Study: ADHD Drugs May Help Boost Child’s Test Scores

By Denise MannMONDAY, April 27, 2009 ( — New York City mom Nancie Steinberg recently received some great news at a parent-teacher conference for her 11-year-old son. The medication that her fifth grader takes to treat his attention deficit hyperactivity disorder (ADHD) seemed to be making a difference in the classroom. “The teachers always had to have him by their right kneecap to keep him focused, but now they feel that he is very focused, an active participant and overall his academics are better,” she says, breathing a sigh of relief.

Now, if a new study is correct, these improvements may actually spill over to his performance on standardized math and reading tests. Elementary school-aged children with ADHD who take medication seem to do better on such standardized tests than their non-medicated peers with ADHD, according to a study in the May issue of Pediatrics.

“Previous research has shown that when children are medicated for ADHD, they get better grades, their teachers like them more, they are less impulsive and they stay focused longer, but we have never been able to say that they learn more, until now,” says lead study author Richard M. Scheffler, PhD, the distinguished professor of health economics and public policy in the School of Public Health and Goldman School of Public Policy at the University of California at Berkeley.

The gains seen in test scores, however, do not erase the test score gap seen between children with ADHD and their peers who do not have the behavioral disorder, the researchers say. About 4.4 million children in the United States have ADHD, which is marked by impulsivity, hyperactivity, and difficulty focusing.

In the study, the researchers looked at survey data from more than 21,000 children who entered kindergarten in 1998 and were followed through fifth grade. They took a closer look at 594 children diagnosed with ADHD who had survey data from all five years. The children with ADHD who took medication scored 2.9 points higher in mathematics tests and 5.4 points higher in reading tests than their peers with ADHD who were not taking medication.

Next page: Gains equivalent to two to three months of school

What does this equate to in the classroom setting? In general, all children gained 90.2 points in average math scores between kindergarten and fifth grade. So the 2.9-point difference in math scores was the equivalent of the gains achieved in about two months of a school year, and the 5.4-point difference in reading scores was roughly equal to three months of schooling. Now, the researchers plan to follow these kids through middle school and beyond to see whether continued medication use has lasting effects on academic achievements.

Still, taking ADHD drugs alone was not enough to close the gap in test scores between kids with ADHD and their ADHD-free peers, the study showed.

“Medication improved math and reading scores, but it did not bring these kids up to the average of kids without ADHD, so other things are necessary,” Scheffler says. “Treating a child for this disorder is a team sport, and medication, if appropriate, is one player.”

Study co-author Stephen P. Hinshaw, PhD, the chair and professor of psychology at the University of California at Los Angeles at Berkeley, agrees. “Medication alone is hardly ever an adequate treatment for ADHD,” he says. “In the realm of academic achievement, it usually takes a team approach—behavioral strategies consistently practiced by parents, teacher [involvement and] direct tutoring before major gains are seen,” he says. Parents can help by giving children more structure, including regular schedules and set bedtimes.Next page: Why turning off the TV can help

Stephen Grcevich, MD, a child and adolescent psychiatrist in Chagrin Falls, Ohio, says parents can also help their children “by turning off the TV and the computer, reading together with their child, taking an interest in their schoolwork, developing a positive collaboration with their child’s teacher and advocating with their child’s school for appropriate evaluation and testing of possible learning disabilities when academic achievement lags behind academic ability.”

More than half of kids with ADHD do take prescription medications to control the symptoms, but this is not a decision that parents like Steinberg enter into lightly. Some parents may fear that there is a stigma attached to taking drugs for behavioral issues, while others may worry about the potential side effects, including poor appetite. In the study, 90% of the children taking ADHD medication were taking stimulants, which may cause poor appetite, weight loss, and sleeplessness.

“It is a balancing act,” Scheffler explains. “Children with untreated ADHD have serious problems in school, they are more likely to drop-out of school, become substance abusers, and they don’t get along well with their peers, but these drugs do have side effects,” he says.

Hinshaw says the “study should allay concerns that the medications act only to make children more compliant and docile.” He adds, “the medication is linked to improvements in reading and math as well.”

The study does suggest that ADHD is a serious condition that has a negative impact on learning, says Dr. Grcevich. “Amidst all the media hype about medication safety and side effects, this study helps demonstrate that there are real risks to the decision to not use medication as a component of a comprehensive ADHD treatment plan.”

The National Institute of Mental Health funded the study.

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Study Links ADHD Stimulants to Rare, Unexplained Deaths in Children

By Amanda MacMillanMONDAY, June 15, 2009 ( — After years of speculation and rare case reports, a study suggests that stimulant medication—mostly used to treat attention deficit hyperactivity disorder (ADHD)—may have played a role in a handful of cases of sudden, unexplained death in children and adolescents.

The study authors stress, however, that parents and doctors should not refrain from treating children with ADHD just because of these results.

