ADHD, Conduct Disorder, Drugs, & Alcohol

ADHD, Conduct Disorder, Drugs, & Alcohol
New study sheds light on this alarming link

Read More: http://psychcentral.com/news/2014/12/11/young-teen-adhd-conduct-disorder-substance-abuse/78495.html

It’s not difficult to find ADHD teens who participate in risky behavior that includes excessive alcohol, drug, and tobacco use. Throw in conduct disorder and lives can spin even further out of control.

Conduct disorder is an emotional/behavioral disorder that (PsychCentral.com) involves specific repetitive behaviors. “These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules time and time again.”

A new study by The Cincinnati Children’s Hospital Medical Center and published in the journal Drug and Alcohol Dependence links ADHD with conduct disorder, drugs, and alcohol.

They study examined data on more than 2,500 teens between the ages of 12 and 15. The scientists found that a teen with both ADHD and conduct disorder was 3 to 5 times more likely to use drugs and alcohol, and begin use at an earlier age than a teen without either disorder.

If the teen had ADHD alone, they had an increased likelihood of tobacco use, but not alcohol use.

“Early onset of substance abuse is a significant public health concern,” says William Brinkman, MD, a pediatrician at Cincinnati Children’s Hospital Medical Center and the study’s lead author. “Adolescents who use substances before the mid-teen years are more likely to develop dependence on them than those who start later. This is why prevention is so important.”

What Causes ADHD?

What Causes ADHD?
After much research, the answer is…

Read More: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

We’ve all heard that ADHD is caused by chemical imbalance. That’s really just a theory. ADHD may be related to a neurotransmitter called dopamine. After much research, it’s still impossible to determine if ADHD is caused by a malfunctioning or slow dopamine system.

How about genetics? Likely, but there’s no absolute certainty about a genetic link either because in some cases, no genetic link has been found.

Other research has indicated that smoking, the use of acetaminophen, or drinking during pregnancy, might be linked to ADHD in children.

The National Institute of Mental Health says:

“Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.”

Some studies have indicated that children with ADHD have reduced brain mass or delayed maturation of certain areas of the brain. Recent research published in the Proceedings of the National Academy of Sciences indicate that delayed brain maturation may be related to the underdevelopment of brain connections related to attention in ADHD children.

Let’s get to the heart of the matter. There is no certain cause of ADHD. It is likely to be caused by a variety of factors.

What do we do as parents, educators, and other concerned people if we don’t know the cause? One of the greatest conundrums in life is thinking that knowing the cause affects the outcome. As far as ADHD is concerned, knowing the cause won’t likely affect your outcomes; knowing that you smoked, used acetaminophen, were exposed to lead, or used alcohol during pregnancy will not change the fact that your child has ADHD.

You’ve got a variety of weapons against it in your arsenal ranging from medicine, to cognitive training, parental training, dietary change, behavioral training for your child, to exercise, and more.

No matter the cause, we know the brain can change and be changed through proper training. There is hope.

ADHD and Increased Risk for Substance Abuse

ADHD and Increased Risk for Substance Abuse
Fact or fiction?

Read More: http://www.uvm.edu/medicine/?Page=news&storyID=13651&category=comall

Research published in the Journal of the American Academy of Child Adolescent Psychiatry reports that children with ADHD may be at significant risk for later substance abuse.

More than 600 children were followed over eight years. Those children diagnosed with ADHD at baseline (average of 8.5 years), had significantly higher rates of substance regardless of their sex 6 to 8 years later compared with their age-matched peers who did not have ADHD.

“Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence,” write the investigators.

“We Need to Do Better…However, similar to managing high blood pressure or obesity, there are nonmedical things we can do to decrease the risk of a bad outcome,” said Dr. Molina, one of the study’s authors.

“As researchers and practitioners, we need to do a better job of helping parents and schools address these risk factors that are so common for children with ADHD.

This echoes previous research by doctors Robert Whelan and Hugh Garavan of the University of Vermont and a cohort of international researchers.

Their report published in the journal Nature Neuroscience (online April 29, 2012) helps answer whether particular brain patterns are caused by drug use or established before drug use. Professors Whelan and Garavan found that certain networks in some teenagers cause a higher risk for experimentation with drugs and alcohol – simply because their brains are wired differently making the teens more impulsive.

A teenager exposed to peer pressure regarding smoking a joint or drinking alcohol, provided parental boundaries and structure have been set, would refuse the offer whild the teenager with lesser orbitofrontal control would likely say, “Yeah, gimme, gimme, gimme!” says Garavan, “and this other kid is saying, ‘no, I’m not going to do that.'”

