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Attention Deficit Hyperactivity Disorder in Children

Attention Deficit Hyperactivity Disorder has long been a problem for children and their families. Part of this information is presented with the permission of Matt Barcellona, Colin Bridgeman, and Christopher Petersen of The Penn State College of Medicine. The information presented at this site is for general use only and is not intended to provide personal advice or substitute for the advice of a qualified professional. If you have questions about the information presented here, please consult a physician, the resources listed, or other professional in your area.

Kids on Behavioral Meds

The Child Advocate is devoted to children and the parents and professionals that work with them and advocate for them. Children on medication for behavioral problems is a major concern for parents. The information presented at this site is for general use only and is not intended to provide personal advice or substitute for the advice of a qualified professional. If you have questions about the information presented here, please consult the resources listed or other professional in your area. US kids on behavioral meds tripled in a decade NEW YORK, Apr 25 (Reuters Health) – The number of children in the United States prescribed medications to treat depression, attention-deficit/hyperactivity disorder (ADHD) or other behavioral conditions nearly tripled between 1986 and 1996, according to the results of a study. The overall annual rate for the prescription of these types of medications–called psychotropic medications because they aim to treat emotional/behavioral conditions–was 14 children per 1,000 in 1987 and increased to 39 children per 1,000 in 1996, the investigators found. In the study, Dr. Mark Olfson of Columbia University in New York City and colleagues reviewed surveys of medication use for more than 50,000 people including about 17,000 children under the age of 18 years in 1986 and 1996. The findings are published in the May issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Olfson and his team found that the number of children taking stimulants such as Ritalin and Adderall, used to treat ADHD, quadrupled from 6 children per 1,000 in 1986 to 24 per 1,000 in 1996. Those taking antidepressants such as Prozac or...

Discipline Disputes

Continued behavior problems often indicate that a child’s program is not appropriate. If parents suspect that behavior problems are preventing their child from succeeding at school, they should write to the principal and request an IEP Team Meeting or “Pre-Hearing Conference.”

AD/HD under IDEA

What You Need To Know About AD/HD Under The Individuals With Disabilities Education Act (By Matthew Cohen, JD)

Attention disorder affects teens’ driving skills

Last Updated: 2002-10-28 10:00:30 -0400 (Reuters Health) By Paula Moyer SAN FRANCISCO (Reuters Health) – The already-steep learning curve for adolescent drivers is a mountain for those who live with attention-deficit/hyperactivity disorder (ADHD), according to Dr. Daniel J. Cox, speaking here at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry. “Motor vehicle accidents are the leading cause of death in adolescents, and the rate for such deaths is four times higher for adolescent drivers with ADHD,” Cox told Reuters Health. “The key ADHD-related problem that interferes with safe driving is inattention. However, when treated with stimulant therapy, adolescents with ADHD drive as well as those without this condition.” He is a professor of psychiatric medicine at the University of Virginia in Charlottesville. People with ADHD have difficulty focusing their attention and controlling their behavior. A mainstay in the treatment of ADHD is stimulant medication, typically methylphenidate (Ritalin, Adderall, Concerta). One issue that can affect the safety of a driver with ADHD may be the type of stimulant therapy he or she is taking and the timing of the dose, Cox said. Because the most common forms of stimulants for ADHD wear off quickly, an evening dose may be appropriate for a teenager with ADHD who will be driving in the evening. In a study presented here, Cox and colleagues compared the effects of an immediate release version of methylphenidate with a sustained-release version taken once daily (Concerta). In particular, the investigators wanted to see the different effects these medications had on the driving performance throughout the day among adolescent drivers who had ADHD. They...

ADHD and Brain Imaging

BRAIN-IMAGING STUDY SHEDS MORE LIGHT ON UNDERLYING CAUSE OF ATTENTION-DEFICIT HYPERACTIVITY SYNDROME Lancet 2003; 362 : 1699-1707 Results of a US study in this week’s issue of THE LANCET provide details of the underlying physical causes of attention-deficit hyperactivity syndrome, with reductions in size of some brain areas and an increase in grey matter proportions being characteristic of children with the disorder. Attention-deficit hyperactivity disorder (ADHD) is a serious neuropsychiatric problem in schoolchildren (an estimated 3-6% of US schoolchildren are affected, for example). The disorder is characterised by poor attention span, impulsivity, and high motor activity. Its nature and cause are poorly understood, although previous research has suggested that structural changes in areas of the brain controlling attention are responsible for the disorder. Elizabeth R Sowell, Assistant Professor of Neurology from the Laboratory of Neuro Imaging at the University of California Los Angeles, USA, and colleagues undertook the first detailed morphological study using high-resolution magnetic resonance imaging (MRI) and sophisticated computational systems to more accurately determine the specific areas of the brain underlying ADHD. Brain assessment of 27 children (11 girls, 16 boys) and adolescents with ADHD was compared with that of 46 control children without ADHD who were matched for age and sex. Abnormal brain structure was observed in the frontal cortices (on both sides of the brain) of children with ADHD, with reduced regional brain size localised mainly to small areas of the dorsal prefrontal cortices. Children with ADHD also had reduced brain size in anterior temporal areas, also on both sides of the brain. Substantial increases in grey matter were recorded in large portions of the...

