Students With ADHD Not Helped by Common Test Accommodations

Offering students with attention deficit hyperactivity disorder extended testing time or frequent breaks does not appear to help them perform better on a standardized test than other students with ADHD who do not get such accommodations, says a new study published in Learning Disabilities, a Multidisciplinary Journal.

In the study Academic Testing Accommodations for ADHD: Do They Help? researchers examined the accommodations and test results of 96 Maryland students with ADHD in grades 3-8. In addition to examining the impact of offering extended test time and frequent breaks, the researchers also looked at the effects of three other commonly offered accommodations: reducing distraction in the testing area, allowing students to have portions of the test read aloud, and allowing use of a calculator.

None of the accommodations were associated with students receiving better scores in reading or math on their Maryland School Assessments compared to similar peers, the study found.

Alison Esposito Pritchard, the lead author of the report, said she grew interested in studying the effects of these accommodations through her work as a clinical psychologist at the Kennedy Krieger Institute in Baltimore. The institute offers care to children with a variety of developmental disabilities.

As she evaluated children in her practice, Pritchard said she found herself recommending that they be offered accommodations, but that the research behind those recommendations was thin, particularly for students with ADHD.

“Conceptually, it made sense that [the accommodations] might be helpful to kids with ADHD,” Pritchard said. “But once I started looking at the literature, I found a gap at looking at the effectiveness of those accommodations.”

Students With ADHD May Not Know How to Use Test Accommodations

There could be several potential explanations for the results, she said. Students with ADHD may not be taught how to effectively use accommodations such as extended testing time. The researchers also could not say if certain accommodations meant the same thing to all students. For example, a particularly diligent student may have used all the extra test time offered, while another student may have chosen to rush through. Or one student may have been given a read-aloud accommodation by a computer, while another may have had the test read aloud by a teacher.

“It’s up to the child as to whether they want to make use of the accommodations that they’re given,” she said. “We can’t say that extended time”—to use one example—”is ineffective, but we can [say] that it’s not working the way we’re doing it right now.”

The findings should prompt more research into what accommodations are effective for students with ADHD and how students can be taught to take best advantage of them, Pritchard said.

“Education is an area where they are really trying to talk about best practices and use evidence-based based teaching strategies, and I think that understanding whether these types of supports work is part and parcel of that,” she said.

Taken from blogs.edweek

Posted in ADHD | Tagged | Leave a comment

Depressed? It could be adult ADHD

Mark Williams had suffered for years from symptoms that “looked like depression”.

Racing thoughts and confused states left him feeling miserable, says the father-of-one.

In 2011, he had a mental breakdown after his wife Michelle developed post-natal depression and he started to experience suicidal thoughts.

“I was having many more bad days than good days. I just didn’t care about anything,” he says. “My body felt inexplicably strange and started to appear as if it was shutting down. I just wanted to stay in bed.”

His GP drew the most obvious conclusion, diagnosing Mark with serious depression and putting him on the antidepressant drug, citalopram, at the maximum dose. “I stayed on that dose for four years,” says Mark, a charity worker from Bridgend.

Psychiatrists diagnosed him with bipolar disorder — the condition formerly known as manic depression, which causes moods to swing between extreme highs and lows.

“I knew it wasn’t that. The symptoms just didn’t fit,” he says. “I wasn’t suffering from manic fantasies or anything like that.”

Mark persuaded his community mental health team to send him to another NHS psychiatrist. This time he was diagnosed with adult attention deficit hyperactivity disorder or adult ADHD.

“It made sense,” says Mark. “It was as if all of the jigsaw pieces came together.”

Adults with ADHD may not have the hyperactivity seen in children with the condition, but they may find it hard to do everyday tasks such as remembering information, concentrating, organising tasks and following directions.

As Mark describes it: “My mind is always going ‘got to do this, got to do that’. Boredom is a massive problem. It is also difficult for me to focus on things I’m not immediately interested in.”