ADHD ‘Inextricably’ Linked to Substance Abuse

New study says parents beware

Abstract: http://pediatrics.aappublications.org/content/134/1/e293.abstract

The journal Pediatrics published a study (June 30) which found that children with ADHD are 2 times more likely to meet diagnostic criteria for alcohol abuse or dependence and more than 2.5 times more likely to develop a substance use disorder (SUD). Additionally, ADHD children are twice as likely to develop cocaine abuse or dependence.

Is there any good news? The researchers noted that stimulant medication may reduce the risk for trying drugs and developing an SUD. Prior studies both contradict and confirm this.

The study’s authors warn, “Individuals with co-occurring ADHD and active SUDs require a careful, individual risk/benefit assessment regarding the safety of prescribing a stimulant medication. Longer acting preparations of stimulant medication, the prodrug formulation of dextroamphetamine, and nonstimulant medications for ADHD all have lower abuse potential than short-acting preparations of stimulant medication and, thus, their use should be strongly considered if there is a high risk of misuse, diversion, or abuse of stimulant medications.”

“Misuse and diversion of stimulant medications are more widespread problems than abuse or addiction,” the report states. What is diversion? Diversion is your child not using the medication as prescribed, but rather selling it to someone else.

The report indicates that prior research suggests that between 16% and 23% of school-aged children are approached to sell, buy, or trade their stimulant medication.

Should We Be Alarmed by Current ADHD Trends?

A surprising answer from an international expert

We should be alarmed. Very alarmed. This comes from Dr. Keith Conners who has led the fight to legitimize ADHD over the last 50 years. His diagnostic checklists are still used today.

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

Crime, ADHD, & Medication

Study by: Paul Lichtenstein, PhD, of the Karolinska Institutet in Stockholm, Sweden

Read full article: http://www.nytimes.com/2012/11/22/health/adhd-study-suggests-medication-may-reduce-crime.html?_r=0

A new Swedish study says that ADHD people who take medication for symptom control may be less likely to commit crimes. Previous research has indicated that people with ADHD are more likely to have substance abuse issues, are likely to experience difficulty in school, maintain a steady job, and sustain personal relationships. Previous research also indicates that they are also at greater risk for depression, anxiety, and may be more likely commit crimes. Paul Lichtenstein, PhD, of the Karolinska Institutet in Stockholm, Sweden studied more than 25,650 people with ADHD. Lichtenstein and his associates then compared medication history with criminal records from 2006 to 2009.They found the during times when they were taking medication for ADHD, men were 32% less likely to commit a crime and women were 41% less likely to do so compared to when they were not taking ADHD medication. The subjects included in the research were prescribed a variety of medications, thus the type of ADHD medication did not affect the results. “The most probable interpretation would be that medication reduces symptoms like impulsivity, and that would be similar regardless of country or culture,” Lichtenstein says. While the study didn’t examine why, he says it’s likely because medication reduces symptoms related to ADHD, such as impulsivity, restlessness, and irritability, that could lead to criminal acts. The study did not conclude why medication may reduce the commission of crime. One obviously has the problem of antecedence; does taking medication reduce the chance of crime commission or is that the person who’s taking medication more motivated to make a change in his/her life and become organized, and productive? This study does not answer this question.

ADHD & Your Future

Analysis issued by the National Bureau of Economic Research.
Author: Jason Fletcher, Yale.

Read full article: www.businessinsider.com/effect-of-adhd-on-employment-2013-1

Left untreated, it isn’t bright

“The Effects Of Childhood ADHD On Adult Labor Market Outcomes” issued by the National Bureau of Economic Research and authored by Jason Fletcher of Yale provides a detailed analysis of the affects ADHD has on adult labor market outcomes.

The author used data stemming from the 1990s through today. This longitudinal study shows that left untreated, ADHD children who carry their symptoms to adulthood are employed 10% to 14% less of the time than their peers. They earn about 33% less and require social assistance 15% more frequently.

Other studies have reached similar conclusions. Additionally, substance abuse and increased crime rates have also been attributed to non-treated ADHD.

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ADHD and Increased Risk for Substance Abuse

Fact or fiction?
Published in the December Journal of the American Academy of Child Adolescent Psychiatry
Research published in the December Journal of the American Academy of Child Adolescent Psychiatry reports that children with ADHD may be at significant risk for later substance abuse. This reflects previous research.

More than 600 children were followed over eight years. Those children diagnosed with ADHD at baseline average of 8.5 years), had significantly higher rates of substance regardless of their sex 6 to 8 years later compared with their age-matched peers who did not have ADHD.

“Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence,” write the investigators.

“We Need to Do Better…However, similar to managing high blood pressure or obesity, there are non-medical things we can do to decrease the risk of a bad outcome,” said Dr. Molina, one of the study’s authors.

“As researchers and practitioners, we need to do a better job of helping parents and schools address these risk factors that are so common for children with ADHD.

Read the full article: http://www.medscape.com/viewarticle/779755

Resources: Dr. Molina, one of the study’s authors.

