A recent study published in the Archives of General Psychiatry showed that children diagnosed with ADHD between 4 to 6 years old were at higher risk of developing depression and suicidality in their teen years. Girls were at especially higher risk than boys. Patients with Attention Deficit Disorder have different subtypes, with and without Hyperactivity. It appeared that patients with just attention problems were at higher risk of depression and those with hyperactivity were at higher risk of suicidality.
This study indicates the importance of identifying and treating ADHD as early as possible to prevent these issues. Parents should discuss treatment options with their physicians. ADHD can be treated with medications and/or cognitive behavioral therapy.
An excellent book on Attention Deficit Disorder is Driven to Distraction; this book is written in clear understandable language.
According to a recent study by a Michigan State University economist, nearly one million children in kindergarten in the United States are misdiagnosed with ADHD. The study attributes this to the disparity of ages in a kindergarten classroom. Most kindergarten classrooms have children who are either 5 or 6 years old. The study shows that the younger children are more likely to be rated by their teacher as being inattentive and hyperactive. However, these ratings may more likely reflect the immaturity of these children rather than a mental disorder.
ADHD is considered a developmental disorder. There is always a disparity in when children within the same age range reach a given developmental milestone and this of course is more pronounced when there is also a disparity in age as well. Actually most children do not develop selective attention until 6 or 7 years of age. For years, studies have shown that teachers will rate 50% of the children in the class with scores indicating possible ADHD when the prevalence is known to be no more than 10%.
Children are starting kindergarten later due to increased academic demands. It make sense that a class of kindergarten children are able to do first grade work since many of them are 6 years old. Imagine the stress of a five year old who may be somewhat on the late side of developing selective attention being required to achieve at least one grade level above his age level. The pressure from teachers and parents and peers can lead to acting out behavior that might be expected under the circumstances but could lead to a professional evaluation.
Parents, teachers, and physicians should be careful to consider not only the chronological age of the child but also the developmental age when considering a possible diagnosis of ADHD. Perhaps the child should be placed in a pre-K class where he or she is truly with peers and the work is more appropriate to the child’s development. This would be a far more appropriate intervention than medication. Unfortunately, I have found that school districts may not want to put a 5 year old in preschool or pre-K because they may not receive funding for the child when state guidelines say a child of 5 must be in kindergarten.
For now, hopefully, this study will evoke caution in all concerned so that decisions will be made based on all of the factors that should be considered. In the future, the whole issue of the mismatch between child development and academic expectations needs to be re-evaluated but that is another blog post.
Up until now, the prescribing of medication for children with attention deficit hyperactivity is often tedious for the physician and the family. Children who do not respond to the first stimulant prescribed may respond to the next one tried or the one after that.
There are two types of stimulants found to be effective for treating ADHD: amphetamine and methamphetamine. A study involving 89 children between the ages of 7 and 11 conducted at Cincinnati Children’s Hospital found that subjects with at least one copy of the 7-repeat DRD4 gene had a positive response to methylphenidate (a methamphetamine) while children without this gene related to dopamine did not. Methylphenidate is the active drug in Ritalin and Concerta along with several other ADHD medications.
This is good news for physicians and parents. This may prove to become part of the prescribing process that could lead to finding the best medication on the first try. According to the lead researcher in Cincinnati, Dr. Froehlich, “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.”
A recent research study to be published in the August 2010 issue of Child Psychiatry and Human Development found that low blood levels for zinc and iron are associated with symptoms of attention deficit hyperactivity disorder based on scores on the Conner’s Parent Rating Scale through the low levels were not associated with higher scores on the Conner’s Teacher Rating Scale.
There were 118 with ADHD (ages 7-14 years). While Conduct Problems and Anxiety were associated with lower zinc levels, increased Hyperactivity scores were related to both lower zinc and iron levels. It is known that these two minerals as involved with dopamine metabolism, one of the two neurotransmitters related to ADHD.
Parents may want to ask their child’s physician to check these levels and recommend supplements if they are found to be out of the normal range. Parents should be cautioned however, to not rush to some the supplement products on the market containing zinc and/or iron. Unless a child’s level is low for either of these two minerals, there is no evidence that boosting normal levels would be beneficial and could be harmful.
It is known that a healthy diet and regular exercise is good for brain development for all children and certainly beneficial for children with attention deficit hyperactivity disorder. With the exception of fish oil with Omega 3 antioxidants, no other supplements containing mega doses of vitamins, minerals or other “natural” substances have been proven through rigorous scientific research to be beneficial for kids with ADHD.
Parents concerned about their child’s ADHD symptoms should rely on treatment recommended by professional organizations which are (1) behavioral interventions, (2) school interventions and (3) stimulant medication for severe symptoms that do not respond to the first two approaches.
Many parents find it difficult to find an effective, affordable and user friendly option for behavioral interventions. Total Focus is a comprehensive behavioral program using evidence-based techniques to improve behavior, learning, self-esteem and social skills. Parents and children work together as a team to bring about real lasting change involving activities that are fun and require less than an hour per day. Total Focus costs less than one visit to a mental health professional.
A recent review of the literature on sleep-onset insomnia in children with ADHD published in the December issue of the Annals of Pharmacotherapy found that Melatonin may be helpful to children with ADHD who have difficulty falling asleep. This is good news as the problem is quite common in ADHD children and may be a symptom of the disorder and/or related to the use of stimulants for treatment of the disorder.
While their are few studies on this subject and the studies that exist have some research methodology limitations, the author of the study concluded that Melatonin along with behavior modification and good sleep hygiene can be beneficial to children and teens with this problem.