“The association is significant in that it’s real, but that doesn’t mean it’s not a very low risk,” says lead author Madelyn S. Gould, PhD, a professor of psychiatry and public health at Columbia University, in New York. “There probably does need to be more careful monitoring, but the bottom line is that parents should not take their children off stimulant medication they’re currently on and should not be scared to have their child go on a stimulant if that’s what they and their doctors decide is the best thing for their child.”

The study, published this week in the American Journal of Psychiatry, is the first to suggest that the stimulants may pose a risk—albeit remote—in children without underlying heart problems. About 2.5 million children in the United States take such medications.

Next page: Stimulants linked to 1.8% of unexplained deaths

Gould and her colleagues compared medical records and parent interviews of children and adolescents who had died between the years of 1985 and 1996, including 564 who had died due to an unexplained heart-rate abnormality or other causes, and 564 who died as passengers in motor vehicle accidents. They excluded cases with other known possible causes of death, such as asthma or congenital heart diseases.

Of all the unexplained cases, the researchers found that 10 children, or 1.8% of the group, had been prescribed stimulant medication. This compared to only two cases of stimulant use, or 0.4%, among healthy children who had died in motor vehicle accidents—a group used to represent a general population of healthy children and adolescents.

In all 10 cases, the children were taking methylphenidate, the active ingredient in Ritalin and Concerta. A similar drug, Adderall, is composed of mixed amphetamine salts and was not included in the study results because it was first approved in 1996.

However, the Food and Drug Administration in 2006 asked the manufacturers of stimulants, including Adderall, to add a warning to their label saying the medications should not be used in children with structural heart abnormalities or other heart problems. At the time, the FDA advisory panel rejected a more stringent black-box warning about the possible risk of sudden unexplained death.

Strattera, another medication approved for ADHD in children, is not a stimulant medication.

A spokesperson for McNeil Pediatrics, which distributes and markets Concerta, says the company welcomes any data that add to the body of knowledge in this therapeutic area, but did not make a specific comment on the new study.

Michael Billings, a spokesperson for Novartis, the manufacturer of Ritalin, notes that the drug has been used for more than 50 years and is the most studied ADHD medication.

“For all of its products, Novartis reviews its global safety and efficacy through post-marketing surveillance and consistently reports new information to health authorities on an ongoing basis,” says Billings.  “Review of Novartis safety data has failed to detect an increased risk in sudden cardiac death associated with methylphenidate use.”

Next page: Not a watershed moment, researchers say

Gould says it’s important to report this association, but she is also concerned about the results being misinterpreted. “We’re very sensitive to not wanting this to be some watershed moment where stimulant medications start to get used less and get used inappropriately,” she explains.

In an editorial accompanying the article, Benedetto Vitiello, MD, and Kenneth Towbin, MD, of the National Institute of Mental Health (NIMH), agree with Gould’s concerns.

They write that the study findings “should underscore that stimulant medications are not innocuous and that their therapeutic use requires careful diagnostic assessment, diligent safety screening, and ongoing monitoring.

“However, it is equally clear that sudden, unexplained death is a rare event, this is only the first such study, it relies on small numbers, and it is not possible to quantify the risk beyond estimating that it is very small.”

Indeed—since a double-blind, placebo-controlled trial isn’t ethically possible in this situation, it is hard to conduct a study that’s not without flaws.

Although the researchers are confident that the results are not due to any underlying factors—children with ADHD often have asthma and heart conditions also linked with sudden death, and so these cases were eliminated from the analysis—“one can never be 100% sure that there aren’t other unknown or undiagnosed issues,” says Gould.

James Perrin, MD, a professor of pediatrics at Harvard Medical School and Massachusetts General Hospital for Children, says the study isn’t surprising “nor particularly convincing.” He says the research is flawed because, among other problems, it may have underestimated the number of children who were taking stimulants. The rate of stimulant use, particularly in the accident-related deaths, was lower than expected, he says.

“The study adds very little to what we already know, i.e., that some children who receive stimulants experience sudden unexpected death,” says Dr. Perrin, who was not involved in the study. “The current study should not change the use of any medications or treatments.”

Next page: More research, careful monitoring is needed

Stimulant medications currently contain a warning targeted to specific high-risk children, including those with structural heart defects, cardiomyopathy, or heart-rhythm disturbances. The medication labels also warn that stimulants may raise blood pressure and heart rate, and have been linked with stroke and heart attack in adults.

When deciding whether to put a child on stimulant medications, both clinicians and parents should weigh the seriousness of the situation, says Gould. The benefits may not outweigh the risk in cases in which attention problems may be keeping a B-student from becoming an A-student, she explains.

But with more serious cases, the choice should be clearer. Untreated ADHD can be harmful in itself, leading to poor performance in school and increasing adolescents’ risk for harmful behavior such as reckless driving, unsafe sexual practices, and substance abuse.

