Research helps end guesswork in prescribing ADHD drug

Children with ADHD who carry a specific type of dopamine receptor gene respond better to the drug methylphenidate (MPH) than those without the genotype, according to new research from Cincinnati Children's Hospital Medical Center.

The findings come from the first-ever placebo-controlled pharmacogenetic drug trial for Attention Deficit/Hyperactivity Disorder in school age children to evaluate variants of the DRD4 dopamine receptor gene using teacher ratings of children's symptoms.

The research makes progress toward ending the guesswork now involved in prescribing effective ADHD medications that deliver the greatest symptom improvement and fewest side effects, according Tanya Froehlich, M.D., a physician and researcher in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's.

"We don't have a good way of predicting who will experience great improvement in ADHD symptoms with a particular medication, so we use a trial-and-error approach. Unfortunately, as a result finding an effective treatment can take a long time," Froehlich said. "With more information about genes that may be involved in ADHD medication response, we might be able to predict treatment course, tailor our approach to each child, and improve symptom response while decreasing health care costs."

The study was presented May 1 at the annual meeting of the Pediatric Academic Societies in Vancouver, Canada.

Dr. Froehlich and her colleagues tested 89 children between the ages of 7 and 11 who were not already taking stimulant medications for their ADHD. The researchers analyzed DNA from saliva samples to see if the children carried the 7-repeat version of the DRD4 gene, an increasing target of ADHD gene-based studies that has been linked to increased risk for the condition.

Children in the double-blind four-week trial were given one week each of placebo and three different doses of MPH for their ADHD. Parents and teachers assessed and scored the children's behavioral symptoms based on the Vanderbilt ADHD Parent and Teacher Rating Scales. In children with at least one copy of the 7-repeat DRD4 gene who took MPH, teachers reported greater improvement in symptoms with increasing doses compared to children who did not have any copies of the 7-repeat gene.

Going forward, Dr. Froehlich said researchers will be studying additional gene variants and their relationship to ADHD medication response. This includes genes that encode MPH drug targets, such as the dopamine transporter, as well as enzymes that help the body metabolize the drug. MPH (which goes by several brand names, including Ritalin and Concerta) is a stimulant frequently used to treat ADHD.

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Teen trippin' on ADHD drugs can be a real downer

Calls to poison control centers about teens abusing attention-deficit drugs soared 76 percent over eight years, sobering evidence about the dangerous consequences of prescription misuse, a study shows.

The calls were from worried parents, emergency room doctors and others seeking advice on how to deal with the problem, which can be deadly. Four deaths were among cases evaluated in the study.

Kids taking ADHD drugs to get high or increase alertness may not realize that misuse of the drugs can cause serious, sometimes life-threatening symptoms, including agitation, rapid heartbeat, extremely high blood pressure.

"They say, 'It's FDA approved, how dangerous could it be?'" said Steve Pasierb, head of The Partnership for a Drug-Free America, based in New York.

In the study, researchers from Cincinnati Children's Hospital Medical Center evaluated 1998-2005 data from the American Association of Poison Control Centers. During that time, nationwide calls related to teen abuse of ADHD drugs, specifically stimulants, increased from 330 to 581 yearly, and there were four deaths. Overall, 42 percent of teens involved had moderate to severe side-effects and most ended up getting emergency-room treatment.

The true number of teen abusers who have bad side effects is likely much higher, because many cases don't result in calls to poison control centers, said study author Dr. Randall Bond, medical director of the hospital's Drug and Poison Information Center.

The surge, from 1998 to 2005, outpaced calls for teen substance abuse generally. It also paralleled an 86 percent rise in ADHD medicine prescriptions for kids aged 10 to 19, from about 4 million to nearly 8 million during that time.

"It's more bad news on an entrenched problem," Pasierb said. His nonprofit group was not involved in the study. Its own research suggests that about 19 percent of teens have abused prescription drugs including medicine for attention deficit hyperactivity disorder.

Government-sponsored surveys suggest that teen abuse of stimulants including ADHD drugs has declined in recent years.

