001). Children taking MTS also completed more math problems correctly on the Permanent Product Measure of Performance (PERMP) scale than did those taking placebo (110 versus 81, respectively).

In the phase III naturalistic trial with 270 participants, investigators found that MTS worn for nine hours reduced the children's overall symptoms of ADHD, compared to a placebo (P less than 0.0001), as measured by scores on the ADHD Rating Scale (ADHD-RS). By the study's end, mean ADHD-RS scores declined 24.2 points (56%) from baseline for children treated with MTS versus a decline of 9.9 (24%) for those treated with placebo (P less than 0.0001). ADHD-RS assesses 18 individual symptoms of ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision(TM), a publication of the American Psychiatric Association.

In both studies, MTS was generally well tolerated during both the dose optimization and double-blind phases. Adverse events typically were mild to moderate, resolved with continued therapy and were consistent with known effects of methylphenidate. The most common adverse events reported by patients who received MTS in clinical trials were: nausea, vomiting, nasopharyngitis, weight decreased, anorexia, decreased appetite, affect lability, insomnia, tic, and nasal congestion.

Antisocial behaviour and ADHD linked to mothers' smoking during pregnancy

Sun, 07 Aug 2005 14:39:38 PST

( from http://www.rxpgnews.com ) Both antisocial behaviour and attention-deficit hyperactivity disorder (ADHD) symptoms in offspring are independently influenced by maternal smoking during pregnancy, a new study has found.

There is already substantial evidence that mothers' smoking during pregnancy is associated with both antisocial behaviour and symptoms of ADHD in offspring.

However, it is not clear whether smoking during pregnancy is independently associated with antisocial behaviour, or whether the association arises because antisocial behaviour and ADHD are linked to each other (there is evidence that ADHD behaves as a risk factor for subsequent antisocial behaviour).

Participants in the study were part of the Cardiff Study of All Wales and North West England Twins, a population-based twin register. At the time of the study, these twins were aged between five and 18.

Of the 2846 families who were sent questionnaires, 73% returned completed forms. A final sample of 723 monozygotic (identical) and 1173 dizygotic twin pairs were studied.

The questionnaires measured antisocial behaviour (e.g. 'often destroys own or other's belongings', 'bullies other children') and ADHD symptoms. Mothers were asked to report retrospectively how many cigarettes they smoked daily during their pregnancy.

It was found that males scored higher for both antisocial behaviour and ADHD symptoms than females. Of the 29.1% of mothers who reported smoking during pregnancy, 38.6% smoked 1-10 cigarettes per day, 55.1% 11-20 per day and 6.3% more than 20 per day.

Maternal prenatal smoking contributed small but significant amounts to the variance of ADHD and antisocial behaviour. The average scores for both antisocial behaviour and ADHD increased with the number of cigarettes smoked, and the two conditions were significantly associated with the amount of maternal smoking.

Maternal smoking during pregnancy contributed 3% to the variance of antisocial behaviour, and 2% to the variance of ADHD. Analysis of the data suggested that smoking in pregnancy has a distinct influence on each condition. The link between smoking in pregnancy and antisocial behaviour is not attributable to its association with ADHD.

The authors of the study cannot conclude with confidence that smoking during pregnancy is not a direct risk factor for both ADHD symptoms and conduct disorder in offspring. Therefore, they say, the safest clinical message is that smoking in pregnancy should be avoided.

Surprise findings on childhood depression

Thu, 02 Jun 2005 16:00:38 PST

( from http://www.rxpgnews.com ) A child's social environment may have only a modest effect on whether very young children become depressed, according to new Australian research.

"Our study found that even dysfunctional family relationships and poor communication styles have a limited impact on the observed mental health of a child," Professor Jake Najman said.

"This was contrary to our expectations."

Professor Najman, from UQ's Schools of Social Science and Population Health, is lead author on a new paper published in the latest edition of the international journal, Social Psychiatry and Psychiatric Epidemiology on predictors of depression in very young children.

Professor Najman heads the Mater/University of Queensland Study of Pregnancy (MUSP), one of the world's major longitudinal health studies, jointly run by The University of Queensland and the Mater Hospital in Brisbane.