Adult ADHD is a comparatively new diagnosis — for years, mainstream psychologists believed childhood ADHD “burnt itself out” in late adolescence.

Now it’s thought the condition can persist into adulthood, with studies suggesting 60 percent of children diagnosed with ADHD suffer symptoms in early adulthood, according to the Royal College of General Practitioners. Research is yet to confirm how many older adults have it.

ADHD in children is easier to detect as their symptoms of inattention, often in school, are more obvious.

The official NHS guidance states: “Adult symptoms of ADHD tend to be far more subtle than childhood symptoms. Hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases.”

The problem is that many adults affected by it are misdiagnosed, as Mark was, with depression — that’s the suggestion from a new study of patients referred to a clinic with diagnoses of depressive mood disorders. Nearly one in three wasfound to have previously undetected adult ADHD.

The study, which was revealed last month at the Anxiety and Depression Association of America conference in Philadelphia, suggests adult patients diagnosed with so-called treatment-resistant depression (where they have failed to respond to at least one type of antidepressant) are most likely to be suffering instead from undetected ADHD.

The study, which examined 105 patients with an average age of 40 found those who had adult ADHD were also most likely to have been put on courses of SSRI (selective serotonin reuptake inhibitor), antidepressant drugs that boost serotonin levels, in failed attempts to tackle their symptoms.

“ADHD is new as a diagnosis made in adulthood, so when people present with symptoms of depression, doctors typically won’t ask any further questions about their history or assess for ADHD,” says lead researcher Tia Sternat, a psychiatrist at the START Clinic for Mood and Anxiety Disorders inToronto.

But depressed patients with adult attention deficit hyperactivity disorder don’t typically respond to SSRIs.

“They come in saying ‘I’m not happy, I’m tired, I’m anxious, I’m having trouble with attention’ and what you are seeing are the adult signs of ADHD coming through.”

Adult ADHD is only the latest in a long list of illnesses commonly misdiagnosed by doctors as depression.

These include Alzheimer’s and Parkinson’s, diabetes, premature menopause, multiple sclerosis, anaemia, an underactive thyroid gland, the gynaecological condition endometriosis and even heavy snoring (or sleep apnoea). Such conditions can all affect people’s moods. And the consequences of misdiagnosis can be serious if notcatastrophic.

Patients not only run the risk of being put on powerful antidepressants with potential side-effects such as loss of libido, but they also may miss out on essential treatment which, given promptly, can cure or alleviate their real illness.

Even brain tumours have been mistaken for depression. Last October, Melvyn Scarborough, an amateur referee, revealed he had been forced to take a year off officiating games after suffering chronic tiredness and lack of balance. Doctors put it down to feeling depressed.

It was only by chance — after being knocked out by a ball at a match — that the 55-year-old from Sheffield was given a brain scan, which revealed a fist-sized tumour.

Within days he’d undergone a life-saving 12-hour operation and is having to take a year off work as a construction site supervisor while he recovers.

“I was really suffering before the diagnosis,” he says. “I was falling down, tripping over things and making silly mistakes. All the symptoms were there and I told the doctors everything — but it wasn’t picked up. I feel a bitter about that.”

Alex Mitchell, professor of liaison psychiatry at the University of Leicester, has found that family doctors in urban areas are liable to over-diagnose one in six patients with depression.

More shockingly, Professor Mitchell’s study, published in The Lancet, found GPs in rural areas were likely to make three times as many incorrect diagnoses of depression as correct diagnoses.

He drew from a review of 41 studies involving more than 50 000 patients. The study recommended that if GPs evaluated people who might have depression over two appointments instead of one, the diagnostic accuracy rate rises dramatically to 90 percent.

Dr Liz England, clinical lead for mental health at the Royal College of General Practitioners, says the NHS protocol of “stepped care” for GPs should help to ensure patients are not rushed into being diagnosed with depression.