The new study was for release Monday in the August edition of Pediatrics.

Mark Stein, a psychiatry professor and ADHD expert at University of Illinois at Chicago, said abuse typically involves crushing and snorting the pills, which speeds up the effects and can produce a buzz or sense of euphoria — along with dangerous side effects.

Kids who develop serious side effects should be taken to the emergency room, where sedatives can be used to treat the problem, Stein said.

The study lacks information on whether abusers were teens with ADHD, but anecdotal evidence suggests many are not.

Stein said the study should not deter use of ADHD drugs in teens who really need them, particularly since there's evidence that kids with ADHD who don't get medication are at risk for abusing illicit drugs.

Source : www.newsday.com

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Can Celiac Disease Cause ADHD?

If you're wondering if wheat gluten & ADHD might be related to each other, then you are smart. Celiac disease which is an allergic reaction to wheat gluten is on the rise. In this article, you'll learn more about the connection between Attention Deficit Hyperactivity Disorder and wheat gluten and what to do about it.

When a child is allergic to gluten (wheat protein), the lining of the small intestine gets compromised, which results in poor digestion and malabsorption of nutrients. This leads to gastrointestinal problems, but is also responsible for other issues related to malnourishment: poor growth and developmental delays which can lead to problems with learning and attention.Obviously, removing gluten from the diet is the first step in reversing the damage.

Anecdotal Evidence for the ADHD-Gluten Diet Link

Most kids who have disorders like ADHD have some form of IBS (inflammatory bowel syndrome). IBS is a classic symptom of celiac disease.

Kids who have celiac disease often have a neurologic dysfunction, which is the hallmark of Attention Deficit Hyperactivity Disorder. ADHD is a developmental disorder that seems to start in the brain, but may actually have its origins in the gut. If your child cannot get the nutrients that he needs from food, he is literally starving himself. We all know that the stomach feeds the brain.

A two-week study of 31 children who were put on a gluten-free diet showed marked behavioral improvements in over half the kids.

Gluten-ADHD Diet Recommendations

Since gluten is a protein that is found in wheat, barley and rye, eliminate these products from your child's diet. Replace them with gluten-free products, but be sure to read the labels and make sure that there are no chemicals or preservatives. If your child is resistant to dietary changes, make them slowly over time.

Eliminate casein from the diet (milk products). Many children who have the gluten-ADHD link are also allergic to milk protein.

Purchase a Gluten-free cookbook and learn how to make healthy, delicious baked goods.

Give your child a natural remedy designed to treat ADHD, so that his brain can heal more quickly from the damage done by celiac disease.

Although following the recommendations for a ADHD gluten diet is important for kids with celiac disease, it's not enough to just remove gluten from the diet. This is because it takes up to 12 months of following a gluten-free diet for ADHD symptoms to resolve. Additionally, since an adverse reaction to gluten has caused changes in your child's brain and nervous system, it is essential to reverse the damage with a natural supplement designed specifically to suppress the symptoms of ADHD, while restoring proper brain function.

Since all supplements are not created equal, look for one that contains proven ingredients like Arsen Iod, Hyoscyamus and Verta Alb. Make sure the formulation has been approved by the FDA and that the company stands behind their product with a no-questions-asked guarantee. Such a guarantee proves that the company has done their research and is confident that their product works. This is the best and safest way to boost the effectiveness of a no gluten ADHD diet and give your child the nutrients he needs to calm his brain, focus, pay attention and get back on track.

By respecting the ADHD gluten diet link, eliminating gluten and casein from the diet and giving your child a natural remedy to relieve symptoms and restore brain function, your child will come into his own and fulfill his unique potential. Don't feel bad that you didn't learn of this connection earlier: just follow the steps right now. You'll be surprised at how fast your child recovers. After all, kids are much more resilient than we think.

by: Laura Ramirez
Source : www.articlecity.com

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Attention Deficit Hyperactivity Disorder Definition: Does My Child Really Have ADHD?

