ADHD and Social Distancing

As I’ve discussed in previous blogs, ADHD children and adults have difficulty recognizing social cues or regulating impulse control and therefore frequently cannot maintain friendships or adapt well socially.

A recent study published in the Journal of Health and Social Behavior, (48, 50-67) examines the other side of this issue; it examines the attitudes of adults toward persons with depression or AD/HD. The study indicates that many adults would personally prefer not to interact or have their child not interact (social distancing) with an AD/HD child. The study also reveals factors that contribute to the desire for social distancing. Participants in the study consisted of 1393 adults from across the US.

Participants were read a randomly selected vignette that provided a brief behavioral description of 1 of 4 different children. While no diagnoses were provided, the vignettes depicted behaviors characteristic of a child with a medical condition (asthma), a child with depression, a child with ADHD, and a child that presented what the authors described as “normal troubles.”

After listening to the vignette, researchers asked a series of questions to learn about the participants’ thoughts and emotions regarding the child depicted in the vignette. To more deeply delve into the reasoning behind social distancing, the researchers also examined participants’ beliefs about the suspected causes of behavior displayed by the child in the vignette. These included whether the participants believed the child had a mental illness, “bad character”, or “chemical imbalance in the brain.” Participants were also queried whether they believed the child depicted was a danger to self or others.

CONCLUSIONS

Interestingly, percentages of adults who were more likely to not engage with a child or child’s family, if that family was described as having symptoms characteristic of AD/HD or depression, were 2-3 times higher than when a child with “normal troubles” or asthma was depicted.

Some clear trends were also established: male participants were more likely to desire distance than females and older children desired distancing more frequently than younger (8 yrs.) children.

Furthermore, preference for distance increased if participants believed that the depicted child’s problems were caused by poor parental discipline.

When participants believed the depicted child’s problems were caused naturally, e.g. from food allergies or “normal ups and downs” their preference for distance decreased.

Attributing the child’s problems to a mental illness increased the preference for distance. Related to this, believing that the child posed a danger to himself or to others increased the preference for distance.

SUMMARY

The researchers cite that “… a substantial minority of American adults are reluctant to interact, or to have their children interact, with children described in ways consistent with ADHD and depression. Specifically, about 1 in 5 adults was unwilling to have these children living next door, in his or her child’s class, or as his or her child’s friend.”

It is a myth that poor parenting causes AD/HD. However it is evident that social distancing is desired if parents deem the offending child’s behavior to be caused by poor parenting.

By middle school, I would suggest a majority of AD/HD children feel socially outcast. Social acceptance of AD/HD children by their peers may be influenced by the parental attitudes either explicitly conveyed or indirectly communicated. Regardless, it’s evident that despite continued public education, barriers toward social acceptance exist albeit on a minor scale as about 4 out of 5 adults did not report these biases.

I think the greatly varying attitudes toward AD/HD reflect a general confusion regarding the subject. It’s regarded a brain disorder, not as a learning disability which is where I would prefer to see it. The brain disorder lends a certain stigma to AD/HD which is unfortunate. If it were considered a simple lack of certain skills (which is what it actually is) then not only could it be better understood by the general populace, but it would force the medical community to broaden their utterly narrow perspective on treatment benefiting all concerned.

Kids with mental illness often rejected socially

March 19, 2007

NEW YORK (Reuters Health) – Research suggests that a “substantial minority” of American adults are reluctant to let their children interact with children who suffer from depression or attention deficit hyperactivity disorder.

About one out of five parents would not want these children as neighbors, in their child’s classroom, or as their child’s friend, report Jack K. Martin and colleagues from Indiana University in the Journal of Health and Social Behavior.

Older children and boys with mental conditions are most likely to be rejected.

This troubling pattern, the investigators report, appears to result from perceptions that a mentally ill child may be “dangerous.”

“If, as it seems, the ‘mental illness’ of either children or adults signals danger to the public, this barrier must be addressed by future political, legal, and research agendas,” according to Martin and colleagues.

The research stems from interviews with more than 1,100 adults as part of the General Social Survey administered by the National Opinion Research Center. The interviewees were given descriptions of children of various ages with asthma, attention deficit hyperactivity disorder, depression or “normal” ups and downs of childhood.

Levels of rejection for children with depression and ADHD were two to three times higher than those reported for children with asthma or “normal” childhood troubles.

The results showed that almost 30 percent of parents said they would not like their child to become friends with a child who was depressed and more than 18 percent wouldn’t want to live next door to a family with a depressed child.

Roughly 23 percent of parents said they preferred that their child not make friends with a child with behaviors consistent with ADHD and 22 percent wouldn’t want to live next door to a family with a child with ADHD.

“In line with the 1999 Surgeon General’s report on mental illness, our analyses point to continuing barriers to public acceptance,” note the report’s authors. “While not as significant an obstacle as the rejection of adults, social distance does reflect stigma surrounding children’s mental health problems.”

