Association of Brain White Matter Structure With Autism Spectrum Disorder and ADHD

MedicalResearch.com Interview with:

Dr. Adriana Di Martino, MD Associate Professor, Department of Child and Adolescent Psychiatry NYU Langone Health

Dr. Di Martino

Dr. Adriana Di Martino, MD
Associate Professor, Department of Child and Adolescent Psychiatry
NYU Langone Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While there has been an increased awareness of the co-occurrence of symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children with a primary diagnosis of ASD, only recently has there been an appreciation that a substantial proportion of children with ADHD may also have ASD traits. These symptom domains overlap pose a challenge for accurate recognition and targeted treatments, yet their underlying mechanisms have been unknown.

With more traditional diagnostic group comparisons we detected a significant influence of ASD on white matter organization, but our analyses of the severity of symptoms across individuals revealed an association between autistic traits and white matter organization, regardless of the individual’s diagnosis. These findings were mostly centered around the corpus callosum, a structure that enables communication between the left and right cerebral hemispheres.

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Risk of Suicide Attempts With Methylphenidate Treatment for ADHD

MedicalResearch.com Interview with:
Professor Ian Chi Kei Wong and
Kenneth KC Man, Senior Research Assistant
Department of Social Work and Social Administration, Faculty of Social Science
Department of Pharmacology and Pharmacy, LKS Faculty of Medicine
The University of Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Patients with attention-deficit/hyperactivity disorder (ADHD) are at higher risk of various mental health problems. Previous studies suggested that individuals with ADHD are having a higher chance of both attempted and completed suicide. Methylphenidate is a psychostimulant that is recommended for the treatment of ADHD. With the increasing usage of methylphenidate over the past decade, there are concerns about the safety of the medication, in particular, psychiatric adverse effects such as suicide attempt.

The current study looked into over 25,000 patients aged 6 to 25 years in Hong Kong who were receiving methylphenidate in 2001 to 2015. Using the self-controlled case series design, in which the patients act as their own control, we found that the risk of suicide attempt was 6.5 fold higher during a 90-day period before methylphenidate was initiated, remained elevated 4-fold during the first 90 days of treatment, and returned to the normal level during ongoing treatment.

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ADHD Medications Reduce Risk of Motor Vehicle Crashes

MedicalResearch.com Interview with:
Zheng Chang PhD MSc
Department of Medical Epidemiology and Biostatistics (MEB)
Karolinska Institutet
Stockholm Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: About 1.25 million people worldwide die annually because of motor vehicle crashes (MVCs). ADHD is a prevalent neurodevelopmental disorder with symptoms that include poor sustained attention, impaired impulse control and hyperactivity. ADHD affects 5 percent to 7 percent of children and adolescent and for many people it persists into adulthood. Prior studies have suggested people with ADHD are more likely to experience MVCs. Pharmacotherapy is a first-line treatment for the condition and rates of ADHD medication prescribing have increased over the last decade in the United States and in other countries.

Among the more than 2.3 million patients with ADHD (average age 32.5), we found patients with ADHD had a higher risk of an MVC than a control group of people without ADHD. The use of medication in patients with ADHD was associated with reduced risk for motor vehicle crashes in both male and female patients.

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ADHD Less Common in Girls, But Has More Serious Consequences

MedicalResearch.com Interview with:

Professor Jill Pell MD Director of Institute (Institute of Health and Wellbeing) Associate (School of Medicine, Dentistry and Nursing) University of Glasgow

Prof. Pell

Professor Jill Pell MD
Director of Institute (Institute of Health and Wellbeing)
Associate (School of Medicine, Dentistry and Nursing)
University of Glasgow

MedicalResearch.com: What is the background for this study?

Response: The novelty of our study lies in its scale and scope. In terms of scope, it reported on six educational outcomes and three health outcomes in the same group of children.

In terms of scale, it is the first study of a whole country to compare educational outcomes of children with treated ADHD with their unaffected peers and is more than 20 times larger than previous studies on similar educational outcomes. The only previous countrywide study on health outcomes, included only children with very severe ADHD who were in psychiatric hospitals.

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Subtle Differences in Brain Volume Detected On MRI In ADHD

MedicalResearch.com Interview with:
M. (Martine) Hoogman PhD.

Postdoc and PI of ENIGMA-ADHD
Radboud universitair medisch centrum
Department of Human Genetics
Nijmegen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many neuro-imaging studies aimed at investigating structural brain changes related to ADHD, but the results are often inconclusive.

There are two main reasons for this:

1) the small sample size of the studies and
2) the heterogeneous methods used.

We tried to address these issues by forming an international collaboration to provide a sample size sufficient to detect even small effects in volume differences. And in addition, we analyzed all the raw scans again using homogenized methods. There are data of more than 1700 patients (aged 4-63 years of age) and more than 1500 healthy controls in our dataset, coming from 23 sites around the world. We studied the possible volume differences between cases and controls of 7 subcortical regions and intracranial volume by performing mega- and meta-analysis.

