Improved ADHD Identification Leads To Growth In ADHD Medication Use

Attention deficit hyperactivity disorder (ADHD) has been traditionally viewed as a childhood disorder, while ADHD in adults has been underdiagnosed and undertreated. A recent study shows that treatment rates have been increasing in all age groups, and improved identification has contributed to rapidly growing treatment rates for adults. Female patients show the greatest increase of all.

The study, published by SAGE in the May issue of the Journal of Attention Disorders, revealed rapid growth of ADHD medication use in all demographic groups except seniors, with some groups showing markedly faster rates than others. Between 2000 and 2005, treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys.

Improved diagnosis of ADHD in adult and female patients contributed to the rapid growth in ADHD medication use. The study found that there were many changes in the types of medications used, as well. Researchers found that methylphenidate and dextroamphetamine use declined for both children and adults, the use of amphetamine mixtures increased for adults, atomoxetine use (introduced in 2002) grew rapidly across both groups, use of extended-release products increased in children more dramatically than adults, and generic ADHD medication use declined significantly in pediatric patients while remaining relatively stable in adults.

Research in the field of attention continues to grow. This study is indicative of the type of important data published in the Journal of Attention Disorders, written by leaders in the field and helpful for both professionals and those who must live with attention disorders every day.

Stuttering And ADHD

ADHD affects anywhere from 3 to 7% of children in the United States and recent research indicates that as many as 26% of these children also stutter.

A new brochure published by the Stuttering Foundation seeks to answer questions and give helpful tips for parents and professionals dealing with the two complex issues.

The treatment most often used for ADHD continues to be medication; yet, some recent research indicates that some of these medications may actually aggravate stuttering. Non-stimulant medications such as Strattera may be indicated for ADHD children who also struggle with stuttering.

What can parents do? Joseph Donaher, M.A., of Children’s Hospital of Philadelphia offers 5 timely tips for parents and speech language pathologists:

1. Keep instructions simple and clear and have the child repeat them back. Have a consistent organized schedule.

2. Increase activities where the child must concentrate and focus and cut back on activities that promote aggressive or impulsive behavior as do some television programs.

3. Use frequent praise to keep the child motivated and interested.

4. Provide visual cues and concrete examples to help the child better understand and retain information.

5. Use good speaking habits yourself such as keeping eye contact and using a easy relaxed rate.

Is ADHD Properly Diagnosed And Treated In Adults?

An editorial written by Professor Philip Asherson, a leading psychiatrist in adult ADHD (Attention Deficit Hyperactivity Disorder), at the Institute of Psychiatry, King’s College London strongly recommends that general adult psychiatrists should diagnose ADHD in adults appropriately with stimulant drugs. It is published in the January issue of the British Journal of Psychiatry.

Although ADHD can be effectively treated with stimulant medication, and such treatment is widespread in the young, general adult psychiatry has not yet followed suit in identifying and treating substantial numbers of affected people.

ADHD is a common disorder affecting children and adults, and is a predictor of adult mental health problems. Symptoms include high levels of inattentiveness, impulsiveness and restless over activity, and are regarded as a source of disability in children and adolescents, as well as a risk to adult psychological adjustment.

Young people are entering adult life whilst still receiving medication for ADHD, and adult psychiatrists are needed to take over treatment when symptoms persist. Moreover, some adult patients with ADHD may be misdiagnosed and ineffectively treated for other disorders, such as depression and personality disorder.

Research suggests that between 15% and 65% of children diagnosed with ADHD still have symptoms of the disorder in adulthood. However, many children with ADHD go unrecognised, and may be diagnosed in adulthood for the first time.

A survey of schoolchildren with ADHD in the London Borough of Newham found that although levels of restless activity diminished between the ages of 7 and 17, the 17-year-olds showed a level of hyperactivity similar to that found in a group of normal 7-year-olds.

When the same people were followed up at the age of 26, they were found to have disabilities associated with high levels of psychiatric disorder, which were all the more significant because of increasing demands in adult life for self-organisation and the ability to plan ahead.

Adult behaviours linked to ADHD are associated with the childhood symptoms of motor hyperactivity, attention deficit, unfocused thinking, mood changes, disorganisation and impulsiveness.

They include – at the severe end of the spectrum – feelings of restlessness, difficulty in relaxing, feeling depressed when inactive, lack of concentration on detail, depression or excitability, poor time management, difficulties sustaining relationships and a tendency to make rapid and facile decisions without full analysis of the situation.

Psychiatrists diagnosing ADHD in adults need to be aware of the fact that people with this disorder often show decreased symptoms in a novel situation like a psychiatric evaluation. It is therefore important to base mental state evaluations on a typical week and a variety of normal situations.

Mood instability is very common in adult ADHD, and can lead to diagnoses of depression or personality disorder. Many adults with ADHD also have other problems, such as antisocial personality, alcohol and drug misuse, anxiety disorders and learning difficulties. ADHD in childhood may also lead to the development of antisocial behaviour.

Some symptoms of adult ADHD are similar to those of bipolar disorder, but ADHD tends to show a persisting trait of irritability and volatility, very different from the grandiose and euphoric symptoms of mania and the depression found in bipolar disorder.

Professor Philip Asherson comments: “Adults with untreated ADHD use more healthcare resources because of smoking-related disorders, increased rates of serious accidents, and alcohol and drug misuse. Further research is needed to quantify the contribution of ADHD to psychiatric disorders in adulthood.”

Professor Asherson’s editorial is published in the British Journal of Psychiatry, January 2007.

Best Practice Guidelines On Identifying And Treating ADHD

The American Academy of Child and Adolescent Psychiatry (AACAP) is proud to announce its new Practice Parameter and Pocketcard on attention-deficit hyperactivity disorder (ADHD). The Practice Parameter represents best practices in evaluating and treating ADHD and the pocketcard is the document’s portable summary. Both the Parameter and Pocketcard were designed to teach health care professionals about the disorder.

AACAP’s Practice Parameter shows that ADHD is a medical illness on par with diabetes or asthma. Like these conditions, ADHD can be successfully managed, but not cured. Left untreated, children with ADHD often experience failure at school, problems at home, substance abuse, and depression.

AACAP’s Practice Parameter presents the effects, including the long-term data, of treating ADHD with and without medication. Although medications must be balanced against rare adverse reactions, the safety of ADHD medicinal treatment is equal to other pediatric conditions.

In addition to updating mental health professionals, the Practice Parameter and Pocketcard will teach health care professionals who do not specialize in mental health about ADHD. As there is a shortage of child and adolescent psychiatrists, most youth with ADHD who receive treatment obtain it from their pediatricans or general practictioners.

The AACAP is a medical association committed to supporting its members’ research on ADHD. Families interested in learning about the disorder should view the video, ADHD, A Guide for Families, and read the AACAP Facts for Families, The Child Who Can’t Pay Attention.

Representing over 7,500 child and adolescent psychiatrists nationwide, the American Academy of Child and Adolescent Psychiatry (AACAP) is the leading authority on children’s mental health.

Mission of the AACAP

Promote mentally healthy children, adolescents and families through research, training, advocacy, prevention, comprehensive diagnosis and treatment, peer support and collaboration.

http://www.aacap.org