Melatonin, a hormone produced by the brain regulates circadian rhythm sleep disorders such as sleep-onset insomnia, is often prescribed for various sleep disorders. The article concluded, when given at doses ranging from 3 to 6 mg within a few hours of a scheduled bedtime, melatonin was associated with improvement in sleep onset and sleep latency in 4 studies in children aged 6-14 years with ADHD and insomnia. Adverse events were transient and mild in all studies.
Parents should discuss this solution to sleep with their child’s physician. For more tips see Healthy Sleep Tips from Akron Children’s Hospital
A recent exploratory study conducted at a private school reported in Current Issues in Education stated that the use of meditation can be beneficial to 11 to 14 year old students diagnosed with attention deficit hyperactivity disorder, or ADHD. According to the researchers, “the technique has potential to improve attention, behavior regulation, and executive function by naturally reducing stress and anxiety and improving brain functioning.”
It is encouraging to see the growing interest in and availability of funding for research dedicated to the investigation of non-medication interventions for ADHD. Actually, relaxation training has been known for some time to provide benefits, and I have been using this technique along with others since the ’80s to help kids with ADHD. When combined with parent training, behavior modification and several other evidence-based techniques, I have found that children with mild to moderate symptoms can achieve significant improvement at home and at school without medication.
Published professional guidelines recommend that children with mild to moderate symptoms receive behavioral interventions, ie, some kind of behavioral help, training or modification, prior to moving on to medication. In the MTA study conducted by the NIMH, 30% of the children in the behavioral-only group normalized after 14 months, which means they were able to function on a normal level without medication. After 3 years, all of the children in the behavioral-only group demonstrated the same improvement in symptoms as those receiving medication and those receiving a combination of medication and behavioral intervention.
Unfortunately, even with this information, the rate of inclusion of behavioral intervention has been limited due to financial and time constraints. After years of working with kids with ADD and ADHD, I developed The Total Focus Program to help parents and families learn how to manage the behaviors that come along with the disorder. It can be used with or without medication as part of a total treatment program. Whether you try Total Focus or another program, I encourage you to seek out some kind of behavioral training program for your child with ADHD.
I have long believed that behavioral therapy is the key to helping kids with ADHD. In fact, a new study on ADHD said that comprehensive behavioral therapy works as well as medication over the long haul. Also, earlier studies showed that after 14 months, 30% of the behavioral therapy group did just as well as those with medication. Of course, there are no side effects to behavioral therapy—except, perhaps, much happier parents and kids.
The results of this research show that 3 years from the start of the study, there was no difference in the amount of improvement between four different treatment methods. Three of the methods used medication alone or in combination with behavioral therapy, one used behavior therapy only. All four groups demonstrated significant improvement in symptoms, but the amount of improvement was the same for all of them. The research also showed slight reduction in predicted height and weight for those taking medication. I developed The Total Focus Program, after having worked with kids with ADHD for more than 20 years and parenting my own son with ADHD.
I think it works because it’s a comprehensive behavioral intervention package that helps both parents and kids learn to not only cope with ADHD, but to overcome it. The format makes it easier for parents and kids to work on getting the help they need into their busy schedules
In a commentary in The Boston Globe, pediatrician Claudia Meininger Gold wrote, “medication can’t fix a broken childhood.” She goes on to say, “with our over-reliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff’s investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.”
Also, US News & World Report also provides in-depth coverage of this topic, starting first by citing the recent recommendation of the National Institute for Health and Clinical Excellence of the UK. They recommend the trial of behavioral intervention prior to medication for the treatment of children diagnosed with ADHD.
Many of you have been talking about the effects of diet and food additives on kids with ADHD, so I wanted to weigh in on this topic.
In a well-known UK study last year, the effects of artificial food color and additives (AFCA) on kids found that food additives make hyperactive behaviors more pronounced in children as young as 3 and up to middle childhood, around 9 years of age. The study found that a significant though small group of children exhibited hyperactivity as a result of drinking a specially concocted drink containing food colors and preservatives.
What this means is that some children react to substances found in many processed foods that may increase hyperactivity and inattention–to the extent of causing problems at school. In the study, 18% of the children were adversely affected by the drink.
So it appears that up to 18% of the child population may exhibit hyperactivity symptoms as the result of consistent exposure to food additives. The question is: Do these kids have ADHD, or something else?
In order to be diagnosed, the child must meet the criteria for the disorder plus not have any other conditions that might cause the symptoms. One could make that point that these kids have an allergy to these substances and should not be diagnosed as having ADHD. (There are other substances, such as lead, that can also cause these symptoms.)
If you suspect an allergy, it should be treated by an elimination diet. A well known program for this purpose is the Feingold Diet. I have always told parents who ask to go ahead and try this approach as it is not harmful at all. (One note of caution: It’s very time-consuming and has not yielded significant results when used with children who already havebeen diagnosed with ADHD.)
The earlier you can diagnose ADHD, the better. Kids often struggle in school and in the community due to a lack of help and from a misunderstanding of their condition. This often leads to frustration, increased inappropriate behavior, poor academic achievement, and eventually low self-esteem and depression, not to mention an increased likelihood for substance abuse. Early and appropriate intervention can prevent these serious consequences, and instead promote healthy development with the prospects for a more satisfying life in childhood and as an adult. If you suspect that your child may have ADHD, start with a trip to a trusted pediatrician and go from there.
And if your child is diagnosed with ADHD, I would recommend that parents look into the type of cognitive behavioral therapy or program that provides cognitive exercises and simple biofeedback to improve attention, concentration and executive functioning that leads to improved academic achievement and success in other activities. Make sure it helps children to understand the difference in brain function, and to learn coping strategies that foster a positive self-image, as well.