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More Medical Students May Have Non-Apparent Disabilities

MedicalResearch.com Interview with:  

Lisa Meeks , PhD
Director, Medical Student Disability
UCSF Medical Center

Lisa Meeks , PhD Director, Medical Student Disability UCSF Medical Center

Dr. Lisa Meeks

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was the first study to include students with AD/HD, learning, psychological, and chronic health conditions. This study found that the prevalence of students with disabilities is up to four times higher than previous studies indicated.

AD/HD, learning, and psychological disabilities were the most prevalent, suggesting that most students with disabilities in medicine have non-apparent disabilities. Within MD granting programs, the number of students self-reporting disability varied between 0% and 12%. Explanations for the high variability between programs are unknown, however, anecdotal reports suggest the degree to which programs have dedicated resources and inclusive practices for students with disabilities influence student disclosure.

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ADHD: Heritability of Structural and Functional Brain Connectivity in Families

MedicalResearch.com Interview with:

Gustavo Sudre, PhD Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch National Human Genome Research Institute Bethesda, Maryland

Dr. Gustavo Sudre

Gustavo Sudre, PhD
Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch
National Human Genome Research Institute
Bethesda, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding.

ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms.

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Specific Genetic Mutations Present in Many Children With ADHD

MedicalResearch.com Interview with:
Dr. Josephine Elia, M.D.

Neuroscience Center
Department of Child and Adolescent Psychiatry
Nemours/Alfred I. DuPont Hospital for Children

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Glutamate neurotransmission may play an important role in ADHD and other neuropsychiatric disorders. The purpose of this study is to determine the frequency of genetic mutations involving specific genes (GRM network genes) which influence glutamatergic neurotransmission. A total of 23 study sites across the USA enrolled 1,013 children, aged 6-17 years who had been previously diagnosed with ADHD. Saliva samples were submitted to The Center for Applied Genomics (CAG) at CHOP for analysis of mutations of interest. Information on medical history, including other neuropsychiatric diagnoses and family history as well as areas of academic and social concern were also collected.

Overall, the mutation frequency was 22%, with a higher prevalence of 25% observed in patients aged 6-12. When compared to mutation negative ADHD patients, the patients with the mutations of interest were more likely to have concerns about anger control and disruptive behaviors.

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Treating ADHD Reduces Risk of Injuries, STDs and Substance Abuse

MedicalResearch.com Interview with:

Anna Chorniy PhD Postdoctoral Research Associate Center for Health and Wellbeing 321 Wallace Hall, Princeton University Princeton NJ 08544

Dr. Chorniy

Anna Chorniy PhD
Postdoctoral Research Associate
Center for Health and Wellbeing
Princeton University
Princeton NJ 08544

MedicalResearch.com: What is the background for this study?

Response: Attention-deficit/hyperactivity disorder (ADHD) is one of the common chronic mental conditions affecting children. In the U.S., 11% of children ages 4–17 (6.4 million) are estimated to have an ADHD diagnosis and almost 70% of them report taking medication for the condition (e.g. Visser et al., 2014). However, little evidence exists on the effects of ADHD treatment on children’s outcomes.
We use a panel data set of South Carolina Medicaid claims paid out in 2003–2013 to investigate the effects of ADHD medication treatment on a seldom studied set of outcomes associated with this condition: adolescent risky behaviors and the incidence of injuries.

The occurrence of injuries allows us to evaluate short-term effects of ADHD treatment, while substance abuse and risky sexual behavior outcomes speak for the long-term effects of medication. Second, we use Medicaid spending on treatment of these negative events to evaluate the impact of ADHD drugs on the severity of ADHD, and compare the cost of ADHD treatment with the costs of negative health events. Continue reading

ADHD and OCD Patients Differ Fundamentally in Brain Abnormalities

MedicalResearch.com Interview with:

Katya Rubia, PhD Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology, and Neuroscience King’s College London London, England

Dr. Katya Rubia

Katya Rubia, PhD
Department of Child and Adolescent Psychiatry
Institute of Psychiatry, Psychology, and Neuroscience
King’s College London
London, England

MedicalResearch.com:  What are the main findings?

Dr. Rubia: ADHD and OCD patients both suffer from poor inhibitory control and in both disorders this has been associated with structural and functional deficits in fronto-striatal networks. However, it is not clear to what extent the two disorders differ in their underlying neural substrates. This study therefore conducted a meta-analysis of all published whole brain structural and functional MRI studies of inhibitory control in both disorders.

MedicalResearch.com: What are the main findings?