Under guidelines, patients with depression symptoms “should be ‘stepped up’ through different care levels so they aren’t initially diagnosed and given drugs for depression”, she says. Patients should first be tried with “low- level” remedies, such as self-help books.

If that doesn’t work, they should be referred to mental health professionals for psychological therapies such as CBT. If that doesn’t work, the patient might be referred for antidepressants.

GPs are not given time to make in-depth consultations, says Dr England. “Often, people don’t just come in with depression, but they have other problems in their lives.”

Meanwhile, many patients with ADHD may not only be taking antidepressants inappropriately thanks to misdiagnosis, they may also be missing out on drug therapies that may help their condition.

As Tia Sternat explains, while adults with ADHD may often complain of an inability to feel pleasure in life — a symptom also seen commonly in depression — the brain mechanisms behind the problem are very different.

In patients with depression, the loss of enjoyment is believed to stem from insufficient levels of the “feelgood” brain chemical serotonin. Hence the use of SSRI antidepressant drugs.

However, in adult ADHD, the depressive symptoms appear linked to the lack of a different “feelgood” brain chemical — dopamine.

Thus a different class of drug is required, one that may help to increase levels of dopamine, such asatomoxetine.

Mark has been taken off the SSRI drug citalopram. Four weeks ago, he was put on the ADHD drug, atomoxetine, which is thought to boost dopamine.

“I have seen the improvement already with my ability to focus my thoughts. I wake up feeling relaxed and focused,” he says.

Mark also uses mindfulness meditation techniques to help cope with his racing thoughts.

He believes the diagnosis has also helped with his work for a charity he founded, Fathers Reaching Out, which aims to increase awareness and understanding of postnatal depression and anxiety in men.

While he is happy to have finally received a diagnosis that makes sense to him, he regrets what he feels to have been decades of lost opportunities.

“I wish that I had been given medication at school. My lack of focus there meant my work was poor and I had low self-esteem.

“I would fidget all the time, which would result in me being humiliated and caned by the teachers.”

Hopefully, delayed diagnosis of ADHD may be changing, according to Dr England.

“It is only recently that anyone is talking about ADHD in adults,” shesays.

“The more we can talk about these things then the more resources can be directed towards them.”

Taken from iol

Posted in ADHD | Tagged | Leave a comment

Allergies during pregnancy linked with autism, ADHD

Despite a wealth of research, how and why autism and other neurodevelopmental disorders appear is still unknown. The search is on for any factors that might contribute to these psychological conditions. A recent study focuses on maternal allergies.

Already, lines have been drawn between allergies and attention deficit hyperactivity disorder (ADHD) and autism.

Similarly, links are known to exist between inflammation and the risk of schizophrenia, ADHD, and autism.

However, although these connections have been glimpsed, the cellular mechanisms that underpin them are not understood; how do inflammatory and immune responses influence cognition and behavior?

Research, recently presented at Neuroscience 2016 – the annual meeting of the Society for Neuroscience in San Diego, CA – adds another piece to this unwieldy puzzle. The study was led by Kathryn Lenz, an assistant professor of psychology at Ohio State University.

Autism is three or four times more common in males than females; Lenz and colleagues set out to investigate this gender difference in rats.

To this end, the team first sensitized female rats to an egg white protein, ovalbumin, prior to them becoming pregnant. Fifteen days into the pregnancy, the rats were presented with the allergen to trigger an immune response.

The team found that the rats whose mothers had been exposed to an allergen had an increase in certain immune cells in the brain – called mast cells. They also showed a reduction in another type of immune cell – microglia. These differences were the same in both sexes.

Another marked change was seen in their behavior. Allergic mothers’ offspring were hyperactive and demonstrated less anxiety-like behavior. Lenz says: “Young rats engage in social play and males are more rough and tumble and usually play much more than females.” However, the males in the allergy group were found to roughhouse with their peers significantly less.