A proper attention deficit hyperactivity disorder definition can help to put parents and children on the right road to healing. In order to properly treat ADHD, it is necessary to first understand it and be sure that your child does, in fact, have the disorder. This means getting medical attention and making sure your doctor conducts a thorough examination and analysis to rule out any other causes for your child’s symptoms.

ADHD (Attention-deficit hyperactivity disorder) is formally defined as a social networking disorder that prevents those affected from interacting normally with others. Symptoms can include lack of concentration, hyperactivity, distractibility and impulsiveness. Those affected may also suffer from other psycho-social disorders such as autism, but ADHD can stand on its own.

Generally, ADHD is diagnosed in children but it can also be present in adults. An attention deficit hyperactivity disorder definition may include a range of symptoms such as becoming easily distracted, daydreaming excessively and having difficulty concentrating. The inability of an ADHD child to sit still for any length of time makes it almost impossible for them to handle standard social and academic settings.

The longer ADHD is left untreated, the more difficult it becomes for patients to lead a normal life. This is why understanding it and finding an effective course of treatment is so very important. In most cases, the primary treatment has been the use of stimulant based medications. While this can help to ease symptoms, it is not always recommended for every patient.

Stimulant based medications such as Ritalin work to mask symptoms like restlessness and lack of concentration, but they do nothing to treat the neurological imbalance which is the cause of ADHD. With a proper attention deficit hyperactivity disorder definition, it is easier to see that only those treatments which actually address the underlying cause will be truly effective.

For parents who choose not to subject their children to standard medications and their potentially dangerous side effects, there are several other options available. These include dietary changes, behavior management, relaxation techniques and focused teaching methods.

With an accepted attention deficit hyperactivity disorder definition has come a better understanding of what causes the disorder. This, in turn, has led to the development of homeopathic remedies for ADHD. Using a special blend of herbs and other plant based ingredients such as Hyoscyamus, Arsen iod, and Tuberculinum, these remedies help to correct neurological imbalances and provide long term results.

Though much remains unknown about ADHD, there have been many strides in diagnosis and treatment in recent years. If you suspect that your child might have ADHD, don’t hesitate to talk to your doctor about it. The better you understand what is going on, the better equipped you’ll be to help your child. So don’t stay in the dark about ADHD, learn what you can about it and put your child on the road to recovery.

by : Laura Ramirez
Source : www.amazines.com

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ADHD Drugs: Sudden Death Risk Higher?

A new study suggests that children and teens who take stimulants like Ritalin for ADHD have an increased risk for sudden cardiac death, but the FDA says the study has major limitations and should not change the way the drugs are used.

There have long been concerns that the stimulants used to treat ADHD may increase the risk for sudden death in children with undiagnosed heart conditions.

The new research finds corroborating evidence for concern, although all agree that the risk of sudden cardiac death is very small.

ADHD Stimulants and Sudden Cardiac Death

Researchers collected data on stimulant use among 564 children and teenagers who died unexpectedly of unknown causes and an equal number who died as passengers in auto accidents. Many of the unexplained deaths were later attributed to previously undiagnosed cardiac arrhythmias.

They concluded that the odds of using stimulant medication were six to seven times greater among the children who died suddenly of unexplained causes than among those who died in car crashes.

Ten children who died of unknown causes (just under 2%) took stimulants, compared to two children (0.4%) who died in auto accidents.

The study does not prove that ADHD drugs cause cardiac deaths. But lead researcher Madelyn S. Gould, PhD, tells WebMD that the results highlight the importance of carefully screening children and teens for heart conditions when the medications are prescribed.

The research was published today online and will appear in The American Journal of Psychiatry.
“These are very rare events, and parents should not be overly concerned,” she says. “This shouldn’t stop anyone from using medications that can help children. But the clinicians who prescribe these drugs must be vigilant about screening and monitoring their patients.”

FDA: Study Doesn’t Prove Link

The FDA and the National Institute of Mental Health funded the study, but FDA officials expressed reservations about the findings in a written statement and news briefing held today.

“Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk-and-benefit profile of stimulant medications used to treat ADHD in children.”

The biggest limitation, FDA officials said, is that information on stimulant use was collected years and in some cases a decade or more after the children died.