They hope a greater understanding of the roots of this stigma will lead to effective efforts to confront the persistent lack of social acceptance of the mentally ill.

SOURCE: Journal of Health and Social Behavior, March 2007.

Brain Volume and ADHD

I’ve briefly mentioned research studies in the past that find ADHD children have decreased brain volumes (essentially smaller brains) than their peers. Recently, another of these studies was published in the American Journal of Psychiatry (April 2007). Using MRI, the study followed 36 children over two years. How research like this gets published is beyond speculation, but in the publish or perish world of academia, it’s fairly standard trash.

The journal reports that the researchers (a group of MDs and PhDs) “…compared the volumes of each lobe of the cerebellar hemispheres and vermis in children with ADHD and comparison subjects and used a new regional cerebellar volume measurement to characterize the developmental trajectory of these differences.”

Just an anatomical note, the cerebellar vermis is a part of the structure of animal brains. It’s a thin wormlike structure between the hemispheres of the cerebellum. It would take far too long to fully detail the brain structures the researchers have noted as being reduced in volume, but the anatomy is easily available for review on the web.

According to the researchers, the “36 children with ADHD were divided into a group of 18 with better outcomes and a group of 18 with worse outcomes and were compared with 36 matched healthy comparison subjects. The volumes of six cerebellar hemispheric lobes, the central white matter, and three vermal subdivisions were determined from MR images acquired at baseline and two or more follow-up scans conducted at 2-year intervals.”

I’m not bothered by the low number of children in the study. However, we cannot forget that ADHD is a subjective diagnosis. This study, like many others before it, seeks to find some biological marker that might reveal the nature of ADHD. Unfortunately, we have several problems: one, go to any search engine you wish, type in ADHD and then any structure in the brain that you wish, e.g. cerebellum, frontal cortex, basal ganglia, putamen, etc. You’ll find a controlled study indicating that that structure of the brain is diminished in volume, not functioning normally, etc. Apparently, if one takes these studies seriously, the brains of ADHD persons are extraordinarily damaged. Not likely.

The Holy Grail of ADHD is to find a correlation between brain structure and specific dysfunction which would cause ADHD. This is a foolhardy endeavor. Since ADHD is diagnosed through a checklist of symptoms presented over time, it is very likely it is caused by a variety of factors including environment, heredity, etc.

Furthermore, brain structures that are smaller in volume (if this rot could be proven), or function differently, may be related to the manner in which they ADHD person engages with his environment, i.e. the different structures may not have been congenital, but are the direct effect the person’s interaction with their environment. This is a problem of antecedence (chicken and egg). Secondly, until we study several million brains to find out what the ‘normal’ brain looks like among the full spectrum of human traits and personality characteristics, studies of the sort mentioned are simply a house of cards ready to fall.

Are ADHD drugs safe? Report finds little proof

M. ALEXANDER OTTO;
The News Tribune
September 13th, 2005

At a time when millions of children and adults are taking drugs for Attention Deficit Hyperactivity Disorder, the most comprehensive scientific analysis of the drugs to date has found little evidence that they are safe, that one drug is more effective than another or that they help school performance.

The 27 drugs studied included Adderall, Concerta, Strattera, Ritalin, Focalin, Cylert, Provigil, and others that, in some households, are well-known for their sometimes calming affects.

The 731-page report was done by the Drug Effectiveness Review Project, based at Oregon State University. The group analyzed 2,287 studies – virtually every investigation ever done on ADHD drugs anywhere in the world – to reach its conclusions

They found:

• “No evidence on long-term safety of drugs used to treat ADHD in young children” or adolescents.

• “Good quality evidence … is lacking” that ADHD drugs improve “global academic performance, consequences of risky behaviors, social achievements” and other measures.

• Safety evidence is of “poor quality,” including research into the possibility that some ADHD drugs could stunt growth, one of the greatest concerns of parents.

• Evidence that ADHD drugs help adults “is not compelling,” nor is evidence that one drug “is more tolerable than another.”

• The way the drugs work is, in most cases, not well understood.

The findings do not mean ADHD drugs are unsafe or unhelpful, just that sound scientific proof is lacking.

The Pharmaceutical Research and Manufacturers of America, the Washington, D.C.-based drug industry lobby group, had no comment on the report, but its senior vice president, Ken Johnson, said the benefits of most drugs “clearly outweigh the risks.”

ADHD is suspected when people have a harder time than others their ages paying attention, sitting still or controlling impulses. To be diagnosed, those tendencies must interfere with work, school or other activities.

Nationally, about 4.4 million kids between 4 and 17 fit the bill. Of those, more than 2.5 million take ADHD drugs. Up to 8 percent of kids in Washington state have been diagnosed with the condition.