He said there had been only a few previous population-based studies of symptoms of depression in young children.

There were no previous population-based studies which examined factors which might cause depression in very young children.

Professor Najman said the researchers examined many factors associated with reports from mothers of symptoms of depression in five-year-olds.

These included marital partner changes, mother's health problems in pregnancy, child health during the first six months of life, maternal anxiety and marital satisfaction early in the child's development and the mother's attitude towards caregiving.

They developed a multiple risk factor model but most of the children perceived to be depressed appeared to lack any exposures to risks. On the other hand, the majority of children exposed to high risk did not appear to become depressed -- they appeared to be resilient.

Professor Najman said the study posed many questions.

Evidence of the early origins of depressive symptoms in children arguably suggested a biological basis for these symptoms, as did the evidence pointing to weak social and environmental effects.

The study also had implications for a population health strategy relating to the early onset of mental health problems in young children.

The Mater/University of Queensland Study of Pregnancy project started in 1981 as a three-year study of more than 8000 expectant mothers, looking at health inequalities.

It has since developed into a 24-year study providing invaluable insights into the health of children and young adults.

The study has followed the study group through prenatal, postnatal, childhood, and adolescent periods, with follow-ups taking place as study children reach 21 years of age.

ADHD Improves with Sensory Intervention

Fri, 13 May 2005 19:58:38 PST

( from http://www.rxpgnews.com ) Preliminary findings from a study of children with attention deficit hyperactivity disorder (ADHD) show that sensory intervention -- for example, deep pressure and strenuous exercise -- can significantly improve problem behaviors such as restlessness, impulsivity and hyperactivity. Of the children receiving occupational therapy, 95 percent improved. This is the first study of this size on sensory intervention for ADHD.

The Temple University researchers, Kristie Koenig, Ph.D., OTR/L, and Moya Kinnealey, Ph.D., OTR/L, wanted to determine whether ADHD problem behaviors would decrease if underlying sensory and neurological issues were addressed with occupational therapy. Their study, "Comparative Outcomes of Children with ADHD: Treatment Versus Delayed Treatment Control Condition," will be presented Friday, May 13, at the American Occupational Therapy Association meeting in Long Beach, Calif.

Children with ADHD have difficulty paying attention and controlling their behavior. Experts are uncertain about the exact cause of ADHD, but believe there are both genetic and biological components. Treatment typically consists of medication, behavior therapy or a combination of the two.

"Many children with ADHD also suffer from sensory processing disorder, a neurological underpinning that contributes to their ability to pay attention or focus," explained Koenig. "They either withdraw from or seek out sensory stimulation like movement, sound, light and touch. This translates into troublesome behaviors at school and home."

Normally, we process and adapt to sensory stimulation in our daily environment. But children with ADHD are unable to adjust, and instead might be so distracted and bothered by a sound or movement in the classroom, for instance, that they cannot pay attention to the teacher.

All of the 88 study participants, who are clients at the OT4Kids occupational therapy center in Crystal River, Fla., were taking medication for ADHD. Of the 88, 63 children each underwent 40 one-hour sensory intervention therapy sessions, while 25 did not.

Therapy techniques appeal to the three basic sensory systems: The tactile system controls the sense of touch, the vestibular system controls sensations of gravity and movement, and the proprioceptive system regulates the awareness of the body in space. Therapy is tailored to each child's needs and can involve such techniques as lightly or deeply brushing the skin, moving on swings or working with an exercise ball.

"We found significant improvement in sensory avoiding behaviors, tactile sensitivity, and visual auditory sensitivity in the group that received treatment," said Koenig.

"The children were more at ease. They could better attend to a lesson in a noisy classroom, or more comfortably participate in family activities," said Kinnealey. "The behavior associated with ADHD was significantly reduced following the intervention."

The research team, which included Gail Huecker, the director of OT4Kids, believes that sensory intervention affects the plasticity, or adaptability, of the brain to sensory stimulation. In this study, changes were seen within six months.

Parents can learn how to continue the techniques at home. Koenig also observed that through this study, parents learned to view the disorder and the behaviors through a different lens.

