ADHD More Common in Grandchildren of Women Who Used DES During Pregnancy

MedicalResearch.com Interview with:

Marianthi-Anna Kioumourtzoglou ScD Assistant Professor Environmental Health Sciences Mailman School of Public Health Columbia University 

MarianthiAnna Kioumourtzoglou ScD
Assistant Professor
Environmental Health Sciences
Mailman School of Public Health
Columbia University 

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

Response: The prevalence of neurodevelopmental disorders, like attention deficit/hyperactivity disorder (ADHD) has been increasing. One of the hypothesized risk factors for increased risk for neurodevelopmental disorders is a class of chemicals known as endocrine disrupting chemicals (EDCs). These chemicals are known to interfere with the endocrine system, i.e. the system that uses hormones to control and coordinate metabolism, reproduction and development. Several high production volume chemicals, ubiquitously present in commercial products, are known or suspected endocrine disruptors. Because of their widespread use in consumer products, the population-wide exposure to known and suspected EDCs is very high.

Recently, there has been increased attention in the potential effects of EDCs on neurodevelopment that span multiple generations. Animal studies have provided evidence that exposure to EDCs, such as phthalates and bisphenol A (BPA), alter the behavior and social interactions in mice in three to five generations after exposure. However, evidence of such multi-generational impacts of EDC exposure on neurodevelopment in humans is unavailable, likely because of the lack of detailed information on exposures and outcomes across generations.

For this study we leveraged information from a nationwide cohort, the Nurses’ Health Study II (NHSII), to investigate the potential link between exposure to diethylstilbestrol (DES) and third generation ADHD, i.e. ADHD among the grandchildren of the women who used DES while pregnant. DES is a very potent endocrine disruptor that was prescribed between 1938 and 1971 to pregnant women thought to prevent pregnancy complications. In the United States, between 5 and 10 million women are estimated to have used DES, although the exact number is not known. DES was banned in 1971, when was linked to vaginal adenocarcinomas (a rare cancer of the reproductive system) in the daughters of the women who had used it during pregnancy. Since then, DES has been also linked to multiple other reproductive outcomes in DES daughters, as well as with some reproductive outcomes in the grandchildren of the women who used it, such as hypospadias and delated menstrual regularization. However, to our knowledge, no study to date has evaluated the association between DES, or any other EDC, and multigenerational neurodevelopment. Continue reading

Children with ADHD Found To Abuse Drugs and Alcohol At Early Age

MedicalResearch.com Interview with:

Brooke S. G. S Molina, PhD Professor of Psychiatry, Psychology and Pediatrics University of Pittsburgh 

Dr. Molina

Brooke S. G. S Molina, PhD
Professor of Psychiatry, Psychology and Pediatrics
University of Pittsburgh 

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

Response: There has been inconsistency across previous studies of children with ADHD and their risk of substance use in adolescence and in adulthood. This study closely examined substance use by children with and without ADHD over a long period of time, considering that experimenting with some substances, such as alcohol and cigarettes, is typical after teens reach high-school age.

This study found that children with attention deficit hyperactivity disorder (ADHD) engaged in substance use at a younger age than those without ADHD and had a significantly higher prevalence of regular marijuana and cigarette use into adulthood.

We also found that children diagnosed with ADHD had a faster progression of substance use during childhood and adolescence.

We confirmed a finding for the ADHD group that is widely replicated in the general population – that early substance use strongly predicts adult substance use.  However, more of the children with ADHD were found to be early substance users, such as having a drink of alcohol before the age of 15.

We did not find higher rates of binge alcohol consumption among young adults with ADHD.  However, alcohol use is still an important part of the bigger picture.

The amount of alcohol consumption was self-reported in a questionnaire where the average age of all participants was 25. Binge drinking is very common in early adulthood, but given our findings of children with ADHD starting to drink at younger ages, it’s important to continue this research so we know how many young drinkers with ADHD continue to have serious, chronic problems with drinking as they age.

MedicalResearch.com: What should readers take away from your report?

Response: It’s very important to understand from our findings that substance abuse begins at a young age – often before high school.  Parents and providers need to understand this and continually assess risk.

We are concerned about the long-term consequences of these substance use patterns.  We do not know how many of these individuals will experience painful and expensive middle age outcomes of chronic substance abuse and associated problems such as divorce, employment problems, injuries, poor health and shortened life expectancy.  Some will be resilient and decrease their substance use.  We need to learn what predicts these outcomes. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The marijuana use finding is also concerning given the increasing availability of cannabis in the United States and the risk and consequences for children with ADHD needs further study. 

MedicalResearch.com: Is there anything else you would like to add?

Response: These results suggest a crucial need for routine clinical practice to include early screening and interventions to prevent early substance use, including cigarette smoking, among children with ADHD.

Many children with ADHD end up being cared for in primary care settings, so pediatricians are the front-line treatment care providers and conversations about substance use need to begin early. When children with ADHD are being treated, we need to start monitoring their potential risk for substance use at a young age, and not only treating with medication, but considering the range of factors that increase their risk for becoming dependent on nicotine and for developing substance use disorders. 

Citations:

J Child Psychol Psychiatry. 2018 Jan 8. doi: 10.1111/jcpp.12855. [Epub ahead of print]

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.

Molina BSG1, Howard AL2, Swanson JM3, Stehli A3, Mitchell JT4, Kennedy TM5, Epstein JN6, Arnold LE7, Hechtman L8, Vitiello B9, Hoza B10. 

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Small Increased Risk of Cardiac Birth Defects With ADHD Drug During Pregnancy

MedicalResearch.com Interview with:

Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120

Dr. Krista Huybrechts

Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120  

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

Response: In recent years, use of stimulant medications in adults, including women of reproductive age, has increased substantially.

However, data regarding the safety of stimulant medications in early pregnancy are sparse and conflicting.  For example, two recent cohort studies failed to detect an association between use of methylphenidate in early pregnancy and overall or cardiac malformations, while another found an 81% increased risk of cardiac malformations, although the estimate was imprecise.

Given the rapidly increasing use of stimulant medications during pregnancy and among women of reproductive age who may become pregnant inadvertently, there is an urgent need to better understand their safety.

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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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Study Finds No Link To Autism, ADHD In Offspring From Antidepressant Use In Pregnancy

MedicalResearch.com Interview with:

Simone Vigod, MD, MSc, FRCPC Psychiatrist and Lead, Reproductive Life Stages Program Women’s Mental Health Program Women’s College Hospital Toronto, ON

Dr. Vigod

Simone Vigod, MD, MSc, FRCPC
Psychiatrist and Lead, Reproductive Life Stages Program
Women’s Mental Health Program
Women’s College Hospital
Toronto, ON

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

Response: Depression is one of the most common problems that can complicate a pregnancy. Untreated, or incompletely treated, it can be associated with significant harm to mother and child. While psychotherapies alone may be effective for women with mild (or even moderate) severity symptoms, sometimes antidepressant medication is required. In these cases, the benefits of treatment must be weighed against potential risks. Previous research suggested that there may be an increased risk for autism in children exposed to antidepressant medication during pregnancy. However, previous studies were limited in their ability to account for other potential causes of autism in their analyses. In our study, we used several different strategies to try to compare children whose pregnancy exposures were very similar, except for exposure to an antidepressant.

The main finding was that after using these strategies, there was no longer a statistically significant association between in-utero antidepressant exposure and autism.

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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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