As Lenz explains: “The males born to the allergen-exposed mothers looked more like females. They were more socially reserved. They were really hyperactive but socially disengaged. That looks a bit like ADHD.”

Taken from medicalnewstoday

Posted in ADHD | Tagged , | Leave a comment

ALIEF ISD IS HELPING KIDS WITH ADHD AND BEHAVIORAL PROBLEMS

Motion is helping kids improve test scores and stay more focused on school work, according to one Houston area school district that’s on the front-line of helping kids with ADHD and behavioral problems.

“Just think when we were kids, the teacher said stop, sit down, turn around, sit still,” said Best Elementary school principal Renee Canales. “Now we are like, get up, move, jump, run.”

Best Elementary is one of at least 14 schools in Alief ISD that have adopted Action Based Learning, ABL, labs or classrooms that include pedaling desks, elliptical, dancing stations, and other moving desks.

There is a science behind the ABL program.

When kids perform movements, they create pathways in their brains.

And when they’re learning math, science or reading at the same time, that subject matter “sticks” better in their minds. Canales said the program, which was introduced three years ago, is working.

“Knowing that our school had a history of low performing, I knew that we had to think outside the box and bring in some innovative programs,” said Canales. “We’ve had tremendous gains academically with our STAR scores. Our attendance has increased. We have reduced our office referrals.”

Canales said the kinesthetic desks are not for every student. There are regular desks in all classrooms. Teachers have been able to incorporate rotations so that every student gets a chance to work on the moving desks.

Taken from abc13

Posted in ADHD | Tagged | Leave a comment

Schools struggle as autism diagnoses rise 25 per cent

Schools are “struggling” to provide for autistic pupils following a 25 per cent increase in autism diagnoses in the past four years, according to government data and local area inspection letters.

The first published inspections of councils’ “local offers” for special education needs and disability (SEND) provision warn of rising autism referrals and lengthy waits – with a nearly 40 per cent increase in pupils with autism statements since 2012 in one area.

Of the 13 joint inspections carried out by Ofsted and health watchdog the Care Quality Commission (CQC), only one did not mention autism in their final letter – and 11 referred to “rising” demand for autism diagnoses or issues with service delivery. One letter was positive.

Sweeping reforms to SEND provision under the Children and Families Act of 2014 means children are now less likely to be seen as having behavioural needs and are instead recognised as autistic, said Kat Dockery, SEND co-ordinator at Greenwood academy in Birmingham.

“Pupils used to get statements for behaviour and it would be presented as a behavioural difficulty. With that category gone because of reform to the SEN code, they now look at it and think, ‘it might be autism’.”

Children once seen as having behavioural difficulties are instead recognised as autistic

The number of pupils with special educational needs – although not necessarily an official statement – reduced by 72,660 between 2015 and 2016, according to the government’s most recent census. The overall figure has dropped from 1.3 million to about 1.22 million.

But pupils with an autistic condition as their primary need on their statement or Education Health Care Plan (EHCP) now make up 25.9 per cent of all pupils with statements, compared with 24.5 per cent in 2015. Since 2012, there has been a 25.5 per cent increase in the prevalence of autistic conditions on statements overall.

In the inspection letters, Bolton council near Manchester was told providers in its area were “struggling to meet the demand for referrals and diagnosis for autistic spectrum disorders”, with a knock-on effect for behaviour in schools.

North Yorkshire was also told to improve post-diagnosis support following “a large increase in the number of children diagnosed with autism”, and in Nottinghamshire a group of schools was said to be “identifying a rise in the number of children and young people diagnosed with autism”.

Gloucestershire county council told Schools Week there had been a 35 per cent rise in children with autism over the past three years, while there was a 39 per cent increase since 2012 in the Greater Manchester combined authority.

Enfield in north-east London was congratulated for addressing rising levels of diagnosis.