“I have two boys, now grown, so I can certainly relate to parents facing these decisions,” Gould says. “If my child was having problems to the extent that a neurologist or psychiatrist was recommending medication, I would want the medication—although, even though we didn’t discuss this specifically in the study, I would want my child to have an EKG.”

In 2008, the American Heart Association recommended that doctors consider routine electrocardiograms (EKGs) prior to starting children with ADHD on stimulants or other psychotropic medications, but underscored the need for future research. An EKG may help to detect cardiac abnormalities that would increase a child’s vulnerability to sudden heart problems.

Parents considering stimulant medication for their children should also provide their doctor with a detailed family history, including any heart problems or sudden deaths of close family members.

Future research should focus on new ways to detect which children are most at risk for sudden death when taking stimulants, says Gould, since not all cases seem to be detectable with routine screenings. Until then, a thorough examination and careful monitoring is the best way to reduce a child’s danger.

The study was funded by a grant from the NIMH and a contract with the FDA.

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Drop That BlackBerry! Multitasking May Be Harmful

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By Theresa TamkinsMONDAY, Aug. 24, 2009 ( — Ever find yourself chatting via instant messaging while checking your email and surfing the Web? Well, don’t pat yourself on the back for your super-productive behavior.

A new study suggests that people who often do multiple tasks in a variety of media—texting, instant messaging, online video watching, word processing, Web surfing, and more—do worse on tests in which they need to switch attention from one task to another than people who rarely multitask in this way.

Specifically, heavy multitaskers are more easily distracted by irrelevant information than those who aren’t constantly in a multimedia frenzy, according to the study in the Proceedings of the National Academy of Sciences.

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One reason may be because the multitaskers tend to retain the distracting information in their short-term memory, which affects their ability to focus, compared with people who don’t check their email while talking on the phone and sneaking in some online shopping.

“This study adds to a growing body of literature that says, in general, that multitasking is going to be problematic for people, that it does compromise productivity, and that its consequences can be quite severe in situations like driving,” says David W. Goodman, MD, the director of the Adult Attention Deficit Disorder Center of Maryland, in Baltimore, who was not involved in the research.

Next page: Multitaskers didn’t perform as well

In the study, Clifford Nass, PhD, and colleagues at Stanford University gave 262 college students a questionnaire about what types of media they used and how often they used them simultaneously. Examples included video or computer games; online audio, video, or television; telephone and cell phones; instant and text messaging; and other computer-based applications, such as word processing.

The volunteers then took a series of tests in which they had to categorize words, evaluate on-screen red triangles (while ignoring blue ones), switch back and forth between classifying letters and numbers, or press a button when there was a match between two letters presented at different times.

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After jumping through the mental hoops, the researchers found that the heavy multimedia users were at a disadvantage. Compared to those who rarely used more than one type of media at a time, heavy multitaskers had slower response times, most often because they were more easily distracted by irrelevant information, and because they retained that useless information in their short-term memory.

While the delay was only about half a second in some tests, this could be enough to cause problems in everyday life, says Dr. Goodman, who is also an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

“You’re being flooded with too much information and you can’t selectively filter out quickly which is important and which is not important,” says Dr. Goodman. “It only takes a fraction of a second for you to take your eyes off the road and miss the guy making a right-hand turn into your lane.”

Gary Aston-Jones, PhD, the Murray chair of excellence in neuroscience at the Medical University of South Carolina, says the findings suggest there may be a cost associated with becoming an expert multitasker.

Multitasking may “lower the threshold of distractibility,” possibly harming the ability to do tasks that require intense sustained focus, such as art, science, and writing, he says.

“There are some possibly frightening implications of the study. If it’s not very reversible, then the way the culture has become might be pushing us all to become more and more distractible and less and less able to focus over sustained periods of time,” he says. “But I think it is a little early to jump to that conclusion—we don’t yet know how reversible and flexible these things might be.”

Next page: How to avoid multitasking

Aston-Jones says that it’s unclear if some people are drawn to multitasking because that’s the way their brain works, or if multitasking itself causes changes in the brain. And it’s not clear if the brain changes caused by switching attention from YouTube to Google to Twitter and then back to your iPhone—if that is what is occurring—are easily reversed.

Dr. Goodman offers the advice he gives to many of his patients with adult attention deficit hyperactivity disorder, or ADHD, who often have difficulty focusing and completing tasks.

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He suggests turning off your BlackBerry so that it doesn’t vibrate every time you get a text or an email. “Put the emails on your schedule and don’t be a slave to the BlackBerry buzzer,” he says. “I check my emails once an hour, once every two hours—I’m not responding to them as they come in.”

However, he says that multitasking won’t give you ADHD, which is a highly genetic condition. “You can’t cause ADHD,” he says. “You don’t wake up at 7 years old or 24 years old and because you played too many video games you have ADHD.”

Aston-Jones says to stay tuned for more research. “There hasn’t been a huge amount of work in this area up to this point,” he says. “It’s an area that’s really starting and will be increasing.”

