Canadians are being asked to Participate in the 2016 ADHD Challenge

Help raise ADHD awareness, show off your skills and help raise funds for ADHD Awareness and advocacy work across Canada, all at the same time!

The Centre for ADHD Awareness, Canada (CADDAC) urges every Canadian to participate in a challenge of their choice for the month of October in an effort to raise awareness of ADHD and help raise funds for ADHD awareness and advocacy work across Canada.  Whether you are 6, 16 or 60+ we want you to decide on a personal challenge that you want to complete during the month of October, ADHD Awareness Month, and complete the challenge with the support of your sponsors. For more details access the CADDAC web site

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.

At the beginning of March CADDAC received a reply letter from Health Canada.View this letter Here.The letter reiterated what we have been told previously.Health Canada requires official reporting of a decrease in effectiveness of a generic when compared to the brand medication to scientifically validate this information. Health Canada states,"Consumers are encouraged to complete reports in conjunction with their health professional, so that additional information about their medical history can be included in order to make the reports more detailed and scientifically valid."

If you have had an issue with an ADHD or other mental health generic medication not being as effective or lasting as long as the brand name, we strongly encourage you to access our Adverse Reaction Form and Guide to assist you with submitting an online report. Also please encourage your physician to do so as well. If this reporting does not occur issues with generic medication substitution proving inferior will not be solved.

Ontario now requires that a trial on a generic or two generics, if two are available, with an adverse event (AE) report completed for each before a pharmacist will honor a "do not substitute" request from a physician for any  medication supplied by the OPDP (Ontario Public Drug Plan). The physician will need to supply the patient with copies of both AE reports with the prescription in order to get full coverage of the brand medication. You can access complete details Here.

Please note: This only applies if the government pays the full price for the brand name medication. If the patient has a patient benefit card, which can be accessed through Innovicares the price of a brand product is covered and trials on generic medications are not required. For more information on which medications are covered please access Innovicares Here (https://www.innovicares.ca/)

If you have an interest in ADHD in females, how symptoms differ in girls, how we under diagnose and misdiagnose it and the consequences of this, you don't want to miss this recording. The interview features Anna, a every insightful 17 year old who was diagnosed with ADHD at the age of 15, and Katherine Ellis, a Pulitzer Prize winning journalist who was diagnosed at 48 and has since then authored three books on ADHD, talking about their experiences. In addition, Dr. Doron Almagor, a child and adolescent psychiatrist and chair of CADDRA, shares his extensive medical knowledge on the subject of ADHD in girls. Access the interview 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