Dr. Rubia: The main findings are that ADHD and OCD patients differ quite fundamentally in their structural and functional brain abnormalities. OCD patients have enlarged volume in basal ganglia and insula, while ADHD patients have reduced volumes in these regions. In fMRI, in the left hemisphere this was also observed for the left insula and putamen, which were increased in OCD and reduced in ADHD. In addition both disorders have different frontal deficits. OCD patients have deficits in rostro-dorsal medial frontal regions that are important for top-down control of affect while ADHD patients had reduced activation in lateral inferior frontal cortex, a key area of attention and cognitive control. The findings fit into the notion of fronto-striatal dysregulation in OCD where basal ganglia are overactive and poorly controlled by medial frontal regions and a delayed fronto-striatal maturation in ADHD where both lateral frontal regions and the basal ganglia/insula are smaller, and presumably less developed in structure and in function in ADHD.

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Pediatric Methylphenidate (Ritalin) May Raise Risk of Cardiac Arrhythmia

MedicalResearch.com Interview with:

Nicole Pratt PhD Senior Research Fellow Quality Use of Medicines and Pharmacy Research Centre Sansom Institute, School of Pharmacy and Medical Sciences University of South Australia GPO Box 2471, Adelaide 5001 South Australia

Dr. Nicole Pratt

Nicole Pratt PhD
Senior Research Fellow
Quality Use of Medicines and Pharmacy Research Centre
Sansom Institute, School of Pharmacy and Medical Sciences
University of South Australia
Adelaide South Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Pratt: The cardiac safety of methylphenidate has been debated. This study aimed to measure the risk of cardiac events in a large population of children treated with these medicines. We found that there was a significantly raised risk of arrhythmia in time periods when children were treated with methylphenidate compared to time periods when they were not. While the relative risk of cardiac events was significant the absolute risk is likely to be low as cardiac events are rare in children.
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ADHD Does Not Always Begin in Childhood

MedicalResearch.com Interview with:

Luis Augusto Rohde MD, PhD Full Professor Department of Psychiatry Federal University of Rio Grande do Sul Director ADHD Program Hospital de Clínicas de Porto Alegre

Prof. Luis. Rohde

Luis Augusto Rohde MD, PhD
Full Professor
Department of Psychiatry
Federal University of Rio Grande do Sul
Director
ADHD Program
Hospital de Clínicas de Porto Alegre 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The idea that Attention-deficit/Hyperactivity Disorder always begins in childhood has been held for decades even without proper testing. The main manuals of psychiatric diagnoses require age at onset in childhood as a core feature of the disorder. In a large birth cohort followed until age 18, we identified many young adults presenting with a full impairing ADHD syndrome. They had consistently worse outcomes – criminality, substance abuse, traffic accidents, among others – than their counterparts without ADHD. However, most of these young adults (84.6%) presenting with a full impairing syndrome did not have a prior diagnosis in their childhood years. This surprising observation held after many secondary analyses exploring possible biases, like comorbidities in young adulthood, subthreshold ADHD in childhood and change of information source.

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Dasotraline Explored For Treatment of ADHD and Binge Eating Disorders

MedicalResearch.com Interview with:

Dr. Kenneth Koblan PhD Sunovion Pharmaceuticals Inc. Fort Lee, NJ and Marlborough, MA

Dr. Kenneth Koblan

Dr. Kenneth Koblan PhD
Sunovion Pharmaceuticals Inc.
Fort Lee, NJ and Marlborough, MA

Medical Research: What is the background for this study?
Dr. Koblan: Assessing abuse potential is important in the clinical development process for any therapy affecting the central nervous system, especially those that may act on dopamine and norepinephrine neurotransmitter systems. Human abuse liability studies are conducted to evaluate the abuse potential associated with drugs that affect the central nervous system.

Drugs that increase dopamine levels may be associated with stimulant effects and abuse (e.g., cocaine and amphetamine), whereas drugs that increase serotonin and/or norepinephrine levels are not generally associated with recreational abuse (e.g., selective serotonin reuptake inhibitors). Among drugs with effects on dopamine neurotransmission, slowing the rate of absorption is thought to reduce abuse potential, and increasing the rate of elimination is thought to reduce rewarding effects and abuse liability due to sustained elevations in drug concentrations resulting in sustained inhibition of dopamine transporters (DAT).

Dasotraline is an investigational dopamine and norepinephrine reuptake inhibitor from Sunovion in late-stage development to evaluate its use in treating the symptoms of attention deficit hyperactivity disorder (ADHD) and binge-eating disorder (BED). Dasotraline has slow absorption and elimination that supports the potential for plasma concentrations yielding a continuous therapeutic effect over the 24-hour dosing interval at steady state.

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Cochrane Analysis Reviews Studies of Ritalin For ADHD

Dr. Ole Jakob Storebø Region Zealand, Child and Adolescent Psychiatric Department, Roskilde Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse University of Southern Denmark, Department of Psychology Faculty of Health Science, Odense Denmark

Dr. Storebø

MedicalResearch.com Interview with:
Dr. Ole Jakob Storebø
Region Zealand, Child and Adolescent Psychiatric Department, Roskilde
Region Zealand Psychiatry
Psychiatric Research Unit, Slagelse
University of Southern Denmark
Department of Psychology
Faculty of Health Science,
Odense Denmark

Medical Research: What is the background for this study? What are the main findings?