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Study: Too Many Video Games May Sap Attention Span

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By Sarah Klein

MONDAY, July 5, 2010 ( — Parents who believe that playing video games is less harmful to their kids’ attention spans than watching TV may want to reconsider—and unplug the Xbox. Video games can sap a child’s attention just as much as the tube, a new study suggests.

Elementary school children who play video games more than two hours a day are 67% more likely than their peers who play less to have greater-than-average attention problems, according to the study, which appears in the journal Pediatrics.

Playing video games and watching TV appear to have roughly the same link to attention problems, even though video games are considered a less passive activity, the researchers say.

“Video games aren’t less likely than television to be related to attention problems,” says the lead author of the study, Edward Swing, a doctoral candidate in the department of psychology at Iowa State University, in Ames. “They were at least as strong as television at predicting attention problems.’

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However, the study doesn’t prove that video games directly cause attention problems. It could be that kids who have short attention spans to begin with might be more likely to pick up a joystick than a book, for instance.

The relationship between video games and attention is probably a two-way street, Swing says. “It wouldn’t surprise me if children who have attention problems are attracted to these media, and that these media increase the attention problems,” he says.

Swing and his colleagues followed more than 1,300 children in the third, fourth, and fifth grades for a little over a year. The researchers asked both the kids and their parents to estimate how many hours per week the kids spent watching TV and playing video games, and they assessed the children’s attention spans by surveying their schoolteachers.

Previous studies have examined the effect of TV or video games on attention problems, but not both. By looking at video-game use as well as TV watching, Swing and his colleagues were able to show for the first time that the two activities have a similar relationship to attention problems.

C. Shawn Green, PhD, a postdoctoral associate in the department of psychology at the University of Minnesota, in Minneapolis, points out that the study doesn’t distinguish between the type of attention required to excel at a video game and that required to excel in school.

“A child who is capable of playing a video game for hours on end obviously does not have a global problem with paying attention,” says Green, who has researched video games but was not involved in the current study. “The question, then, is why are they able to pay attention to a game but not in school? What expectancies have the games set up that aren’t being delivered in a school setting?”

Next page: Do video games make schoolwork seem dull?

Experts have suggested that modern TV shows are so exciting and fast paced that they make reading and schoolwork seem dull by comparison, and the same may be true for video games, the study notes.

It’s unclear from this study whether that’s the case, however, because Swing and his colleagues didn’t look at the specific games the kids were playing.

“We weren’t able to break [the games] down by educational versus non-educational or nonviolent versus violent,” says Swing, adding that the impact different types of games may have on attention is a ripe area for future research.

The study also suggests that young kids aren’t the only ones whose attention spans may be affected by video games.

In addition to surveying the elementary school kids, the researchers asked 210 college students about their TV and video-game use and how they felt it affected their attention. The students who logged more than two hours of TV and video games a day were about twice as likely to have attention problems, the researchers found.

These attention problems later in life may be the result of “something cumulative that builds up over a lifetime” or “something that happens early in life at some critical period and then stays with you,” Swing says. “Either way, there are implications that would lead us to want to reduce television and video games in childhood.”

The American Academy of Pediatrics, the leading professional organization for pediatricians and the publisher of Pediatrics, recommends that parents limit all “screen time” (including video and computer games) to less than two hours per day.

For his part, Green says that how much time kids spend playing video games should be a matter of common sense and parental judgment.

“A hard boundary, such as two hours, is completely arbitrary,” he says. “Children are individuals, and what makes sense for one won’t necessarily work for another.”

Children With ADHD at Risk for Depression

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By Amanda Gardner

MONDAY, October 4 ( — Young children with attention-deficit hyperactivity disorder (ADHD) are roughly four times more likely than their peers to become depressed or attempt suicide in later childhood, a new study suggests.

Researchers followed 125 children with ADHD for up to 14 years beginning at ages 4 to 6, and compared them with a similar group of children without ADHD. Thirty-nine percent of the children with ADHD were diagnosed with depression during the study period, versus 8% in the control group.

The risk for depression increased if the child demonstrated symptoms and behaviors that are distinct from—but often occur alongside—ADHD, such as anxiety, defiance, hostility, bullying, and fighting. The risk for depression was also more pronounced if the child’s mother had a history of depression.

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“The only children with ADHD who were not at increased risk for depression were those without a depressed mother and who exhibited very few symptoms of other types of mental health problems,” says the senior author of the study, Benjamin Lahey, PhD, a psychologist and professor of epidemiology at the University of Chicago. “That is only a small proportion of children with ADHD.”

ADHD also increased the risk of suicide attempts. Roughly 18% of the kids with ADHD attempted suicide at least once during the study, compared to 6% of the kids in the control group. (None were successful, fortunately.) Children who were primarily hyperactive and impulsive appeared to be at greatest risk, which suggests that impulsivity may play a role in suicidal behavior, the researchers say.