The Drug Effectiveness Review Project was formed in 2003 to give consumers and state insurance plans trustworthy information about pharmaceuticals.

Industry studies, which researchers have shown sometimes are rigged for favorable outcomes, don’t give the confidence “many of us would like to decide whether or not we should be using a given medication,” said the project’s deputy director, Mark Gibson.

Complicating efforts to get reliable information, the U.S. Food and Drug Administration doesn’t require companies to compare new drugs to ones on the market. Most times, firms instead compare their wares to sugar pills because it is easier to show benefit and get approved for sale.

The problems leave insurers and patients in the lurch when they need to know what drugs work best. That’s where the Drug Effectiveness Review Project comes in. Its physicians and pharmacists analyze virtually every study on a given class of pharmaceuticals to find the best drugs.

The American Association of Retired Persons and Consumers Union, the publisher of Consumer Reports, use the project’s findings to tell people what drugs give the most for the money. Fourteen states, including Washington, also use its services to decide what drugs to cover for beneficiaries. Those states are the project’s chief funders.

For ADHD, the project analyzed published studies as well as unpublished data from the six leading makers of ADHD drugs. The group rejected 2,107 investigations as unreliable, and reviewed the remaining 180 to find superior drugs.

Instead, it found that evidence to choose one drug over another for safety or effectiveness is “severely limited” by a lack of studies measuring “functional or long-term outcomes.”

The project could not find a “good quality” study that tested the drugs against each other. It also could not find comparative evidence to determine which ADHD drugs are less likely to cause tics, seizures and heart and liver problems.

That evidence is needed. Canadian authorities have recently warned against using Adderall Extended Release in patients with heart problems. Cylert and Strattera have been linked to liver damage, the report said.

Until better research is done, the findings mean that choosing the right ADHD drug is largely a matter of trial and error. They also suggest some people might do as well or better on cheap generic Ritalin, sold by its scientific name methylphenidate, instead of far more expensive, newer options such as Concerta and Adderall.

In fact, in the few instances where the Oregon group could draw conclusions, it found Concerta “did not show overall difference in outcomes” compared to generic Ritalin, and proof that Adderall is better “lacking.” What little evidence there is comparing another newer expensive drug, Strattera, to generic Ritalin “suggests a lack of difference in efficacy.”

Gibson cautioned that his project’s latest report is still open for public comment and possible fine-tuning. But the overall results did not surprise Libby Munn, a nurse practitioner at Greater Lakes Mental Healthcare in Lakewood.

“I’ve never been aware of any evidence of any one being better than another,” said Munn, who treats patients for ADHD and other conditions. “That’s true of antidepressants and antipsychotics, too. Once you compare meds for a given disorder, there are often no proven differences.”

Tacoma psychiatrist Dr. Fletcher Taylor, an expert in adult ADHD at Rainier Associates, works with drug companies to develop new products. He said he stands by the effectiveness and safety of the drugs.

Still, he said, Adderall and Concerta are largely equal in their effect, though some people do better on one than another. Their greatest advantage over generic Ritalin is that people take fewer pills during the day.

ADHD DRUG COSTS*

• Methylphenidate (generic Ritalin) $15.69

• Ritalin (brand name): $27.79

• Amphetamine/dextroamphetamine (generic Adderall): $47.09

• Adderall (brand name): $94.49

• Concerta: $103.99

• Strattera: $123.99

• Focalin: $25.99

*Comparisons based on the lowest dose for 30 days.

Source: Walgreens Pharmacy

FIND THE RIGHT DRUG

These Web sites offer help comparing drugs to find what works best:

• The American Association of Retired Persons lets you compare drugs at www.aarp.org/health/comparedrugs/

• Consumers Union, the publishers of Consumer Reports, gives tips on the best drug buys for safety and effect at www.crbestbuydrugs.org/

• The consumer-advocacy group Public Citizen has a solid record of spotting problem drugs, calling, for instance, for the removal of Vioxx in 2001, when few knew there were problems. The group is now worried about the cholesterol pill Crestor. Public Citizen’s drug information site is www.worstpills.org/

• The Oregon State University Drug Effectiveness Review Project is online at www.ohsu.edu/drugeffectiveness/

M. Alexander Otto: 253-597-8616 alex.otto@thenewstribune.com

Autism and Parents Education

LONDON, UK: The Daily Telegraph reports of a highly controversial study indicating that parents of autistic children tend to be more highly educated than parents of children with other mental problems. Researchers found that 46% of parents of autistic children achieved a General Certificate of Secondary Education (GCSE) compared to 35% parents of other children in the study. A GCSE is the name of a set of British examinations, usually taken by secondary school students.

The study, conducted by the Office for National Statistics, was an attempt to closely examine children with autism as well as to determine whether mental disorders were rising.

Researchers found that autistic children were also less likely to live in poor families. However, many autistic children live in families where neither parent worked. While only nine percent of parents with autistic children earned less than £200 per week, 20 percent of other children lived in homes with a weekly income of less than £200 per week.