Dr. Storebø: Despite widespread use of methylphenidate for the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD), a comprehensive systematic review of its benefits and harms has not yet been conducted. Over the past 15 years, several reviews investigating the efficacy of methylphenidate for ADHD (with or without meta-analyses) have been published. Each of these reviews, however, has several shortcomings and these are described in detail in the review. The most important concerns are that none of these reviews are based on a pre-published protocol, and most assessed neither the risk of bias (systematic errors) of included trials nor adverse events. Moreover, none of these reviews considered the risk of random errors. Therefore, their interpretation of findings is unlikely to have taken into account the poor reporting of adverse events, the impact of combining data from small trial samples, or the impact of risk of bias on their analyses; information about adverse events is also missing from several RCTs. Because of this it is our opinion that these previous reviews might have overestimated the true treatment effect.

We found that Methylphenidate may improve ADHD symptoms, general behaviour and quality of life in children and adolescents aged 18 years and younger with ADHD. We rated the evidence to be of very low quality and, as a result, we cannot be certain about the magnitude of the effects from the meta-analyses. The evidence is limited by serious risk of bias in the included trials, under-reporting of relevant outcome data, and a high level of statistical variation between the results. We found no evidence for serious adverse events, but a lot of non-serious adverse events. Most of these are well known but the number of adverse events might even be higher than the number we found due to underreporting of adverse events. We know very little about the long term effects or harms as most of the trials in our review did not measure outcomes beyond 6 months. The risk of rare, serious adverse events seem low over the short duration of follow-up of the trials that reported on harms, but in general there was inadequate reporting of adverse events in many trials.

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Brain Circuits Limit Our Ability To Multitask

Michael M. Halassa, MD, PhD, Assistant professor Departments of Psychiatry and Neuroscience and Physiology The Neuroscience Institute Depts. of Psychitatry Langone Medical Center New York, NY 10016

Dr. Michael Halassa

MedicalResearch.com Interview with:
Michael M. Halassa, MD, PhD, Assistant professor

Departments of Psychiatry and Neuroscience and Physiology
The Neuroscience Institute Depts. of Psychitatry
Langone Medical Center
New York, NY 10016

Medical Research: What is the background for this study? What are the main findings?

Dr. Halassa:  Attention is a vital aspect of our daily life and our minds are not merely a reflection of the outside world, but rather a result of careful selection of inputs that are relevant. In fact, if we indiscriminately open up our senses to what’s out there, we would be totally overwhelmed. Selecting relevant inputs and suppressing distractors is what we call attention, and as humans we are able to attend in a highly intentional manner. Meaning, we choose what to pay attention to, and we do so based on context. If you’re driving and getting directions from your GPS, you’ll be intentionally splitting your attention between your vision and hearing. Now, in one context, you might have just updated the GPS software, so you know it’s reliable; this would allow you to intentionally pay attention more to the voice coming from the GPS. In another context, the GPS software may be outdated making voice instructions unreliable. This context would prompt you to direct your attention more towards using visual navigation cues and less to the GPS voice. How the brain intentionally and dynamically directs attention based context is unknown.

The main strength of our study is that we were able to study context-dependent attention in mice. Mice are unique models because they provide genetic tools to study brain circuits. Meaning, we can turn circuits on and off very precisely in the mouse, and in a way we cannot do in other experimental animals. The inability to do these types of manipulations has been the major roadblock for progress in understanding what brain circuits mediate attention and its intentional allocation.

Because we couldn’t train mice to drive and listen to the GPS, we decided to do something much simpler. Based on context (the type of background noise in the experimental enclosure), a mouse had to select between conflicting visual and auditory stimuli in order to retrieve a milk reward. Mice love milk; it turns out, and will work tirelessly to do well on getting it. Each trial, the mouse is told ‘you need to pick the light flash’ or ‘you need to pick the auditory sweep’; these stimuli appeared on either side of the mouse randomly so the animal really had to pay attention in order to get its reward. It also had to take the context into account. We found that mice did this task, and as humans would do, they were reliant on the prefrontal cortex for determining the appropriate context. The major finding was that the prefrontal cortex changed the sensitivity of the brain to incoming stimuli (meaning, made the visual stimulus brighter when the mouse cared about vision and made the auditory stimulus louder when the mouse cared about hearing), by influencing activity in the thalamus. The thalamus is the major early relay station in the brain. The prefrontal cortex does that by instructing the brain’s switchboard, known as the thalamic reticular nucleus (TRN) to control how much visual or auditory information the thalamus was letting through. So in a sense, we discovered that executive function, represented by the prefrontal cortex, can talk to ‘attentional filters’ in the thalamus to determine what ultimately is selected from the outside environment to build our internal world.
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Working Memory Problems Can Persist Into Adulthood in Children with ADHD

Dr. Graham Murray PhD University Lecturer Department of Psychiatry Addenbrooke's Hospital Cambridge UKMedicalResearch.com Interview with:
Dr. Graham Murray PhD
University Lecturer
Department of Psychiatry
Addenbrooke’s Hospital
Cambridge UK

Medical Research: What is the background for this study? What are the main findings?