Girls were at greater risk than boys for both depression and suicide attempts, but there weren’t enough girls in the study to draw firm conclusions about gender, according to the authors.

The study appears in the Archives of General Psychiatry.

ADHD is estimated to affect 4.4 million children in the U.S. and has been shown to raise the risk for academic and social difficulties, employment problems, and even brushes with the law later in life.

Next page: Results may not apply to all kids with ADHD

However, this study is the first to examine the risk factors for depression in very young children with ADHD, and the first to follow children for an extended period of time. Experts have long suspected an ADHD-depression link in childhood, but the research to date has been inconclusive.

“This study adds more data to the notion that early manifestations of hyperactivity and impulsivity…are not necessarily benign,” says Benedetto Vitiello, MD, chief of the research branch dedicated to child and adolescent treatment and prevention at the National Institute of Mental Health, which funded the study.

But the children in the study aren’t necessarily typical of all children with ADHD, says Rafael Klorman, PhD, a professor of psychology at the University of Rochester Medical Center, in New York. It’s relatively uncommon for ADHD to be identified in children as young as 4, he explains, and kids who are diagnosed at that age tend to have more severe symptoms.

“These kids were diagnosed earlier, which means that the researchers have a sample with especially higher severity,” Klorman says. “They may be getting the high end of the spectrum.”

Parents should not “panic and think their children with ADHD are destined for depression or suicide,” Lahey says. However, he adds, if parents are concerned that their child is showing symptoms of ADHD or depression, they should consult a mental health professional and consider family therapy.

More research is needed to identify effective interventions that can lower the chances of depression in high-risk kids with ADHD, Dr. Vitiello says, echoing Lahey and his colleagues.

Early intervention and treatment are important, as the risk of depression and other health problems associated with ADHD can last well into adulthood. Previous studies have estimated that anywhere from 16% to 37% of adults with ADHD have been diagnosed with major depressive disorder or dysthymia, a milder form of depression.

And in another new study, which appears in the Archives of Pediatric & Adolescent Medicine, researchers at New York University report that teenagers with ADHD are about twice as likely to have problems with alcohol and drugs in their 30s than those without the disorder.

However, the risk seems mainly due to the overlap between ADHD and conduct disorder, a related condition that’s characterized by physical aggression and delinquent behavior, such as stealing and vandalism. The teens who did not show signs of conduct disorder did not appear to be at increased risk for substance abuse, the study found.

Both ADHD and conduct disorder may be an early warning sign for alcohol and drug problems, the researchers suggest.

CDC: Childhood ADHD Rate Rises 22%

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By Ray Hainer

WEDNESDAY, November 10 ( — Nearly 1 in 10 children in the U.S. has been diagnosed with attention deficit hyperactivity disorder (ADHD), and the rate appears to be growing, according to a report released today by the Centers for Disease Control and Prevention (CDC).

The percentage of children ages 4 to 17 who have ever been diagnosed with ADHD rose from 7.8% to 9.5% between 2003 and 2007—a 22% increase, the CDC found. The report was based on the results of the National Survey of Children’s Health, a nationwide telephone survey of parents.

The increases were especially dramatic among 15- to 17-year-olds and Hispanics.

It’s unclear from the survey data whether the increase in diagnoses is due to an actual rise in ADHD cases stemming from social or environmental factors, or to growing awareness of the disorder, the researchers say.

Susanna Visser, an epidemiologist at the CDC and the lead author of the report, says that factors including lead exposure, low birth weight, and premature birth have all been shown to contribute to ADHD symptoms. “This collection of risk factors could be moving in a direction that causes certain demographic groups to have higher rates of ADHD,” she says. “We have to figure out what’s driving the change.”

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Getting to the root of ADHD trends will require studies that follow groups of children over time, as well as genetic and MRI studies, Visser says. Several such studies are already under way at the National Institutes for Health, she adds.

Although ADHD rates went up in all 50 states, the increases were especially striking in 12 states, including Indiana, North Carolina, and Colorado. In North Carolina—which had the highest ADHD prevalence in the nation—the rate rose from 9.6% to 15.6%, an increase of about 63%.

Those 12 states “largely account for the increase” nationwide, Visser says.

States with very high diagnosis rates included Alabama (14%), Delaware (14%), Ohio (13%), West Virginia (13%), and Arkansas (13%), in addition to North Carolina.

Roughly half of all children diagnosed with ADHD had a “moderate” or “severe” case of the disorder, and two-thirds of all children with ADHD were taking medication to control it. The estimated 2.7 million children ages 4 to 17 taking ADHD drugs represent 5% of all children nationwide in that age group, according to the report.

If parents are concerned about their child’s behavior, they should seek out information about ADHD and consult a doctor, Visser says. “There are ways to manage and control the symptoms of ADHD, through work with your doctor and with school professionals. This can be successfully managed.”