Researchers suggested that the unusual combination of high educational status and low economic activity among parents of autistic children “reflects their heavy caring responsibilities.”

Seven percent of US children are suspected of having ADHD while the British study indicates on two per cent had Attention Deficit Hyperactivity Disorder (ADHD), and only one per cent had a less common disorder, such as autism. As is true in the US, boys were more likely to have a mental disorder than girls.

“The prevalence of mental disorders was also greater among children and young people in certain families, such as lone parent families (16 per cent) compared with two-parent families (eight per cent) and in step-families (14 per cent) compared with those with no stepchildren (nine per cent).

Dinah Morley, deputy director of Young Minds, the children’s mental health charity, said the figures were a wake-up call to the “tremendous cost” of divorce.

“We can’t turn the clock back to a time when all children stayed with their birth families,” she said. “But we can start to be more aware that these things that adults do impact very deeply on children. I think it is a wake-up call to adults to be more aware when they decide to divorce of the tremendous cost to the children. It is important for society to think how in the future it is going to support children better.”

However, statisticians emphasised that while there was a link between divorce and mental health problems in children, it was not clear whether the divorce followed the diagnosis of the mental problem or whether it may have triggered it in some way.

They added that mental health problems in children were also more common where the parent had no educational qualifications (17 per cent) compared with those who had a degree (four per cent) and where a parent was an unskilled manual worker (15 per cent) compared to a doctor or lawyer (four per cent).

One per cent of children aged 5-16 had autistic spectrum disorder.

The majority – 82 per cent – were boys. Almost all the children had a physical complaint as well (89 per cent compared with 54 per cent of other children).

Tim Loughton, the shadow Health Minister, said: “The Government urgently needs to make it easier to identify problems early on in schools and to provide appropriate treatment. That does not mean admission to adult wards or excessive reliance on the chemical cosh of drugs.”

(Source: Daily Telegraph, September 1, 2005)

Adult ADD: Many Children Maintain their Disorder into Adulthood

ADHD haunts children into adulthood, study shows

Psychological Association published research from Dr. Mariellen Fischer, a psychologist with the Medical College of Wisconsin. Her study was co-authored by Dr. Russell Barkley. The results of her 13 year study show that if AD/HD is left untreated in childhood, children will carry their disorder into adulthood.

For thirteen years they monitored 147 children with ADHD by age 7, comparing them with 76 neighbor children who didn’t have the disorder. About one third dropped out of high school. This seemed significantly high as none of the neighbor children dropped out. Leaving school is quite likely due to the public school system’s inability to accommodate the needs of ADHD students as well as ADHD student inability to learn coping skills which are seldom taught in school or at home.

Interesting data about adults with AD/HD in this study:

  • They are more likely than their peers to get fired
  • They are more likely to shun birth control and become parents by age 21
  • They are more likely to have higher credit card debt and fewer saving
  • They took medication for AD/HD as children, but few were being treated by their early 20s
  • They are more likely to start having sex a year earlier than classmates
  • 1 out of 3 had become parents by their early 20s vs. 1 in 25 of the classmates
  • They had less than half the savings of young adults they had grown up with and more debt

Dr. Fischer indicated that many children maintain their disorder into adulthood. The article is not clear whether this data was relevant to treated or untreated ADHD. However, clinical data suggests that perhaps 60% of ADHD children will carry their disorder into adulthood. This may be a conservative estimate.

While the data are compelling, the study is too small to conclude that ADHD alone causes these ill effects.

Girls With ADHD and ADD Are Often Overlooked

Girls With ADHD Are Often Overlooked

HealthNewsDigest.com – August 29, 2005 (HealthNewsDigest.com) reports that ADHD likely affects 3% to 7% of the entire child population in the US. However, girls are frequently overlooked because they often do not display hyperactive symptoms.

When teaching at the elementary level, I found this particularly true. Girls with ADHD often were simply daydreamers with poor time management skills. While some did display the outward social and behavioral problems that their male peers did, it was not very frequent.

HealthNewsDigest.com is published by the American Psychological Association. I’ve cited bits of this report and am alarmed by its look and feel. It reads like an endorsement and advertisement for Adderall XR.

Their report, edited down:

The federal Food and Drug Administrations (FDA) recent nod to ADDERALL XR for the treatment of attention deficit hyperactivity disorder (ADHD) in adolescents aged 13 to 17 spotlights an underidentified and under treated population with this disorder, experts tell Health NewsDigest.com.

If left untreated, the symptoms of ADHD can have a profound effect on a child’s life, both inside and outside of a classroom setting.

For Janice Lowder, a quiet, well-behaved child, learning was always stressful.

