The content of CADDAC's new paper on the impact of ADHD in the Canadian Justice system was recently featured on CBC Radio's "The Current". The half hour segment featured three interviews, a young offender diagnosed after several incarcerations, Heidi Bernhardt our Executive Director, and a lawyer who has worked with clients impacted by ADHD. Access this LINK to listen to the interview or read the transcript. Please spread the word far and wide by sharing the link with everyone you know.
If you have ever wondered how to respond when your friends and family question the validity of ADHD? Or do you get hot under the collar whenever you read another article telling you that ADHD is due to bad or lazy parenting or unmotivated or defiant kids? If so, you need to read Patricia Tomasi’s response to an article in the Huffington Post by Alyson Schafer. Not only does Patricia correct many of the mistruths in Ms. Schafer’s article she calls out the Huffington Post for publishing the article. The Huffington Post will most likely hide behind the fact that this is a commentary and not a factual piece. But let me ask you this, would they have published a commentary questioning the validity of depression as a disorder? Of course not, they would be tarred and featured. But for some strange reason people still use the fact that there is no blood test that can be used to diagnose the disorder as justification to question its existence. Well there are many conditions in mental and physical health that do not have a particular test that validates their existence, but that is why we use experienced physicians to rule out other disorders that could be causing the symptoms and validate the occurrence and history of the symptoms of the disorder, just as we do with ADHD. So the next time someone brings up the issue with you and you start to feel your blood boil, pull out Patricia’s article and know that she has it covered.
Access Patricia Tomasi’s article Here
Results of a recently published study, “A randomized, double-blind, cross-over, phase IV trial of oros-methylphenidate (CONCERTA®) and generic novo-methylphenidate ER-C (NOVO-generic)” confirms concerns expressed to CADDAC over the past number of years by adults with ADHD, parents of children with ADHD and physicians treating patients with ADHD who have been switched to a generic medication. The objective of this study was to evaluate adult ADHD subject outcomes when they were switched from a stable dose of CONCERTA® to the same dose of generic Novo-methylphenidate ER-C®.
The small study consisted of 20 participants with a primary diagnosis of ADHD. It consisted of two phases; 3 weeks of treatment with CONCERTA or generic Novo-Methylphenidate ER-C, followed by 3 weeks where participants were crossed-over to receive the other treatment. The effectiveness of each treatment was assessed through the use of the Treatment Satisfaction Questionnaires for Medication, Version II (TSQM-II).
A pharmacist, outside of the physician’s office was used to produce the medication. In order to maintain the “blind”, both CONCERTA® and novo-methylphenidate ER-C were put into a white opaque capsule. Neither the investigator, research team, nor the participant knew which medication was being taken during which three week period.
Results:
The participants treated with CONCERTA® were more satisfied in terms of the medication’s effectiveness and lack of side effects, than those receiving an equivalent dose of the generic version novo-MPH. These results were also supported by the physician-reported Clinical Global Impression (CGI) outcomes. The Clinical Global Impression – Severity scale (CGI-S) allows a clinician to rate the severity of a patient's illness. All study subjects chose to return to treatment with CONCERTA® at the conclusion of the trial. The researcher’s interpretation of these results was that the adults with ADHD were satisfied and feeling better with CONCERTA ® treatment than with the generic form of the medication.
The paper explains that when a generic medication is deemed to be bioequivalent by Health Canada it is assumed that it will provide patients the same therapeutic effect and the same level of tolerability (number and degree of side effects) as the branded drug. The paper then goes on to explore a potentially serious issue, since the generic medication was deemed to be bioequivalent by Health Canada - if the study’s results indicate clinical differences between the generic and brand medication, at least for those patients who have been stabilized on the brand medication, is the current method of determining bioequivalency sufficient to ensure equivalent treatment when switching a person to the generic product? At this time, the only criteria requirement for bioequivalency is that - at any given time - the amount of medication in the bloodstream must be 80% to 125% of the amount of the same medication that would be in the blood stream if the brand medication was taken. Differences in the delivery system of the medications are not taken into account when determining bioequivalency.