FDA Weighs Food Dye, Hyperactivity Link

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By Amanda GardnerTUESDAY, March 29, 2011 ( — Jell-O, Hawaiian Punch, Pop-Tarts, Skittles, and other brightly colored foods designed to appeal to children aren’t exactly health food. But do they make kids hyperactive?

Doctors and consumer advocates have long wondered whether hyperactivity might be tied to certain dyes and additives used in processed foods, but in decades of research no studies have been able to conclusively prove—or disprove—such a link.

Now, the Food and Drug Administration (FDA) is formally weighing the evidence, raising the possibility that the agency may eventually strengthen its regulation of these ingredients.

In a two-day meeting beginning Wednesday, an FDA advisory committee will discuss the strength of the evidence surrounding food dyes and behavior changes in children, whether food labels should be changed to better protect consumers, and whether more studies on the subject need to be conducted. (The FDA is not required to follow the recommendations of its advisory committees, but it usually does.)

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The debate over the potential effects of food dyes has been simmering since the 1970s. Why is the FDA acting now?

The main impetus appears to be a 2008 petition from a Washington, D.C-based watchdog group, the Center for Science in the Public Interest (CSPI), which asked the FDA to ban eight different food dyes including Yellow No. 5—found in macaroni-and-cheese mixes, lemon-lime Gatorade, Lucky Charms cereal, and many other foods.

The FDA reviewed the petition and, in September 2010, decided that color additives didn’t directly cause hyperactivity or attention deficit hyperactivity disorder (ADHD), a condition characterized by chronic attention and behavioral problems. However, it didn’t rule out that they might exacerbate preexisting problems in children with ADHD.

No one knows what the FDA committee will decide, but the research so far “doesn’t appear to be conclusive evidence that food additives actually cause ADHD,” says Kate Ulbricht, cofounder of the Natural Standard Research Collaboration, an independent research group based in Somerville, Mass. “Some research suggests that they may be linked to exacerbated symptoms in people who already have ADHD.”

Tying hyperactivity to specific food dyes or additives is especially difficult, Ulbricht adds, because “most products contain more than one.” Indeed, some types of candy contain as many as 10.

Next page: A long-standing debate

A long-standing debateThe first inkling that food additives might be linked to attention problems arose more than three decades ago, when California pediatrician Ben Feingold, MD, developed a diet free of artificial dyes and flavorings that supposedly quelled hyperactive symptoms in children.

Many people enthusiastically tried the so-called Feingold Diet, but the enthusiasm waned as the years went on and “some very well-done randomized controlled studies” questioned Dr. Feingold’s theory, says Deborah Pearson, PhD, the director of the ADHD Research Laboratory at the University of Texas–Houston Health Science Center.

“I don’t think there was a great deal of evidence suggesting that withdrawing food dyes and food additives were helping those children,” Pearson says. “For a very small subset of kids there might have been an indication but, for the vast majority, not eating cookies with that frosting with the red dye in it didn’t make a difference.”

More recently, a pair of government-funded studies in the U.K. revived interest in the link between food dyes and behavioral problems.

In one study, published in 2004, researchers found that a diet free of artificial colorings and the preservative sodium benzoate appeared to reduce hyperactive behavior among preschoolers. In the other, published in the Lancet in 2007, preschool and grade-school children seemed to be more hyperactive when given a juice drink with these same additives than they were after consuming an otherwise identical, additive-free drink.

Both of these studies—which inspired the CSPI’s petition to the FDA—marked a departure from previous research in that they looked at children without ADHD who were not suspected of being sensitive to food additives.

“Those studies were not definitive, but they extended the concern from children with behavioral issues to the general population,” says Michael Jacobson, PhD, executive director of the CSPI. “Almost every other study used as subjects children who were hyperactive or inattentive or suspected of being sensitive to dyes.”

Could food dyes be banned?Last year, the European Union placed warning labels on food containing the six artificial colors used in the Lancet study (three of which are not approved in the U.S.). And in 2009, the British counterpart to the FDA, the Food Standards Agency, asked food companies to voluntarily phase out these additives.

The FDA has not said that it is prepared to take similar steps. And because food dyes are more prevalent here than in Europe, an outright ban on some or all of the additives would be very difficult to implement, Jacobson says.

However, some food manufacturers are proactively reducing their use of food dyes and other additives, and some retailers are declining to stock products containing artificial coloring. Whole Foods, for instance, has had such a policy in place since the 1980s, says Joe Dickson, quality standards coordinator for the company.

The food industry, meanwhile, has defended the safety of its products.

“[Added] colors are safe and play an important technological role in foods. In many cases they replace color that’s lost during processing or for consistent appearance, for instance,” says Sean Taylor, Ph.D., the scientific director of the International Association of Color Manufacturers, a trade association representing food-dye makers.