Dr. Murray: There is debate about the extent to which ADHD persists into adulthood, with estimates suggesting that between 10-50% of children still have ADHD in adulthood. Diagnosis (whether in childhood or adulthood) is currently reliant on meeting symptom checklists (such as the American Psychiatric Association’s Diagnostic and Statistical Manual), and a current diagnosis is often the prerequisite to access health care from psychiatric services. We decided to follow up a sample of 49 teens who all had a confirmed diagnosis of ADHD at age 16. We also followed a control group made up of comparison healthy volunteers from the same social, ethnic and geographical background.

When we used the symptom checklist criteria of persistence, only 10% of patients still met ADHD diagnostic criteria in adulthood. However, there is more to ADHD than this. When it comes to adult brain structure and function, it didn’t make any difference whether symptom checklists were still met or not. On reaching adulthood, the adolescent ADHD group show reduced brain volume in the caudate nucleus – a key brain region that supports a host of cognitive functions, including working memory function. When we assessed working memory ability, we noted persistent problems in the adolescent ADHD group, with a third of the adolescent ADHD sample failing the memory test. The poor memory scores seemed to relate to a lack of responsiveness in the activity of the caudate nucleus that we could detect using functional MRI scans. In the control group, when the memory questions became more difficult, the caudate nucleus became more active, and this appeared to help the control group perform well; in the adolescent ADHD group, the caudate nucleus kept the same level of activity throughout the test. It was as if, for the controls, when the test got harder, the caudate nucleus went up a gear in its activity, and this is likely to have helped solve the memory problems. But for the adolescence ADHD group, the caudate couldn’t go up a gear when the test became harder, and this likely resulted in poorer performance.  Continue reading

C- Section May Raise Attention Deficit Risk in Neonates

Scott A. Adler, Ph.D. Associate Professor Coordinator Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research Visual and Cognitive Development Project York University Toronto, Ontario CanadaMedicalResearch.com Interview with:
Scott A. Adler, Ph.D
.
Associate Professor Coordinator
Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research
Visual and Cognitive Development Project
York University
Toronto, Ontario Canada

 

Medical Research: What is the background for this study?

Dr. Adler: Experiences that we have early in life clearly have an impact on our brain development and behavior as we get older.  Numerous studies have detailed these experiences, ranging from how we were fed as a baby to how many languages we hear to traumatic events.  These experiences have been shown to influence formation, maintenance, and pruning of the networks of synaptic connections in our brain’s that impact all manner of thought and behavior.  Yet, the impact of one of the earliest experiences, that of being born, on brain and psychological behavior has not before been explored.  A recent study with rat pups has strongly suggested that the birth process has a definite impact on initial brain development.  If that is the case, what happens if the infant’s birth is one in which she does not experience the natural birth process, such as occurs with caesarean section births?

Medical Research: What are the main findings?

Dr. Adler: There were two main findings from this study.  We measured the speed and timing of infants’ saccadic eye movements, which are overt indicators of attention, relative to the onset of visual events on a computer monitor.  Moving attention and eye movements can occur through two general classes of processes.  The first is bottom-up mechanisms in which attention is moved reactively and automatically to the appearance or existence of unique and salient events in the world.  In this case, where attention goes is essentially controlled by the events in the world.

The second is top-down mechanisms in which we move attention voluntarily to what we determine to be relevant event in the world based on our own cognitive biases and goals.

This study found that 3-month-old infants born by caesarean section were significantly slower to move attention and make eye movements in reaction to the occurrence of visual events on the basis of bottom-up mechanisms than were infants born vaginally.  In contrast, there was difference between infants in moving attention and making eye movements in anticipation of the appearance of visual events on the basis of top-down mechanisms.  Additionally, maternal age, which has been shown to be related to the occurrence of caesarean sections, was found not to be related to the current effects.

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CDC Discusses Best Practices and Resources For Childhood ADHD

Susanna N. Visser, DrPH Epidemiologist at the National Center on Birth Defects and Developmental Disabilities CDCMedicalResearch.com Interview with:
Susanna N. Visser, DrPH

Epidemiologist at the National Center on Birth Defects and Developmental Disabilities
CDC

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Visser: Attention-Deficit/Hyperactivity Disorder, or ADHD is one of the most common chronic conditions of childhood. It often persists into adulthood.   When children diagnosed with ADHD receive proper treatment, they have the best chance of thriving at home, doing well at school, and making and keeping friends.