“My husband and I hired a one-on-one tutor to help Janice with her studies. We also tried to help her, and all dreaded the nightly battle of completing a homework assignment. Janice would get so frustrated with her homework and the fact that she didn’t ‘get it,’ that she would cry,” said her mother Beth Lowder.

“By the time Janice reached the seventh grade, a nurse at her school suggested we talk to a doctor. Janice was diagnosed with ADHD and was started on treatment,” Beth explained.

“I knew my daughter just needed the right help,” said Beth.

By the tenth grade, Janice had improved from a C to a B student but homework was still challenging. In addition, she had low self-esteem and was embarrassed to take her medication at school. Her psychiatrist prescribed Adderall XR®, an extended-release formulation that enabled Janice to take her medication once a day at home.

With continued tutoring and medication, her grades improved.

“She came home from school one day and said, ‘Mom, I’m smart,’” said her mother.

A recent study presented at the American Psychiatric Association annual meeting showed that girls with ADHD demonstrated significant improvement in both behavior and attention with Adderall XR.

“The study suggests that girls with ADHD can benefit from Adderall XR and that this treatment will help them control symptoms all day while they are in the classroom, during after-school activities or doing homework with relatively few side effects,” said Joseph Biederman, M.D., professor of psychiatry, Harvard Medical School and Chief of Pediatric Psychopharmacology at Massachusetts General Hospital. “While ADHD in girls is becoming more recognizable it is still often overlooked, and there is a need for safe and effective treatments that will allow girls to interact more effectively with other children and adults, to concentrate in school and to focus on finishing tasks.”

I’d expect to find a more diluted version in Parents Magazine or Family Journal as an outright advertisement. Makes one wonder who wrote this? Shire Pharmaceuticals?

9/8/2005 Adults with Attention Deficit Hyperactivity Disorder Do Well on Deadline and Love a Challenge?

From the Kansas City Star by DIANE STAFFORD:

ADHD SUFFERERS FIND THEIR NICHE: Adults with Attention Deficit Hyperactivity Disorder Do Well on Deadline and Love a Challenge?

Can you say clueless? Stafford interviews Dr. William Dodson, MD who spoke to about 50 Hallmark Cards employees. His recommendation? If you want an employee who performs best on deadline, hire someone who has trouble staying on task. Dodson apparently specializes in treating with AD/HD. He said that adults with the neuropsychiatric condition generally respond well to urgency and fast pace. This seems true, meeting deadlines? That’s one of the greatest problems for adult AD/HD people.

“Workers with ADD need to be challenged or feel competitive,’’ Dodson generalized. “They like the new, the novel, the fleeting. They need ADD-friendly jobs – not accounting.’’

Sure they do. They are great in marketing. But don’t rely on them to get a job done on time. I’ve worked with many AD/HD adults. They’ll accept 20 jobs and finish none of them. Dodson truly seems clueless here.

Stafford also cites Blythe Gross, who has a doctoral degree in organizational psychology, also specializes in ADD treatment. After working with or interviewing hundreds of adult ADD patients, Gross wrote Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder. Gross has been in the trenches with hundreds of AD/HD adults. She’s much more realistic in her perspective. She indicates that adult AD/HD “symptoms can range from an inability to get started on a task, to an inability to follow through on a task, to perfectionism that makes a project drag on forever because it’s never good enough.” This statement is the antithesis of Dodson’s.

I’d go with Gross and recommend her book, Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder. With so many ‘experts’ on this subject, someone has to cry ‘baloney’ when nonsense like Dodson’s is put to press.

Ritalin and Cancer

The FDA has taken an interest in the University of Texas’ preliminary research regarding Ritalin and cancer. While the research is alarming, it is far too premature to be conclusive.

From HealthCentral.com:

Researchers Urge Caution on Ritalin-Cancer Link Finding Despite FDA concerns, Texas scientists say their study was only preliminary.

By Amanda Gardner HealthDay Reporter

FRIDAY, July 1 (HealthDay News) – As the U.S. Food and Drug Administration moved to examine a potential link between Ritalin and cancer, the scientists who first unearthed the connection stressed Friday that the finding was preliminary and should not be cause for panic.

The concerns about the drug, a stimulant that has been used to treat attention-deficit hyperactivity disorder (ADHD) for decades, surfaced during a FDA pediatrics advisory committee meeting Thursday. The findings, by researchers from the M.D. Anderson Cancer Center at the University of Texas, showed damage to the chromosomes of 12 children who had taken Ritalin for three months.

The advisory committee had been called to discuss yet another health issue surrounding the class of ADHD medications known as methylphenidates, to which Ritalin belongs: Some psychiatric side effects have been reported among children using Concerta, Ritalin and other versions of these drugs.

But the Texas scientists said their Ritalin study was far too small to prompt the parents of ADHD patients to abandon the drug.