They expressed concern that recalling their children's stimulant use many years later might be greater for parents and physicians of children who died suddenly of unexplained causes.

Robert Temple, MD, of the FDA, said an ongoing study of cardiac outcomes among children taking stimulants for ADHD should provide additional information about risk.

Results from this study, also funded by the FDA and the Agency for Healthcare Research and Quality (AHRQ), should be published in a few months, he said.

ADHD Drugs Have Warnings

It is estimated that more than 2.5 million children and teens in the United States take stimulants to control their ADHD.

Drugs like Ritalin, Adderall, Dexedrine, and Concerta are known to increase heart rates and raise blood pressure, but the risk has not been considered significant in otherwise healthy children.

The FDA requires that these drugs include labeling warning of the risk of sudden cardiac death in patients with heart problems, but the incidence of cardiac events among children and teens taking the drugs for ADHD is not known.

In March of 2006, an FDA panel reported that between 1992 and 2005, 11 sudden cardiac deaths occurred in children taking Ritalin and Concerta, which both contain the stimulant methylphenidate, and 13 sudden cardiac deaths occurred among children taking the amphetamine-containing stimulants Adderall and Dexedrine. Three sudden cardiac deaths were also reported among children taking the ADHD drug Strattera, which is not a stimulant.

Late last year, a special panel of the American Heart Association recommended screening all children and teens taking ADHD drugs for hidden heart problems. The panel also called for electrocardiogram (ECG) screening of all patients being placed on the stimulants for the first time.

Editorial: ‘Drugs Aren’t Innocuous’

In an editorial published with the study, Benedetto Vitiello, MD, and Kenneth Towbin, MD, of the National Institute of Mental Health, write that this report “should underscore that stimulants are not innocuous and that their therapeutic use requires careful diagnostic assessment, diligent safety screening, and ongoing monitoring.”

Ritalin, Concerta, and other ADHD drugs are increasingly being used recreationally, usually in an effort to boost academic or job performance.

Vitiello tells WebMD that recreational users mistakenly think of these drugs as safe.

“These drugs are being widely misused, and people need to know that they are not benign,” he says.

A spokeswoman for McNeil Pediatrics, which makes Concerta, told WebMD that the company “welcomes any data that adds to the body of knowledge in this therapeutic area.”

Calls to Shire Pharmaceuticals, which manufactures Adderall, and Novartis Pharmaceuticals, which markets Ritalin LA, were not returned in time for publication.

Source : www.webmd.com

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Funding approved for new ADHD drug

Government funding has been approved for a new once a day, non-stimulant treatment for behavioural problems in children.

The new drug was not a stimulant and would not be open to the kind of abuse that had been a problem with other drugs used for treating people with attention deficit hyperactivity disorder (ADHD), government drug funding agency Pharmac said today.

The drug, atomoxetine (Strattera), would be funded from April 1 for people with ADHD.

Available under special authority, the drug would be available to people who had not responded to, or who were unable to take, stimulant-type ADHD treatments such as methylphenidate and dexamphetamine.

"Atomoxetine is a long-acting treatment for ADHD that has a different therapeutic action than other funded treatments," said pharmac medical director Dr Peter Moodie.

This provided benefits for patients who were not responding to other ADHD treatments.

"To date the ADHD treatments we have funded have all been stimulant-type drugs," Dr Moodie said.

"This means they are classed as controlled drugs, so have to be carefully managed. Unfortunately, it also means those drugs are open to abuse and there have been reports in the past of there being a `black market' trade in ADHD treatments."

Dr Moodie said atomoxetine was a different type of drug, so the risk of it being abused, or given to a person it was not prescribed for was greatly reduced. The fact it was not a controlled drug had benefits for doctors and pharmacists too.

For patients, the drug had the added benefit of only having to be taken once a day.

About 11,000 people are prescribed ADHD treatments.

Dr Moodie said it was difficult to estimate how many of these might be prescribed atomoxetine, however, Pharmac's modelling estimated subsidies for around 900 people after three years.

Source : www.nzherald.co.nz

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