The paper also looks at the risk of substitution with a generic product when only comparing cost benefits of generic medications. Things such as costs of increased doctor and emergency room visits, and nonadherence to the treatment may cost much more in the long run. The paper closes with a call for further investigation into all these questions and concerns.
Some researchers around the world have been thinking about a different way to think about mental and neurological disorders. They have found that current diagnostic categories may not align with new genetic and neuroscience findings. A unique Ontario project, the province of Ontario Neurodevelopmental Disorders (POND) Network is studying multiple disorders at the same time looking for patterns that will lead to a better understanding of the underlying neurobiology. The hope is that this research will lead more effective treatments.
Researchers acknowledge that to date separating and classifying the disorders has helped them to distinguish between disorders and collect statistics aiding in the development of health strategies, but recent research into genetic mutations has been “the big poke in the eye, if you will – the thing that made it impossible to go any further,” he says.
Research found hundreds of possible mutations when looking at Autism, but also discovered that these mutations were not only seen in Autism, but also appeared in other neurodevelopmental disorders. Researchers now realize that there new goal is to figure out what is common among the disorders and what differs.
This new approach does not conduct separate studies but rather looks for traits. An excellent example is a recent study which looked at the ability of study participants with Autism, ADHD and OCD to read other people’s emotions by looking at their eyes. This has generally been thought to be an Autism trait, but researchers found the same trait in participants with ADHD. Therefore children with ADHD will also struggle with impaired social functioning.
Access the full article HERE
I was just interviewed about a recent study published in the Journal of Pediatrics. This study looked at data from 378,881 children, ages 4-17, from 1997 to 2011 in Taiwan and analyzed the percentage of children who were diagnosed with ADHD and prescribed medication. Researchers compared the percentage of children diagnosed from youngest to oldest in a particular grade and found the younger the child (born closer to the cut off for enrollment in that year) the greater chance they were diagnosed with ADHD and treated with medication. The data was consistent for this finding in pre-school and school age children, but not adolescence.
Several things struck me while reviewing the study and the researcher’s conclusions. Here are my comments;
The findings are important for medical professionals, educators and perhaps parents to take note of, as are most research findings;
If the child’s age and maturity may be in question further monitoring may be a first step,
Since professionals who diagnose ADHD are trained in child development, one would think varying rates in development should already be on their radar, but reminders never hurt;
While the data is of interest, conclusions should not be drawn too quickly;
Since we know that many factors such as, higher levels of intelligence, parental support and lack of hyperactivity, to name a few, can delay or prevent the diagnosis of ADHD even when it exists, perhaps the data may be indicating that the older the child (in that school year) the greater risk of being undiagnosed and untreated. The increased age and maturation level may be masking their ADHD symptoms.
Of further interest, is that these researchers give us significant insight into their bias with their statements, ”On the basis of the aforementioned studies, we conclude that the relative age among classmates affects the academic performance of children and their risk of receiving ADHD diagnosis and medication. Furthermore, clinicians should be reminded of the potential harm of overdiagnosing and overprescribing.”
Access more information on the study HERE
The title says it all. Access this great blog post in the Huffington Post by Dr. Diane McIntosh, psychiatrist and assistant clinical professor at the University of British Columbia Here.
The subjective nature of tools used to assess ADHD, such as rating scales and feedback from parents and educators has long been criticized by media and naysayers even though all mental health disorders are diagnosed in this manner. For this reason a recent study’s findings may be are of interest to the ADHD community. Weidong Cai PhD, an instructor in psychiatry and behavioural sciences and the study’s lead author indicated that it would be very beneficial to have a diagnostic measure that uses more objective and reliable measures.
The team of researchers studied functional magnetic resonance imaging brain (MRI) scans from 180 children, half with ADHD and half without. The children were also assessed for ADHD with the usual diagnostic tools. The team focused on a set of brain regions that work together to help decide where one’s attention should be directed. They scored each brain according to its level of synchronization.