Across 13 inspection letters from July to December –which are “narrative” rather than graded judgments – autism was mentioned more than 30 times.

Only one council’s letter, Stoke, did not mention it.

Other special needs such as dyslexia, anxiety, attention hyperactivity disorder (ADHD), Down’s syndrome and hearing impairments were infrequently mentioned, with Schools Week finding one instance of dyslexia, one of Down’s and two of ADHD.

Autism was possibly “the most complex of all special educational needs” because it varied so much between individuals, according to Dockery, yet it was hard to get funding because of some pupils’ high cognitive ability.

“Every pupil with dyslexia has a very similar profile, whereas with autism you can’t repeat your provision for one pupil again and again because they’re all so different.”

Rochdale borough council was told to submit a “written statement of action” after Ofsted and the CQC criticised high waiting times for autism diagnoses and a “lack of ability and expertise of mainstream schools” for pupils with autism.

Two of the council’s four areas of “significant weakness” related to autism. A spokesperson for Rochdale said rising diagnoses was “in keeping with a wider national and regional trend.

“We are aiming to put an ‘autism champion’ in every school to help to ensure the social and emotional wellbeing of pupils who need support.

“Additionally, despite the fact we are faced with the challenge of meeting increasing demands with limited resources, we are now completing a new SEND strategy that includes a significant increase in autism support.”

Taken from @ schoolsweek.

Posted in ADHD | Tagged | Leave a comment

Atopic Dermatitis Increases Risk for ADHD

Atopic dermatitis (AD) was associated with increased risk for attention deficit and attention deficit hyperactivity disorders (ADD/ADHD) in both children and adults, and risk was further heightened for those with more severe AD symptoms and frequent sleep interruption, according to a new analysis of US population-based surveys.

Jonathan Silverberg, MD, PhD, MPH, department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, and colleagues hypothesized that AD disease severity and sleep disturbance act in concert to increase the risk of ADD/ADHD. Their study is published, in an article titled, “Association between Atopic Dermatitis and Attention Deficit Hyperactivity Disorder in US Children and Adults,” in the November issue of the British Journal of Dermatology.

Previous studies have documented an association between childhood AD and ADD/ADHD, but Silverberg and colleagues noted that here has been little investigation of the possible association with atopic dermatitis in adults, or of the factors that may underlie the increased risk.

To examine the association and to search for underlying clinical factors and comorbidities, the investigators assessed cross-sectional data from 19 population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children’s Health 2003/4 and 2007/8.

Silverberg and colleagues found that severe atopic dermatitis and sleep disturbance independently and synergistically contribute to increased risk for ADD/ADHD in children and adults. Other conditions that appeared to further increase risk of ADD/ADHD in children with atopic dermatitis included asthma, anemia, headaches, and obesity.   In adults with atopic dermatitis, the increased risk for ADD/ADHD appeared heightened by comorbid allergic disorders, insomnia and headaches. The risk in adults with atopic dermatitis was found to be negatively related to body mass index (BMI), however, with less than average BMI characterized by the investigators as appearing “protective.”

“The reasons for these findings are still unclear,” Silverberg and colleagues indicated. “It is possible that children with severe AD have more severe symptoms of itch, causing them to exhibit more severe symptoms of inattention and hyperactivity.”

Other possible mechanisms suggested by the investigators include upregulation of neuroimmune factors in atopic dermatitis which could contribute to increased sensitivity to stimuli in ADD/ADHD.

“The relationship between AD, sleep disturbance and ADD/ADHD requires further exploration,” they concluded.

Taken from hcplive

Posted in ADHD | Tagged | Leave a comment

Subtle Signs May Lead to More Precise ADHD Diagnosis

Researchers are making progress toward characterizing different subgroups of attention-deficit hyperactivity disorder. Experts believe this differentiation could aid in determining optimal treatment options for patients based on their specific symptom profile.