In 2011, the American Academy of Pediatrics (AAP) updated their guidelines for ADHD treatment. The new guidelines give this advice to healthcare providers, psychologists, educators, and parents of children with ADHD:

  • For preschoolers ages 4-5 with ADHD, use behavioral therapy before medication.
  • For older children and teens with ADHD, use behavioral therapy along with medication.

In order to learn more about ADHD treatment patterns, CDC researchers looked at data from a national sample of children with special health care needs, ages 4-17 years, collected in 2009-10 just before the release of the 2011 guidelines.

We found that most children with ADHD received either medication treatment or behavioral therapy. However, we also found that many children were not receiving treatment in the way it was outlined in the 2011 best practice guidelines.

  • Less than 1 in 3 children with ADHD received both medication treatment and behavioral therapy, the preferred treatment approach for children ages 6 and older.
  • Only half of preschoolers (4-5 years of age) with ADHD received behavioral therapy, which is now the recommended first-line treatment for this group.
  • About half of preschoolers with ADHD were taking medication for ADHD, and about 1 in 4 were treated only with medication.

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ADHD Linked To Increased Risk of Accidents and Premature Death

Dr Søren Dalsgaard National Centre for Register-based Research Aarhus University DenmarkMedicalResearch.com Interview with:
Dr Søren Dalsgaard
National Centre for Register-based Research
Aarhus University Denmark

Medical Research: What is the background for this study? What are the main findings?

Response: This is the first large-scale prospective study of all-cause-mortality in people with ADHD. The nationwide Danish registers offer unique research possibilities. We followed a cohort of almost 2 million individuals prospectively, from birth and for up to 32 years. Using a personal identifier we were able to merge data from a number of different registers at the level of each individual and within the cohort we identified and followed more than 32,000 individuals with ADHD and the rest of the cohort were controls

Medical Research: What should clinicians and patients take away from your report?

Response: In this study we document that children, adolescents and adults with ADHD are at risk of premature death, compared to people without ADHD, in fact, ADHD doubles the risk. Still, it is important to notice that although ADHD increases the relative risk of premature death, the absolute risk is very low, i.e. very few died during follow-up, in fact only 107 out of the more than 32,000 individuals with ADHD we followed.

The most common cause of death in individuals with ADHD was accidents.

Those diagnosed with ADHD in adulthood had higher mortality than those diagnosed in childhood and adolescence. In addition, co-existing problems such as conduct disorder or substance use disorder in individuals with ADHD further increases mortality. However, even those with more pure DHD had an increased mortality, compared to those without ADHD. Finally, we also examined gender-differences in mortality and found that girls and women with ADHD had a higher mortality than boys or men with ADHD.

Our results adds to the overwhelming existing evidence that ADHD is a true disorder and should not be taken lightly. ADHD has huge impacts on everyday life and people with ADHD and their families deserves that this is acknowledged.

Although the risk of premature death is twice that of individuals without ADHD, it is important to remember reassure patients with ADHD and their families, that there was very few absolute number of deaths among individuals with ADHD.

Citation:

Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study
Published online: February 25, 2015
Søren Dalsgaard, Søren Dinesen Øtergaard, James F Leckman, Preben Bo Mortensen, Marianne Giørtz Pedersen
The Lancet

DOI: http://dx.doi.org/10.1016/S0140-6736(14)61684-6

Dr Søren Dalsgaard, National Centre for Register-based Research, & Aarhus University Denmark (2015). ADHD Linked To Increased Risk of Accidents and Premature Death 

Pesticide Exposure May Impact Development Of ADHD

MedicalResearch.com Interview with:
Jason R. Richardson MS,PhD DABT Associate Professor
Department of Environmental and Occupational Medicine
Robert Wood Johnson Medical School and
Resident Member
Environmental and Occupational Health Sciences Institute
Piscataway, NJ

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Richardson:  Although ADHD is often though of as a genetic disorder, no single gene can explain more than a fraction of the cases. This suggests that environmental factors are likely to interact with genetic susceptibility to increase risk for ADHD. Our study reports that exposure of pregnant mice to relatively low levels of a commonly used pesticide reproduces the behavioral effects of ADHD in their offspring. Because the study was in animals, we wanted to see if there was any association in humans. Using data from the Centers for Disease Control and Prevention we found that children and adolescents with elevated levels of metabolites of these pesticides in their urine, which indicates exposure, were more than twice as likely to be diagnosed with ADHD.

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ADHD and Conduct Disorders Linked to Early Tobacco and Alcohol Use

William Brinkman, MD, MEd, MSc Associate Professor of Pediatrics Director, Research Section, Division of General & Community Pediatrics Research Director, Cincinnati Pediatric Research Group James M. Anderson Center for Health Systems Excellence Cincinnati Children’s Hospital Medical CenterMedicalResearch.com Interview with:
William Brinkman, MD, MEd, MSc

Associate Professor of Pediatrics
Director, Research Section, Division of General & Community Pediatrics
Research Director, Cincinnati Pediatric Research Group
James M. Anderson Center for Health Systems Excellence
Cincinnati Children’s Hospital Medical Center

MedicalResearch.com: What is the background for this study?