“We’re not telling people to all go off their medication because you don’t know what this means,” said Melissa L. Bondy, co-author of the study, which first appeared in the Feb. 16 online issue Cancer Letters. “You can’t base changing practice on 12 patients. Look how many millions of kids are on this. Do you want to tell all the mothers and fathers to take their kids off of the drugs?”

Bondy said she and her colleagues have submitted a grant proposal to the National Institutes of Health for a larger study looking at more patients and more ADHD drugs.

“We definitely need a larger study,” said lead researcher Dr. Randa A. El-Zein. If approved, the study would not even be funded until March 2006.

The government interest is there, however.

Scientists from the FDA, the NIH and the Environmental Protection Agency traveled to Texas on May 23 to examine the study methods used by the researchers. “They thought, ‘Yes, we do have a public concern,’ and that a larger study should be performed,” El-Zein said.

“We’re hoping that they’ll see this as a major public health issue, and as something that needs to be done,” Bondy added.

Meanwhile, the question of labeling changes because of possible psychiatric effects of Ritalin and other methylphenidates have been put on hold after the advisory committee told FDA officials that it was hesitant to recommend such changes.

According to an FDA release, committee members suggested waiting until more safety data have been collected on two other types of drugs used to treat ADHD – methamphetamines such as Adderall and the non-stimulant Strattera, something that won’t happen before early 2006.

The FDA should “delay the labeling change until they have a good sense of class effect,” Acting Committee Chairman Robert Nelson, of The Children’s Hospital of Philadelphia, told FDA officials according to the release.

“We heard there is no terrible signal,” Office of Pediatric Therapeutics Director Dianne Murphy added.

The FDA had been considering labeling changes to all methylphenidates with regard to psychiatric events and potential cardiovascular side effects. A review had found 36 psychiatric events for Concerta, compared to 16 for Ritalin and other methylphenidates. These side effects included hallucinations and suicide ideation. Concerta had 20 cardiovascular event reports, while the other methylphenidates had four such reports.

Despite the committee’s advice, Murphy said the agency still may change labeling about psychiatric side effects to “try to make it clearer what the situation is with regard to certain adverse events.”

The FDA’s decision to take a closer look at the psychiatric side effects of medications for ADHD did not surprise some experts.

“These types of issues theoretically were possible with the medication because of the way it works. It’s not surprising that they’ve had some reports that relate to psychiatric side effects… ” said Dr. Lenard Adler, director of the Adult ADHD Program at New York University Medical Center.

The drugs have been around for 40 years, Adler added, and have a “wide margin of safety.”

“Any medicine that has therapeutic effect can have some side effects,” Adler continued. “This is appropriate scrutiny by the FDA, but the benefits are also very clear and clearly outweigh the risks.”

Another expert believes labeling changes may not be the answer.

“Labeling is an oversimplification of the problem,” said Dr. Eugenio M. Rothe, director of the child and adolescent psychiatry clinic at Jackson Memorial Hospital and an associate professor of psychiatry at the University of Miami School of Medicine. “It scares people, and it doesn’t address the other problems that are affecting the outcome. The problem is much more complex than that, and has to do primarily with the stigma associated with mental health conditions.”

This is just the latest chapter in the ongoing debate over the safety of ADHD medications.

In February, Health Canada ordered Adderall XR off the market, after reports of sudden cardiac death in 20 patients. The FDA, however, elected at the time only to require the company to update Adderall’s label to warn that it should not be used in anyone with structural cardiac abnormalities.

Almost 2 million children in the United States have been diagnosed with ADHD, according to the National Institute of Mental Health.

ADHD Diagnosis Caution: No Test Exists to Support Chemical Imbalance Claim

Is there a trend here or much ado about nothing?

Hollywood actor Tom Cruise created quite a stir recently in his heated debate with NBC Today Show anchor, Matt Lauer.  Cruise proposed that psychotropic drug use, especially the drugging of children was unnecessary and immoral. Following suit, Sebastian Sainsbury of the Sainsbury family (one of Britain’s wealthiest and most respected families known for it patronage of the arts, and its commercial and political influence) spoke to United National Newspapers:

“As a parent of two young children, I hold an inherently responsible position for the welfare of my children. Following some of the recent media and speaking with other parents, I feel the need to extend that responsibility to encompass a wider sphere by informing parents of a situation that could potentially affect all children.”

“I’ve come across recent FDA warnings that I have found quite chilling. Ritalin, an amphetamine classified in the same category as cocaine, has been used for over four decades by psychiatrists and doctors, over much controversy and now the FDA comes up with black-box labels warning parents of side effects that include suicidal tendencies, hallucinations, aggression, violent actions, heart failure. The FDA has also recently issued black-box warnings on all anti-depressants both for children as well as adults.”

“We have all witnessed children being somewhat argumentative, perhaps a little boisterous and even disruptive at times. This would be described as poor behaviour, just as it has been described for centuries. However, these behavioural characteristics have been redefined by today’s psychiatrist as a mental disorder called Attention Deficit Hyperactivity Disorder or ADHD.”