In a new study, Penn State investigators discovered young adults diagnosed with ADHD may display subtle physiological signs that could lead to a more precise diagnosis.

Specifically, researchers discovered young adults with ADHD, when performing a continuous motor task, had more difficulty inhibiting a motor response compared to young adults who did not have ADHD. The participants with ADHD also produced more force during the task compared to participants without ADHD.

Attention-deficit hyperactivity disorder is a common childhood disorder that can continue to affect up to 65 percent of these children as they become adults, according to the researchers.

“A large group of individuals have the label ‘ADHD,’ but present with different symptoms,” said Dr. Kristina A. Neely, assistant professor of kinesiology.

“One of the goals of our ADHD research is to discover unique physiological signals that may characterize different subgroups of the disorder.”

Previous studies have shown that some individuals with ADHD may have poor control of their motor systems, but until recently, the way that it was measured was not very sensitive.

“In previous tasks, motor and cognitive function was evaluated with a key-press response: You hit the button or you didn’t,” said Neely.

“We measure precisely how much force an individual is producing during a continuous motor task. This type of task provides us with more information than the dichotomous ‘yes/no’ response.”

In a recent study using a continuous motor task, participants produced force with their index finger and thumb in response to cues on a visual display.

Participants were instructed to produce force when the visual cue was any color except blue. In the “blue” trials, participants were told to withhold force production.

Neely and colleagues found that participants with ADHD symptoms produced more force on trials when they were told to withhold a response, compared to those without ADHD.

Further, the amount of force that was produced during these trials was correlated with specific ADHD-related symptoms. The researcher was presented at the annual Society for Neuroscience meeting.

“The use of a precise and continuous motor task provides a more nuanced understanding of inhibitory control, compared to a button-press task,” said Neely.

“We found that young adults with ADHD produced more force on the ‘blue’ trials compared to young adults without ADHD. And the amount of force produced was related to self-report of ADHD-related symptoms of inattention, hyperactivity and impulsivity. Moving forward, we will manipulate the parameters of our force-production task to determine which aspects of motor control are related to specific symptoms.”

Taken from psychcentral

Posted in ADHD | Tagged | Leave a comment

Why and how doctors can treat ADHD?

Attention deficit hyperactivity disorder is a neurodevelopmental disorder of childhood and adolescence. It is a controversial subject for multiple reasons, including concerns about overdiagnosing the disorder, excessively medicating young children, why the prevalence is different among various countries and whether it is a real diagnosis.

The primary medications used to treat ADHD, methylphenidates and amphetamines, are controlled substances and can be abused, further exacerbating the controversy and concerns.

I have to admit that I was no stranger to these questions and have often approached patients with a good dose of skepticism. However, over the years, I have seen the impact that being “different” and being told that they are not doing things right, day in and day out, can have on children with ADHD.

TREATING ADHD

Children with ADHD are often perceived as kids who don’t listen, who misbehave and who sometimes take on the role of the class clown. They are often social outcasts due to their inability to manage their symptoms among peers and in the classroom. The persistent failure in multiple social and academic areas contributes to high rates of depression and anxiety seen in the population.

Not only does ADHD lead to poor achievement in school, it is also highly associated with conduct disorder, a condition with emotional and behavioral disturbances that can include physical aggression, lying, stealing and destructive and delinquent behavior.

Children with ADHD are also very impulsive and are more likely to experiment with drugs far sooner than children without ADHD, leading to more risk for developing addictions. All of this contributes to fewer opportunities for success in friendships and relationships and at school and work, paving the way for more depression and anxiety.

Medications are not the only way to treat ADHD. A big part of treatment for children is helping parents, teachers and other people around them to understand and be aware of the symptoms and to respond with firm kindness. They should put in place a clear and consistent structure, using behavioral methods and reward systems. When these measures alone are insufficient, medications can be beneficial when used judiciously.