House Democratic Policy Committee’s Public Hearing on the Use of Ritalin

Testimony by House Democratic Policy Committee’s Public Hearing on the Use of Ritalin Presented December 14, 1999 and Revised 2005 Issues Definitions of ADHD Associated conditions Treatment issues   ADHD issues in adults   Is this a marketing scheme to sell Ritalin? No, the use and effectiveness of Ritalin is well established. Ritalin is referenced in 1157 studies in medical journals from 1960 to 1999 and the evidence overwhelmingly supports the therapeutic benefits. About 100 years ago Dr. Still, a pediatrician, defined the disorder.   Original symptoms included hyperactivity, learning problems, inattention and conduct problems.   Is ADD/ADHD just new name for old-fashioned hyperactivity? The name is not as important as the key concept of inattention. Many names are associated with this problem of inattention. Minimal Brain Dysfunction (MBD) was an early name. Others include Hyperactive Child Syndrome Attention Deficit Disorder (ADD) was introduced in 1980   Attention Deficit Hyperactivity Disorder (ADHD) since 1994   Does everyone have ADD? No, a longstanding dysfunctional pattern is necessary. Symptoms or features must be distinguished from a life long pattern before 7 years old. Exuberance is different from symptoms way beyond average and causing dysfunction in life. Using standard rating scales such as Conners or others is necessary for assessment.   Rule out other disorders that can cause similar symptoms   What are the criteria? Inattention   Careless mistakes Not listen   Fail to complete tasks   Impulsivity Frequently interrupts   Shouts out answers   Hyperactivity   Fidgeting Out of seat   Excessive talking   Is the disorder mostly in boys? Yes, boys are often inattentive and hyperactive. Girls do have the...

Multimodal Treatment Study of Children with ADHD (MTA)

 Matt Barcellona  Penn State College of Medicine 2002 Goal of study: 3 Questions 1) How do long term and behavioral treatments compare with one another? 2) Are there additional benefits of combining medicinal and behavioral treatments? 3) How does careful systematic treatment compare to routine community care?   Study Design: 4 Groups (Strategies) 1)Medication management 2)Behavioral Treatment 3)Combined Treatment 4)Community Care number of children = 579 over 14 month period   6 Major Outcome Domains 1) ADHD core symptoms (inattention, impulsivity, hyperactivity) 2) Oppositional/Aggressive symptoms 3) Social skills 4) Internalizing symptoms 5) Parent-Child relations 6) Academic achievement   Results & Conclusions – All groups showed marked reductions in symptoms over time, with significant differences in degrees of change. – Med management superior to behavioral treatment in controlling core symptoms of ADHD (parents/teachers). No significant difference on other domains. – Combined treatment and med management were superior to behavioral treatment in controlling core symptoms (parents/teachers) while Community Care was NOT. – No significant advantage of combined therapy versus medications alone on any domain -combined treatment consistently used lower doses than med management – Combined treatment superior to behavioral treatment on 4 domains: 1) Inattention (parents/teachers), Hyperactivity-Impulsivity (parents) 2) Oppositional/Aggressive behaviors (parents) 3) Internalizing symptoms (parents) 4) Academic achievement (reading) – Combined treatment was superior to Community Care on all 6 domains (parents). – Treatment satisfaction scores for parents of combined and behavioral treatments were superior to Med management parents.     Presentation References 1) Abukoff, HB, et al. “A 14-Month Randomized Clinical Trial of Treatment Strategies for ADHD.” Archives of General Psychiatry. Vol 56. Dec. 1999. p1073-1085. 2) Brown, Ronald...

Children and Psychiatric Medication – a multimodal presentation

Children’s Medications – a multimodal presentation A Presentation from  Penn State College of Medicine Supported in part by an advocacy grant from The American Academy of Child and Adolescent Psychiatry 2005 – 2008 Chrome browser users may need the IE-On-Chrome extension added to their browsers to view this presentation. On your browser go to “More tools”, then “Extensions”, then Get more extensions to find it. Highlights of the presentation on psychiatric medication for the child include: Medication in ADHD, Anxiety and Depression Multimodal Treatment Study of Children with ADHD (MTA) Pediatric OCD, Treatment of OCD, and Cognitive Behavioral Therapy Treatment of Adolescent Depression Study...

ADHD and Tourette Treatment

ADHD and Tourette Syndrome:  A Treatment Challenge  Colin Bridgeman Pennsylvania State University Penn State College of Medicine 2004   Tourette’s Syndrome or Disorder (TS):   1)   First described by Georges Gilles de la Tourette in 1885   2)  Epidemiology:   A)  The occurrence of Tourette Syndrome in school-age populations has been reported to be anywhere from 0.7% to 4.2% depending on the diagnostic criteria used. B)  The mean age of onset is 6.7 years. (Robertson 2003)   3)  Diagnosis criteria from Tourette Syndrome Classification Study Group:   A) multiple motor tics and one or more phonic tics must be present at some time during the illness B) tics must occur many times a day, almost every day or intermittently throughout a period of more than a year C) the anatomical location of the tics, type, complexity, or severity of the tics must change over time D) onset must be before age 21 E) must not be explainable by other medical condition F) tics must be witnessed by reliable examiner     Attention Deficit Hyperactivity Disorder (ADHD):   1)  Epidemiology:   A)  The prevalence of ADHD is estimated to be between 8-10% in school-aged children. B)  Four times more common in boys than girls C)  Three subtypes of ADHD exist including: Inattentive, Hyperactive-Impulsive, and Combined   2) Diagnosis Criteria for ADHD from DSM IV include, but not limited to:   A)  Symptoms of inattention and/or hyperactivity and impulsivity, such as fidgeting, failure to pay attention to details, difficulty organizing tasks, easily distracted, and interruptive. B)  Symptoms present for at least six months C)  Symptoms present in more than one setting D)  Symptoms present before age seven E)  Symptoms impair academic, social, or occupational activities...

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