ADHD and dropout rates

The July issue of the Journal of Psychiatric Research reports a study by the University of California, Davis. The researchers examined whether ADHD could be predictive of failure to graduate high school on time.

When the UC Davis scientists reviewed different types of ADHD, they found all of the types of ADHD are associated with a high dropout rate.

"The study found almost a third (33%) of students with ADHD, don’t graduate with their peers. That’s high compared with the national high school drop out rate of 15 percent. High school dropout rate really is a national crisis. We know that a third of kids nationally who start in ninth grade don’t graduate in four years," says  lead study author Dr. Joshua Breslau.

The researchers conducted structured diagnostic interviews with a US national sample of adults (18 and over). The interview process also correlated smoking and smokeless tobacco use. According to the National Institute of Health, nearly a 25% of high school students in the U.S. smoke cigarettes and another 8% use smokeless tobacco. The study found that students who use alcohol, smoke cigarettes and use other drugs are more at risk to drop out.

"There are really two main disorders, ADHD and conduct disorder, and there is an interlinking of smoking and drop out that is troubling…it really suggests that socioeconomic differences in health are already becoming established very early in life in adolescents…whether they smoke is probably the biggest indicator of their health in adulthood," said Breslau.

Intuitively, as parents and educators, we know this to be true. We have seen it in other families too. Intuitively we also know that we must do something as education and medicine alone fall far short.

Cognitive training, behavioral shaping, memory skills, and more must be instituted if we are to change the tide.

Sleep Disorders & ADHD

It’s suspected that nearly 25% of all cases identified as attention deficit hyperactivity disorder (ADHD) are not really ADHD at all, but are symptoms related to sleep disorders.

One of the leaders in this research is University of Michigan professor Ronald Chervin.  Chervin theorizes that very important brain development is done during sleep. Among other things, this includes the ability to regulate emotion and processing. So, if a child has chronic sleep problems, brain development may be impaired. Chervin also suspects that the brain does not receive enough oxygen if the child snores which further inhibits development.  According to Chervin’s research, children who snore are more likely to have ADHD.

He likens the ADHD-sleep connection to a child who doesn’t get a nap; he becomes restless, irritable, and acts out.

Chervin developed his theory based on a sleep/behavior survey of the parents of 866 children.  Chervin’s data exposed a sleep disorder -behavior relationship.  It was only logical to conclude that if the sleep disorder could be corrected, the ADHD symptoms would be extinguished. 

According to Newsweek: “To test this theory, Chervin then studied 79 kids (5 to13 years old) who were about to have an adenotonsillectomy. Prior to the surgery, 22 of the 79 were categorized as having ADHD, based on standard measures for such a diagnosis. One year later,  Chervin’s team tracked down the kids for a follow-up. Of the 22 identified as having ADHD, 11 kids no longer qualified as having the disorder.”

Two problems lingered: 1) New cases of ADHD cropped up and 2) 50% of the surgical patients received no benefit at all.

Before you go and get your child’s tonsils and adenoids out, let’s discuss the distinct problems in the logic associated with this research.

First, we have a problem of antecedence; does ADHD exist because of sleep problems? or does the sleep problem exist because of  ADHD? That relationship cannot be clearly identified and is a confounding problem.

Secondly, new cases of ADHD appeared and others did not benefit at all from the surgery. This would lead one to think that the outcomes may not be related at all to the procedure.

I’m reminded of an old story about researchers who taught a frog to jump upon saying, “Jump!” Many weeks were spent training the frog.  The researchers were quite happy that they had proved the frog could hear and could respond to the human voice. One of the researchers  decided they should amputate the frogs hind legs. After carefully surgically removing the frog’s legs and rehabilitating the poor frog, the researchers stood in front of the frog and yelled, “Jump!” When the frog did not respond, they all heartily nodded in agreement that the frog’s hearing was severely impaired by the removal of his hind legs.

There is little doubt that sleep problems affect brain development. Past studies have demonstrated that preschoolers with a sleep disorder are twice as prone to substance abuse by early adolescence and more likely to suffer from anxiety in their 20s. Even the American Academy of Pediatrics concurs that sleep problems are not benign.

However, before we undertake invasive, painful surgery as an option, far more research should be performed to absolutely indicate a direct correlation. One currently does not exist and other options should be explored. playing241

It has become obvious that adequate, restful, uninterrupted sleep is essential to our personal well being. Abnormal sleep patterns may result in behaviors that can be easily confused with ADHD.

If your child has a sleep problem, taking them to a sleep specialist may help. Getting adequate exercise, providing a consistent sleep routine/schedule, reducing stress,  and eating a proper diet may also assist in getting better sleep and better behavior. 

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  • Chervin, RD, Rusicka DL, Giordani BJ, et al. Sleep disordered breathing, behavior and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769-e778
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