There is more and more evidence to show that there are genetic and environmental factors contributing to the delayed brain maturation seen in ADHD. It affects certain regions of the brain, specifically those that control reasoning, logical thinking, planning, inhibition of behavior and paying attention.

As children grow, their brains also grow and adapt, resulting in improvement of much of the hyperactivity and impulsivity. Approximately half of the symptoms improve by late adolescence, and most adults can function without much impairment.

WHY TREAT ADHD?

Would it be better to wait until children grow up and “grow out of it”? There is no easy or correct answer to that question. ADHD affects between 5 and 7 percent of children in the U.S. That’s at least one child in every class of 20 who is at increased risk for the impairments associated with ADHD and myriad other issues, and it is one child too many.

Medications for ADHD have been shown to have more than marginal benefits. While overmedicating and overdiagnosing ADHD will need to be suitably addressed, treating those in true need will go a long way toward reducing the burden of ADHD in our children.

Dr. Emaya Anbalagan is a psychiatrist with Savant Care, an integrative mental health practice in Los Altos. For more information, visit savantcare.com.

Taken from losaltosonline

Posted in ADHD | Tagged | Leave a comment

Why it’s time to investigate the overlap between autism and ADHD?

The most influential psychiatric handbook prohibited a joint diagnosis of autism and ADHD until 2013. But the link could be significant

Until as late as 2013 a joint (or comorbid) diagnosis of autism and attention deficit hyperactivity disorder (ADHD) was not permitted by the most influential psychiatric handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is an essential tool in psychiatry as it allows clinicians and researchers to use a standard framework for classifying mental disorders. Health insurance companies and drug regulation agencies also use the DSM, so its definition of what does or doesn’t constitute a particular disorder can have far-reaching consequences.

One of the reasons for the prohibition of a comorbid diagnosis of autism and ADHD was that the severity of autism placed it above ADHD in the diagnostic hierarchy, so the inattention that is normally present in autism did not seem to merit an additional diagnosis. Nevertheless, that was an odd state of affairs, as any clinician working in the field would be able to quote studies that point to anything from 30% to 80% of patients with autism also having ADHD. More problematic still is the fact that patients with both sets of symptoms may respond poorly to standard ADHD treatments or have increased side effects.

The fifth edition of the DSM opened the way for a more detailed look at this overlap, and just a year after the new guidelines were adopted, a consortium (which I am a part of) at the Radboud University in Nijmegen (Netherlands) called NeuroIMAGE published a paper which showed that autistic traits in ADHD participants could be predicted by complex interactions between grey and white matter volumes in the brain.

Structures of the brain that were investigated in the research published in the journal Plos One. The caudate nucleus, which was found to be able to predict levels of autistic traits in ADHD participants, is shown in red.

A more general finding from that work was that autistic traits were significantly raised in ADHD participants, a curious result given that a diagnosis of clinical autism was an exclusion criterion for participation in the study. Raised levels of autistic traits in ADHD participants in the NeuroIMAGE study reflect the fact that autism is a spectrum disorder distributed throughout the entire population. Interestingly, research from last year shows that autistic traits are also much higher among scientists compared to the general population.

A paper (which I co-authored) published at the begining of this month in the journal Plos One, looking at MRI scans from over 500 participants in the NeuroIMAGE project has moved on to examine in detail the brain structures involved in the overlap of ADHD and autism. One structure in particular, called the caudate nucleus, was able to predict the level of autistic traits in ADHD, but similar to the earlier paper, a complex interaction was shown to be at work with another structure, the globus pallidus, also influencing results. Both of these structures are located in a part of the forebrain called the striatum that operates as a monitoring system for rewards, with the caudate guiding the selection of goals and the globus pallidus updating the reward value depending on the outcome of an action. With this kind of monitoring, the striatum plays a key role in planning, decision-making and motivation.

The results showed that autistic traits were highest when there was a coupling of higher caudate volume with lower globus pallidus volume. The statistical tools (called mixed-effects models) used in the paper were devised and optimised by a zoologist who has used similar models to study the transfer of information in flotillas of vultures as they optimise their search space while scavenging for food .