"It's easy for parents to look at ADHD and blame themselves or the child for the bad behavior," said Koenig.

The goal of ADHD treatment is to prevent failure in school, family problems and poor self-esteem. If not addressed early, the disorder can trouble sufferers into adulthood.

In its current study, the group is working with a total of 135 children who have ADHD. Children who did not receive occupational therapy during the study have been scheduled to receive it afterward.

Medication Combined with Behavior Therapy Works Best for ADHD

Sat, 07 May 2005 18:43:38 PST

( from http://www.rxpgnews.com ) A new University at Buffalo study of treatments for children with attention deficit hyperactivity disorder (ADHD) has found that combining behavior modification therapy with medication is the most effective way to improve the behavior of many ADHD children.

In fact, when the two are combined, the study showed, the amount of medication required to achieve the same results as use of medication alone can be reduced by two-thirds.

"One of the major findings of the study is that when using behavior modification, you can get away with tiny, tiny doses of medication, much lower than previously thought," said ADHD researcher William E. Pelham, Jr., University at Buffalo Distinguished Professor in the Department of Psychology, UB College of Arts and Sciences and UB School of Medicine and Biomedical Sciences.

The study is the first to test the effectiveness of a new drug treatment, a methylphenidate (MPH) patch. Methylphenidate is the stimulant used in pill form by ADHD drugs Concerta and Ritalin.

The study is published in the May issue of Experimental and Clinical Psychopharmacology. It was funded by a grant from Noven Pharmaceuticals. Shire Pharmaceuticals Group, which purchased the rights to the MPH patch from Noven, will seek FDA approval for the MPH patch in 2006.

Twenty-seven children with ADHD, ages 6 to 12, participated in the study, conducted at the University at Buffalo's Summer Treatment Program for children with ADHD. Pelham and co-researchers assessed the effects of behavior modification, the MPH patch and a placebo on the children in classroom and organized play settings, and through use of parental behavior ratings.

The researchers found that when used alone, the MPH patch and behavior modification therapy were equally effective treatments. The MPH patch was effective in all doses tested, with few reports of side effects and good wear characteristics.

Combined treatment -- using a very low dose of the MPH patch with behavior modification -- was superior to either treatment alone, however.

"The patch used with behavior modification caused the greater amount of improvement in the

behavior of the children," says Pelham, who helped develop Concerta and who has conducted many other trials involving other stimulant drugs.

Significantly, the study also found that with combined treatment children required much lower doses of medication -- as much as 67 percent lower -- to achieve the same effects as high doses of medication used alone.

Lower dosages of medication lowers the risk of long-term drug side effects, which studies have shown to include loss of appetite and stunting of growth, Pelham points out. "Long-term side effects of ADHD drugs are almost always related to dosage," he says. "If you want to lower a child's dosages daily and throughout their lifetime, the best way to do that is to combine the medication with behavior modification."

According to Pelham, the MPH patch's dosage flexibility potentially makes it ideal for administering lower dosages of methylphenidate in combination with behavior modification. The MPH patch can be applied to a child for short periods during the course of the day. The most commonly used pill forms of methylphenidate, which last for 12 hours, do not offer such flexibility, Pelham says.

"The patch enables users to use less medication for short time periods, and that's good in my opinion," Pelham says. "I think parents are becoming more concerned about the safety of medications than they have been in the past."

The study is the first comparison study of medication and behavior modification to control for the presence and absence of behavior modification that is received by a child daily from parents, teachers, siblings or peers, according to Pelham. As such, the study is the first to accurately isolate the effects of medication and behavior modification treatments, Pelham says.

"There's so much behavior modification that goes on naturally in the world that unless you do a study where you guarantee that all of it is taken away you underestimate the effect of behavior modification because it's always there," Pelham says.

"This study shows that when you control for those outside factors, you get effects of behavior modification that are just as big as high doses of medication."

The study's results, Pelham says, should send a clear message to parents of children with ADHD. "You definitely should be using behavior modification," he says. "You'll be giving your children much lower doses of medication over their lifetimes if you combine behavior modification with medication."