“ADHD was literally voted into existence eighteen years ago when the American Psychiatric Association (APA) by a show of hands. A show of hands was enough to see ADHD enshrined in the psychiatric textbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM). They also created “Reading Disorder”, Oppositional Defiance Disorder”, “Expressive Language Disorder”, “Mathematics Disorder” and a litany of similarly ridiculous disorders by the same show of hands. The treatment for these disorders are drugs.”

“Psychiatrists are telling parents, whose children may be displaying poor behaviour, that their child has so-called ADHD due to a “chemical imbalance” in the brain. A parent would be prudent to ask the psychiatrist for evidence to support the claim of a “chemical imbalance”. If they did ask however, they’d find that the evidence would not be forthcoming – as it doesn’t exist.”

Psychiatrist David Kaiser said, “Patients [have] been diagnosed with “chemical imbalances” despite the fact that no test exists to support such a claim, and … there is no real conception of what a correct chemical balance would look like.” The words of the President of the APA should also be noted. Mr. Steven Sharfstein said, “We do not have a clean-cut lab test [to detect chemical imbalances in the brain].” How then would the psychiatrist know when the child has recovered?”

“Poor behaviour is empirical, but the purported cause for such behaviour is usurping the inherent rights of both the child and the parent. Environmental factors of the child need to be addressed rather than prescribing powerful psychiatric drugs on the basis of a subjective decision that is entirely unsubstantiated. Current figures from the Prescription Pricing Authority for England and Wales reveal that in 1991, the number of prescription items for psychiatric drugs commonly prescribed for children labeled with ADHD were 2000. In 2004, that figure had risen astronomically to 359,100. Remember, this is for a so-called “disorder” that has never been scientifically validated.”

“As with all problems in life, we pursue the avenues of knowledge open to us to find the solution. As far as poor childhood behaviour goes, parents want only the best for their child, a corollary of being a responsible parent, and will look high and low for those solutions. Consider this: a study carried out last year by Professor John Warner, Professor of Child Health at the University of Southampton, revealed the adverse reactions that food additives were having on behaviour. The incredibly talented Jamie Oliver has demonstrated through his series Jamie’s School Dinners that changing a child’s diet can bring about a desired change in behaviour. And educational psychologist Dr Madeleine Portwoodhas demonstrated that essential fatty acids, a natural organic product, produced improvements not only in childhood behaviour but in academic performance as well.”

“We are in the 21st Century, full of technological advancements that defy science. If however we consider the psychiatrist to be the custodian of poor behaviour, we are bowing to a profession that masquerades as technically advanced, but which in reality could be called nothing more than a pseudoscience at the behest of the pharmaceutical industry.”

“The ramifications of being a poorly behaved child in this contemporary society are too gruesome to comprehend.”

Turning Adult ADHD Around

ABC News online probes the work of Robert Jergen, and ADHD adult who carefully manages and optimizes his attention difficulties.

What is important to realize in reading this report is that he is a minority; he is one of the very few ADHD adults who successfully manage their attention difficulties. Although his success story is quite moving, it is not the norm as Dr. Joseph Biederman found in his recent study that indicated ADHD adults lose $77 billion yearly to ADHD related job issues.

Also, note the fact that Jergen almost committed suicide because of ADHD. Obviously, what doesn’t kill you will make you stronger. However, one must wonder how many adults haven’t adapted and successfully put an end to their ADHD troubles by suicide.

What can be gleaned readily from Jergen is that ADHD is manageable using a variety of tools. The true question may be what enabled him to succeed where others fail?

ABC’s story:

Robert Jergen writes two books a year, works on several research projects simultaneously and, after finishing a PhD in half the normal time, began a successful teaching career. It takes a special person with special skills to complete such a heavy load, but one would never guess the secret to Jergen’s success.

“I have ADHD,” says Jergen.

ADHD, or attention deficit hyperactivity disorder, is often considered a childhood disorder. Yet an estimated four percent of adults may also suffer from the hyperactivity, inattentiveness and impulsivity that ADHD causes.

With information about this disorder spreading quickly, many adults are suddenly realizing that their previously unexplainable childhood and adult problems may have stemmed from ADHD. Jergen, now in his late 30s, didn’t have a name for his problems until he was 22, and ironically, taking a class on special education.

But, as Jergen explains in his book, The Little Monster, the signs started much earlier.

“As soon as my eyes would pop open after a nap, the crib would start to tremble and [my mother] would always know when the little monster was awake,” says Jergen.

Growing Up Different

The nickname “little monster” was bestowed upon Robert as he destroyed everything in his path; his parents just didn’t understand that he couldn’t control his actions. Jergen describes numerous situations where he would impulsively throw a knife, dismantle a lamp or toss lit matches at a model ship, each time thinking a moment too late, “Now that wasn’t such a good idea.”