“Specifically, relating to hyperactivity studies, our association strongly supports sound scientific approaches to understanding any effects of any type with food additives,” adds Taylor, who is scheduled to address the advisory committee on Thursday. “What we see right now is no clear causal relationship with these studies and [feel that] there isn’t enough information here for the FDA to establish a clear causal relationship.”

CDC: Autism, ADHD Rates on the Rise

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By Amanda Gardner

MONDAY, May 23, 2011 ( — The proportion of children and teens in the U.S. who have been diagnosed with a developmental disability such as autism has increased 17% since the late 1990s, according to a new report from the Centers for Disease Control and Prevention (CDC).

Between 1997 and 2008, the number of children diagnosed with a disability rose from 8.2 million to roughly 10 million, or more than 15% of all kids between the ages of 3 and 17, the researchers found.

This upward trend has been driven largely by surges in the number of children diagnosed with autism and attention deficit hyperactivity disorder (ADHD), although the prevalence of stuttering and learning disabilities has also increased.

The study, which appears in the June issue of the journal Pediatrics, is the first time nationally representative data on developmental disabilities has been collected since 1988, says Sheree Boulet, DrPH, one of the study’s authors and an epidemiologist at the CDC’s National Center on Birth Defects and Developmental Disabilities.

Related links:

What Causes ADHD? 12 Myths and Facts

Questionnaire May Help Predict Autism at 1 Year

9 Food Additives That May Affect ADHD

The reasons for the increases aren’t clear, but growing awareness and increasing acceptance of developmental disabilities have probably played a big role, Boulet says. For instance, she explains, the availability of early and effective treatments for conditions such as ADHD might be encouraging more parents to have their children screened for the disorder.

The study findings are to be expected, given the “increased awareness and much better reporting,” says Alan Hilfer, PhD, the director of psychology at Maimonides Medical Center, in New York City. (Hilfer was not involved in the new research.)

At the same time, the occurrence of disabilities may be genuinely increasing. A shift toward having babies later in life, more premature births, and growing use of fertility treatments—all of which are risk factors for developmental disabilities—could be contributing to the higher rates, the researchers say.

The findings “suggest that there are some more prevention strategies that could be put into use,” Boulet says.

The study was based on nationally representative health surveys that included in-person interviews with nearly 120,000 children across the country. During the interviews, the researchers asked parents whether their kids had been diagnosed with autism, ADHD, learning disabilities, cerebral palsy, seizures, stuttering or stammering, hearing loss, blindness, or intellectual disability (formerly known as mental retardation).

The overall disability rate rose from about 13% to just over 15% during the 12-year study period. In 2008, the most common disabilities were ADHD (7.6%) and learning disabilities (7.2%). Roughly 0.75% of children had been diagnosed with autism, up from 0.19% in 1997.

The only disability to decrease was moderate-to-profound hearing loss, which went down 31%.

Next page: Striking gender and ethnic differences

The differences in diagnosis rates across economic, ethnic, and gender lines were striking, Boulet says.

Nearly twice as many boys as girls had a disability, for instance. This might be because some genetic disabilities are more likely to be inherited by males, although it could also be that the symptoms of ADHD and other disabilities are more obvious in boys, and are therefore more likely to be diagnosed, the study notes.

Rates were also substantially higher than average among children from low-income families and children on Medicaid. Hispanic children had lower rates of disabilities than white or black children, which perhaps reflects language difficulties and other barriers to accessing health services rather than the true rate of disability.

The rise in disabilities seen in the study points to the growing need for specialized health and social services (such as mental-health services and therapists), Boulet and her colleagues say. However, due to budget pressures throughout the health-care system, children are at risk of missing out on exactly that kind of specialized treatment and prevention, Hilfer says.

“We are more aware that early intervention is the key to the greatest success in these kids,” he says, “[but] we need the resources to do that.”

Can't Focus? How to Tell When It's Time to Try Medication

I really can’t focus and constantly feel frazzled. Would it hurt to try ADHD medication?

Before you even think about drugs, it’s important to get the correct diagnosis. Stress and lack of sleep, as well as anxiety or depression, can cause problems with concentration, and all these things require specific treatments. Look back to when your issues started. If symptoms began only recently, they’re more likely due to increased stress or a lack of sleep. If they’ve been going on for a month or more and you’re also feeling sad or hopeless, getting headaches or having trouble making decisions, you may have depression or an anxiety disorder.

RELATED: 15 Signs You May Have Adult ADHD

Many people think that ADHD (attention-deficit/hyperactivity disorder) is all about an inability to focus, but it actually involves much more than that. Other symptoms may include poor impulse control, restlessness, chronic disorganization and unstable relationships. If you do have ADHD, it’s likely that you not only have trouble focusing on certain tasks or sitting still but also consistently miss work deadlines or meetings because of an inability to manage your time. You may also tend to have angry outbursts or find it difficult to wait in line or get through minimally stressful situations without feeling overwhelmed. Because of increasing news reports on the rise of adult ADHD diagnoses, another common misconception is that the condition can start in adulthood. In reality, ADHD always begins in childhood, though some people don’t get a diagnosis until later in life.