Dr. Brinkman: Early onset of substance use is a significant public health concern as those who use substances before the mid-teen years are more likely to develop dependence than those who start later. The association of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) with tobacco and alcohol use has not been assessed in a young adolescent sample representative of the U.S. population.

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ADHD Genetic Risks Also Predict Milder Attention and Language Difficulties

MedicalResearch.com Interview with:
Joanna Martin, PhD student
MRC Centre for Neuropsychiatric Genetics and Genomics
Institute of Psychological Medicine and Clinical Neurosciences,
Cardiff University School of Medicine, Cardiff

Medical Research: What are the main findings of the study?

Response: In this study, we found that genetic risks which are collectively important for ADHD diagnosis also predict higher levels of traits of hyperactivity/impulsiveness, inattention and  pragmatic language difficulties in childhood in the general population.
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Study Links Loss Of APC Gene with Autistic Behaviors and Cognitive Impairments

Michele Jacob, Ph.D. Professor of Neuroscience Sackler School of Graduate Biomedical Sciences Tufts UniversityMedicalResearch.com Interview with
Michele Jacob, Ph.D.
Professor of Neuroscience
Sackler School of Graduate Biomedical Sciences
Tufts University


MedicalResearch: What are the main findings of the study?

Dr. Jacob: Autistic-like behaviors and cognitive impairments associate with loss of the Adenomatous Polyposis Coli (APC) gene.  We deleted APC chiefly from excitatory neurons in the mouse developing forebrain; the mice exhibited changes in synapse maturation and density, reduced social interest, increased repetitive behaviors, and learning deficits.  In addition, we found  molecular changes that define a novel role for APC in linking to and regulating the levels of particular proteins that function in synaptic adhesion complexes and signaling pathways that are required for normal learning and memory consolidation.

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Study Finds No Increase In Suicide Events With ADHD Drug Treatments

Dr. Henrik Larsson PhD Associate Professor Department of Medical Epidemiology and Biostatistics Karolinska Institute Stockholm, SwedenMedicalResearch.com Interview with:
Dr. Henrik Larsson PhD
Associate Professor
Department of Medical Epidemiology and Biostatistics
Karolinska Institute
Stockholm, Sweden

MedicalResearch: What are the main findings of the study?

Dr. Larrson: We found no evidence for an overall increased rate of suicide related events associated with the use of stimulant or non-stimulant drug treatment for ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs.
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Prenatal Exposure To Tobacco Increases Risk of ADHD Symptoms

MedicalResearch.com Interview with:
Nathalie E. Holz, MA
Department of Child and Adolescent Psychiatry and Psychotherapy
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

MedicalResearch: What are the main findings of the study?

Dr. Holz: Using data from a prospective community sample followed since birth, we investigated the impact of prenatal maternal smoking on lifetime Attention-Deficit/ Hyperactivity Disorder (ADHD) symptoms and on brain structure and inhibitory control assessed with Magnetic Resonance Imaging in the adult offspring. Those who were prenatally exposed to tobacco not only exhibited more ADHD symptoms, but also showed decreased activity in the inhibitory control network encompassing the inferior frontal gyrus as well as the anterior cingulate cortex. Activity in these regions was inversely related to lifetime ADHD symptoms and novelty seeking, respectively. In addition volume in the inferior frontal gyrus was decreased in these participants.
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ADHD and Acetaminophen During Pregnancy

Jørn Olsen, M.D., Ph.D.  Professor Institute of Public Health, Department of Epidemiology UCLA Aarhus University Aarhus,DenmarkMedicalResearch.com Interview with:
Jørn Olsen, M.D., Ph.D. 
Professor Institute of Public Health, Department of Epidemiology UCLA
Aarhus University
Aarhus,Denmark

MedicalResearch.com: What are the main findings of the study?

Dr. Olsen: Acetaminophen (paracetamol) is drug being used by many, including pregnant women. In our data about half of all pregnant women in 1995 to 2002 had used the drug all least once during their pregnancy. The drug has shown hormonal disruptor properties in animal studies.

We found that women who used this drug during pregnancy gave birth to children who 5 – 10 years later slightly more often had behavioral problems or were treated for ADHD. The risk was highest for those who took the medication late in pregnancy and/or had taken the drug several times. The increased risk was about 10-30%.
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Autistic Spectrum Reclassification Should Not Affect Patient Services Eligibility

Bennett L. Leventhal, MD Nathan S. Kline Institue for Psychiatric Research 140 Old Orangeburg Road, Building 35 Orangeburg, NY 10962MedicalResearch.com Interview with:
Bennett L. Leventhal, MD
Nathan S. Kline Institue for Psychiatric Research
140 Old Orangeburg Road, Building 35
Orangeburg, NY 10962


MedicalResearch.com:  What are the main findings of the study?