It’s not that Jergen didn’t know right from wrong; he just acted without realizing. And being hypersensitive, like many other ADHD children, Jergen’s head is still filled with his mother saying over and over, “Jesus Christ, give me strength! You are such a rotten kid!” even though he is not entirely sure if she ever said it more than once.

It was the constant disappointment and scolding, both at school and at home, and constant comparisons to his athletic, intelligent, sweet brothers that caused a slow slide into depression.

“I always heard, ‘Rob, I love you, but you don’t do what you’re told, you don’t finish what you start, you do things without thinking,’” he says. “And what I grew up hearing was, ‘I really don’t love you, but I would, if you would stop doing this.’”

By eighth grade, Jergen had twice attempted suicide.

The Lowest Point

Jergen’s outlook improved after meeting an accepting group of friends in high school, but the hopelessness returned in college when he fell in with a group who called themselves the “All-American Drinking Team.”

Jergen, typical of those with ADHD, found alcohol to be the one tool that could be used to quiet his head, which helped him concentrate in class, improve his grades and calm his constant anxiety over how he appeared to others. But alcohol also brought out years worth of pent-up rage. So, after an ugly night at a bar, Jergen realized he had to stop drinking.

With the drinking stopped, Jergen’s head became noisy again. And while he loved his job teaching adolescents with special needs, it was the quiet paperwork, long meetings and coworkers angry with his antics that made work miserable. The stress was quickly driving Jergen back to alcohol and depression.

To try to stem the tide, Jergen returned to school, where he last felt most comfortable. It would be here that he would receive an answer to all of his problems.

A Wall of TVs

At the beginning of a master’s program, Jergen’s condition became steadily worse. Rude comments would just pop out of his mouth without him even realizing. He once poked his boss in a thin patch of hair and proclaimed “bald spot!” Unable to concentrate on any of his reading assignments, unable to control his actions or even his mind, Jergen was again considering suicide.

Oddly enough, Jergen would find help in a student, Troy, who had schizophrenia. Jergen was furious one day when he found out that Troy was not taking his medication and lectured him about how smart and successful he could be if only took a little pill every day.

A bell went off in Jergen’s head.

“I thought, ‘you are such a hypocrite. You are just sitting there waiting for death or a white padded room. Maybe there is some drug that you could take to make you normal.’”

This was the beginning of Jergen’s turnaround. After countless therapy sessions, incorrect diagnoses of hypoglycemia and hyperglycemia, an abnormal MRI and EEG (two tests that are commonly used to diagnose ADHD), Jergen happened to attend a support group meeting of ADHD adults for a special education class, when someone said:

“My mind is like a wall of television sets, each on a different channel and I don’t have the remote.”

For the first time, Jergen found a way to describe what was going on in his head. “One second I thought that I was a loser. A freak,” he says. “The next moment I knew that I had ADHD. I wasn’t alone.”

Turning ADHD Around

Most patients with ADHD go through years of trying different types and doses of medications before a successful combination is achieved. For Jergen, after two years of trying various medications with no success, or unbearable side effects, he became resolved to make ADHD work for him, instead of relying on medications to control it.

Jergen is not against medication, and he openly agrees that it can help one focus. “But medications do not teach people to learn, do math or act appropriately,” he says. So, he reminds parents and teachers that one will not just “get better” with medication and advocates behavior therapy to help a person with ADHD learn the organizational and social skills they may not have learned as a child.

For Jergen, however, the goal became to use the hyperactivity of ADHD instead of masking it. “All my problems were when I was trying to slow down, when I was trying to go at everybody else’s pace,” he says.

He became hyper-productive. Jergen kept a log outlining when and where he got the most work done. Then, he designed a work environment that would push out distractions and allow him to remain focused.

For example, Jergen’s office is dimly lit with one bright light shining on his computer, constantly reminding him where his attention should be. Soft music playing in the background blocks any outside noise. A computer game runs on a nearby laptop to give him something to do for a few seconds when his mind begins to wander. If the heavy clouds of ADHD begin to roll into his head anyway, Jergen hops on his treadmill. He has found that a short burst of exercise clears his head and allows his focus to return.

Most importantly, Jergen understands the importance of a strong support system. An honest, encouraging mentor got him through his PhD program and, now, his wife helps to keep him on track, reminding him to take a walk when he seems most on-edge. It is this support system that has helped Jergen build his self esteem after so many years of failures.

There are still problems. Jergen has a hard time staying quiet when his students are taking a test, and not everyone at work is so understanding of his disorder. Even his parents still doubt that he has ADHD, saying instead that he just needs to try harder. Nevertheless, Jergen is currently testing some of his techniques to see if they will help others with ADHD turn their greatest challenge into their greatest advantage.

“Don’t repress ADHD, utilize it,” says Jergen. “ADHD is A-OK.”