RELATED: Celebrities With Attention Deficit Hyperactivity Disorder

So the best advice is to speak to a mental health professional about your current symptoms as well as patterns in your past. If you are diagnosed with ADHD, a psychiatrist may recommend stimulants along with targeted talk therapy. But this isn’t a decision to take lightly. Medications used to treat ADHD can have side effects such as insomnia or irritability, and it may take some trial and error to come up with the right medication and dosage that helps without causing new problems. Even with drugs, most adults with ADHD still need targeted talk therapy to help them learn to manage time, prioritize tasks and get organized.

RELATED: What Causes ADHD? 12 Myths and Facts

Health‘s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

Meet Dr. Raj at the Health Total Wellness Weekend at Canyon Ranch in May 2015. For details, go to

How ADHD Is Different in Boys Versus Girls

By Tara HaelleHealthDay Reporter

THURSDAY, Oct. 22, 2015 (HealthDay News) — Attention-deficit/hyperactivity disorder (ADHD) manifests itself differently in the brains of girls than in the brains of boys, new research suggests.

The results may help scientists better understand how ADHD affects boys and girls in unique ways, the researchers said.

“The findings showed differences in the white matter microstructure between boys and girls,” said study co-author Lisa Jacobson, a pediatric neuropsychologist at the Kennedy Krieger Institute, in Baltimore. White matter helps different regions of the brain communicate with each other.

“These structural differences were associated with observed behavioral differences,” Jacobson said. “Taken together, our findings provide preliminary evidence for unique differences in the brain’s white matter structure and function between boys and girls with ADHD.”

Kathryn Moore, a psychologist at Providence Saint John’s Child and Family Development Center in Santa Monica, Calif., said, “Females are more likely to present with the inattentive symptoms of ADHD, while males are more likely to present with hyperactive and impulsive features of ADHD.”

Moore, who was not involved with the new research, noted that the study authors could not explain the reasons for their findings. ADHD is also diagnosed in boys at about twice the rate as in girls, she said, but this study does not necessarily explain why that is.

“The most striking finding in this study is that there are differences in brain functioning between boys and girls with ADHD,” Moore added. “Perhaps the disorder of ADHD is caused by these neurological differences, or perhaps ADHD causes these neurological differences.”

For the study, 120 children between the ages of 8 and 12 had a type of MRI called diffusion tensor imaging, which allows researchers to see neurological differences in the brain. Half of the children had been diagnosed with ADHD. The children without ADHD were matched to the children with ADHD, based on age, IQ and handedness (being left- or right-handed). Each of the groups, with and without ADHD, had 30 boys and 30 girls.

The researchers found several differences in the white matter of children with ADHD compared to those without ADHD, but the variations showed up in different parts of the brain based on gender.

In boys with ADHD, the differences showed up in the primary motor cortex, a part of the brain responsible for controlling basic motor functions. In girls with ADHD, the differences appeared in the prefrontal regions of the brain, which control motivation and ability to regulate emotions, the study authors said.

It’s possible that the differences seen relate to how the different sexes mature, suggested Dr. Glen Elliott, chief psychiatrist and medical director of Children’s Health Council in Palo Alto, Calif.

“Boys and girls differ in a number of different ways, obviously including rates of maturation,” Elliott said. He added that differences in the brains of males and females are present even during fetal development.

“Certainly some aspects of these findings might be reflective of previous studies done by other researchers showing that ADHD is associated with a delay in maturation, especially of frontal brain structure,” Elliott said.

Moore explained that the differences seen in the brain functioning of people with ADHD, regardless of sex, is generally in the same larger region of the brain, the frontal lobe. The frontal lobe controls executive functioning, which involves “impulse control, decision-making, cognitive flexibility and planning,” she said.

Elliott said: “Possibly more relevant are the findings that, as they move through their teens into adulthood, boys with ADHD tend to get into trouble with externalizing problems, such as conduct disorder and reckless behaviors, while girls with ADHD have, in general, a more internalizing presentation, with depression, anxiety, eating disorders and self-harm.”

But none of this might make a difference in how the disorder is treated, Elliott said.

“The ‘why’ of these differences remains unclear and could well be associated with quite distant other parts of the brain that connect to the regions being studied,” Elliott said. “Similarly, the findings do not really suggest unique treatment options.”

The primary first-line treatment for ADHD is still medication, usually stimulants, Moore said.

“Most psychologists would also advocate for additional interventions, such as using rewards and consequences to shape behavior, learning better problem-solving skills and increasing effective communication between parents and the child,” Moore added.

The study findings were published Oct. 22 in the Journal of the American Academy of Child and Adolescent Psychiatry.

More information

For more about ADHD, visit the U.S. Centers for Disease Control and Prevention.