The study found that interactions between three brain regions that assist us with paying attention were weaker than normal in these children. Brain circuits that help us to stay focused and stop day dreaming had less influence on the brain activity of children with ADHD. Dr. Vinon Menon, the study’s lead author reported that issues with these three brain networks continuously showed up regardless of which cognitive task the children were asked to do.
The difference was significant enough that brain scans could distinguish between those children with ADHD and those without. In addition, the severity of their ADHD correlated with the degree of weakness.
Future research is required to assess whether functional MRIs can be used to differentiate between brains of children with ADHD and other conditions and as an ADHD diagnostic tool.
Access more detailed information Here
A recent study will be of interest to parents of children with ADHD who have a history of severe mental illness. The study looked at 141 children and young adults in Nova Scotia, taking stimulant medication, who have a parent with a history of serious mental illness such as a major depressive disorder, bipolar disorder, or schizophrenia. The study found that nearly two thirds of the study’s participants experienced a psychotic side effect such as hallucinations, delusions, hearing voices, and/or perceptual disturbances. Past research has shown that the same type of psychotic effects were found in one-quarter of children and young adults, with this family history, who had not taken these medications. While these side effects have been known for some time the quantity seen in this research was surprising.
Dr. Rudolf Uher at Dalhousie University in Halifax, the lead author of the study noted that this study by no means indicated that stimulant medication treatment, which can be very helpful for these children should be stopped, however it should alert physicians that they need to actively ask children and young adults about any unusual experiences. Dr. Uher noted that children rarely tell people about these experiences unless asked.
The study was not designed to prove cause and effect only that there was an association with taking these medications and psychotic effects.
Access additional information Here
Two large case-control studies from three Massachusetts health care systems has found no evidence that prenatal exposure to antidepressants increases the risk for autism or attention-deficit hyperactivity disorder (ADHD). Any increase of Autism or ADHD found in previous studies is thought to be due to the severity of the mother’s depression, which is a known risk factor, rather than the use of antidepressant medication.
These new finding should bring some reassurance to expectant mothers’ faced with a decision about taking antidepressant medication throughout their pregnancy.
The study looked at data form more than 1200 children with an autism related diagnosis and 1700 children with ADHD to control large groups of children with no neuropsychiatric diagnosis. The fact that both autism and ADHD incidence rates increased in children of women who were taking antidepressant medication or experiencing psychotherapy prior to becoming pregnant, indicates that the risk factor is actually the severity of the depression rather than use of antidepressants during pregnancy.
Dr. Perlis senior author of the report stated "While taking any medicine during pregnancy can be a difficult decision, we hope the results of our two papers - which now cover more than 2,500 children with autism and almost 4,000 with ADHD - will provide some reassurance to women concerned about getting treatment for depression or anxiety during pregnancy. While there are depression treatments that don't involve medication, for some patients they are not effective, available or preferred. We want women and the clinicians working with them to be as informed as possible when making this decision."
Access more information Here
A new Australian study looked at why some children with ADHD present quite late without having receiving any professional services. Researchers wanted to understand what drives parents to look for medical services for their child’s issues. The study collected information on 179 children ages 6 to 8 who met the diagnostic criteria for ADHD from 43 schools in Melbourne and found that 37% had not received any professional services within the past year. The researchers found families sought out help more for older children and children whose behaviour impacted the family. When impact on the family increased it doubled the likelihood that that child had received services.
This is of significant concern because research tells us that in fact it is the impairment in attention regulation and not the outward hyperactive or impulsive behaviour that causes the most impairment for these children, especially academically. These research findings may also be helpful when looking at why fewer girls are diagnosed at earlier ages.
The parent’s mental health, education level or socioeconomic status did not influence whether parents had accessed services for their child. Of the 17% who had been diagnosed before the survey 94% had received services. Fifty-seven percent had not been diagnosed before the survey. One of the physicians who commented noted that when they finally diagnosed older children parents frequently stated that symptoms had been evident for many years.
To access the full article