The latest findings add to a growing body of evidence that suggests that problems in the reward circuits of the striatum may lead to diminished motivation to attend to social stimuli, such as a smile or a frown or a voice. An earlier study in autistic children found a striking pattern of under-connectivity between voice-selective areas of the temporal lobe and nodes of the reward pathway suggesting that autistic children may not find voices inherently interesting. The first account of autism in the modern era, published by Leo Kanner in 1943, noted that one patient “did not register any change of expression when spoken to”. Kanner’s seminal paper contains many poignant descriptions of “social-blindness”, such as the case history of Elaine C, a seven-year-old girl, who did not look at a face when spoken to, was rarely communicative, never played with children but instead moved among them “like a strange being, as one moves between the pieces of furniture in a room.”

A consistent thread in autism research has been the inconsistency of results. Some groups have shown a larger caudate in autism while others have shown the opposite. Small sample sizes are partly to blame, but another problem is that levels of ADHD in autism are often ignored. This is a serious oversight, as the degree of ADHD present in autism can have a large impact on the results. The latest publication in Plos One goes some way to addressing these problems by drawing on a sample size of over 500 participants and more importantly by looking at the subtle hinterland between the two disorders rather than separating them into binary units.

There are many debates about the usefulness of the DSM since it first appeared in 1952. The first edition contained 130 pages and 106 diagnoses. Today’s edition runs to over 800 pages with almost 400 diagnoses, leading to criticism from Dr. Robert Spitzer, who was once the chairperson of a DSM task force, that the handbook has led to the medicalization of 20-30% of the population who may not have any serious mental health problems. Outside of this debate, it cannot be denied that the DSM has a large impact, positive and negative, on the way research is conducted but at least some of the changes to the fifth edition may lead to better clinical management of patients with both autism and ADHD. From a research point of view, the fifth edition of the DSM will certainly provide a better scientific framework for studying the overlap of these two disorders in more detail.
Taken from theguardian

Posted in ADHD | Tagged | Leave a comment

Several children hospitalized for taking classmate’s ADHD medication

Six children at Liberty City Elementary School have been transported to the hospital after ingesting a fellow student’s prescription pills.

According to the Miami-Dade County School Board, a fifth-grade student shared Clonidine, Friday morning, with several of his peers.

This medication is used to treat ADHD. It lowers blood pressure and decreases the level of certain chemicals in the blood.

Officials confirmed the medicine was prescribed by a doctor.

One concerned parent went directly to the school upon hearing the news. “My heart just like, oh, no. Hell, no. I need to go get to my child right now, so I’m here,” Laqesha Fulwood said. “Even if I had to walk here, run here, skip here, I’m here.”

“It’s real scary,” said parent Patrice Moore. “It starts from home first. That parent was aware that that child had it before they came to the school, and it’s not the school’s responsibility to keep up with a child with medication just because it’s prescribed through the parent to the child.”

The student, according to school officials, gave the medication to five other students.

“I got to get to the school,” said parent Kenya Brockington. “Like any parent, you’re going to be concerned about what’s going on, even if you don’t got all the details and the facts.”

Miami-Dade Fire Rescue transported the six students as a precaution to Jackson Memorial Hospital.

Parent Jenay Brown said a situation like this should be upsetting to all parents who send their kids to school. “It’s a concern. It should be a concern for all parents because you bring your children to school for education. You’re not expecting to get a call or anything about, ‘OK, get to the school because your child is sick.’”

Fulwood believes that these situations should be addressed at home. “People need to control their children at home and watch what their kids are doing,” she said. “Nowadays, people don’t have control, especially young parents. They don’t have control over their children.”

The condition of the affected children remains unknown.

Taken from wsvn

Posted in ADHD | Tagged | Leave a comment