Dr. Leventhal: In the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders, 5th Edition (DSM5) released in May 2013, changes include major alterations in criteria for developmental disorders, in particular, the DSMIV diagnostic criteria for Pervasive Developmental Disorder (PDD), including elimination of subtypes found in DSMIV such as Asperger Disorder and PDD NOS. Additionally, DSM 5 adds a new diagnostic category, Social Communication Disorder (SCD): individuals with SCD have difficulties similar to ASD but these problems are solely restricted to the realm of social communication and do not include the restrictive and repetitive behaviors found in ASD.
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ADHD: Using MRI to Measure Brain Iron

Dr. Vitria Adisetiyo, Ph.D. Postdoctoral Research Fellow Medical University of South Carolina Center for Biomedical Imaging Charleston, SC 29425MedicalResearch.com Interview with:
Dr. Vitria Adisetiyo, Ph.D.
Postdoctoral Research Fellow
Medical University of South Carolina
Center for Biomedical Imaging Charleston, SC 29425


MedicalResearch.com: What are the main findings of the study?

Dr. Adisetiyo:  Using a non-invasive MRI method called magnetic field correlation imaging, we detected significantly reduced striatal and thalamic brain iron in medication-naive children and adolescents with ADHD compared to age-, gender- and IQ-matched typically developing controls. ADHD patients who had a history of psychostimulant medication treatment (e.g. Ritalin, Aderrall) had brain iron levels comparable to controls, suggesting brain iron may normalize with psychostimulants. Blood iron measures did not differ between patients and controls.

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ADHD: Environmental Risk Factors

MedicalResearch.com Interview with: Professor Desiree Silva MB BS, FRACP, MPH Consultant Paediatrician Suite 210 Specialist Centre, Joondalup Health Campus 60 Shenton Avenue, Joondalup WA 6027MedicalResearch.com Interview with:
Professor Desiree Silva MB BS, FRACP, MPH
Consultant Paediatrician
Suite 210 Specialist Centre, Joondalup Health Campus
60 Shenton Avenue, Joondalup WA 6027


MedicalResearch.com: What are the main findings of the study?

Prof. Silva: Our study is one of the largest population based studies of 12,991 children with ADHD. We found that smoking in pregnancy, maternal urinary infections, preeclampsia, being induced and threatened pre-term labour increases the risk of ADHD with little gender differences.  Prematurity also increased the risk of ADHD including babies born late preterm and early term marginally increased the risk of ADHD.
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Psychotropic Medication Use Patterns in Children

Tanya Froehlich, MD, MS Associate Professor Division of Developmental and Behavioral Pediatrics Cincinnati Children's Hospital Medical Center 3333 Burnet Avenue, MLC 4002 Cincinnati, OH  45229MedicalResearch.com Interview with:
Tanya Froehlich, MD, MS
Associate Professor
Division of Developmental and Behavioral Pediatrics
Cincinnati Children’s Hospital Medical Center
3333 Burnet Avenue, MLC 4002
Cincinnati, OH  45229

MedicalResearch.com: What are the main findings of the study?

Dr. Froehlich: In a national sample of 2 to 5 year olds, the likelihood of psychotropic prescription peaked in the mid-2000s (at 1.5%), then stabilized in the late 2000s (to 1.0%). Increased psychotropic use in boys, white children, and those lacking private health insurance was documented.
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How Does Stimulant Medication for ADHD in Children Affect Later Substance Use?

Kathryn L. Humphreys, M.A., Ed.M.  Clinical Psychology Doctoral Student UCLA Department of Psychology 1285 Franz Hall, Box 951563 Los Angeles, CA 90095MedicalResearch.com eInterview with Kathryn L. Humphreys, M.A., Ed.M.

Clinical Psychology Doctoral Student
UCLA Department of Psychology
1285 Franz Hall, Box 951563
Los Angeles, CA 90095

MedicalResearch.com: What are the main findings of the study?

Response: Our primary question was to answer whether the use of stimulant medication in the treatment of ADHD was associated with increased or decreased risk for a variety of substance use (ever tried) and substance use disorder (abuse or dependence) outcomes (alcohol, cocaine, marijuana, nicotine, and non-specific drug use).

Prior research from individual studies of children have provided mixed evidence (i.e., some found medication increased later risk, some found medication decreased risk, and still others found no difference in risk). We examined available longitudinal studies (i.e., medication treatment preceded measurement of substance outcome) together using meta-analysis, a technique that aggregates findings from a number of studies, in order to examine this question in a much larger sample of individuals.

Our main finding was that children with ADHD who received medication treatment did not differ in risk for lifetime substance use or abuse or dependence compared to those children with ADHD who did not receive medication treatment.
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