ADHD

Posted on ADHD

Understanding the Differences Between ADD and ADHD

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Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are terms that often come up in discussions about attention and behavior issues, especially in children. While they are related, there are key differences between the two.

ADD vs. ADHD: The Basics

ADD (Attention Deficit Disorder) is an outdated term that was once used to describe individuals who had trouble focusing but did not exhibit hyperactivity. People with ADD often appeared dreamy, inattentive, or easily distracted.

ADHD (Attention Deficit Hyperactivity Disorder) is the current, official term used to describe individuals who have difficulty with attention, hyperactivity, and impulsivity. ADHD is categorized into three main types:

  1. Predominantly Inattentive Type: This is similar to what was once called ADD. Individuals have trouble focusing, following instructions, and completing tasks but do not show significant hyperactive or impulsive behavior.
  2. Predominantly Hyperactive-Impulsive Type: Individuals exhibit high levels of hyperactivity and impulsivity but may not have significant trouble with attention.
  3. Combined Type: This is the most common type, where individuals display symptoms of both inattention and hyperactivity-impulsivity.

Symptoms of Inattention

For those with the inattentive type of ADHD (formerly known as ADD), the symptoms may include:

  • Difficulty sustaining attention in tasks or play activities.
  • Frequent careless mistakes in schoolwork or other activities.
  • Often seeming not to listen when spoken to directly.
  • Frequently losing items necessary for tasks and activities.
  • Being easily distracted by extraneous stimuli.
  • Forgetfulness in daily activities.

Symptoms of Hyperactivity and Impulsivity

For those with hyperactive and impulsive symptoms, the behavior may include:

  • Fidgeting with or tapping hands and feet, or squirming in their seat.
  • Inability to stay seated in situations where it is expected.
  • Running or climbing in situations where it is inappropriate.
  • Inability to play or engage in activities quietly.
  • Excessive talking.
  • Blurting out answers before a question has been completed.
  • Difficulty waiting for their turn.

Diagnosis and Treatment

ADHD is diagnosed through a comprehensive evaluation that includes interviews, questionnaires, behavior assessments, and sometimes standardized tests. A diagnosis can be made by a healthcare provider, such as a pediatrician, psychologist, or psychiatrist.

Treatment for ADHD typically involves a combination of behavioral therapy, educational support, and medication. Behavioral therapy focuses on teaching strategies to manage symptoms, improve organization, and regulate emotions. Medications, such as stimulants or non-stimulants, can help improve attention and reduce hyperactivity and impulsivity.

The Importance of Understanding ADHD

Understanding the differences between ADD and ADHD is crucial for effective diagnosis and treatment. ADHD can impact various areas of life, including academic performance, social interactions, and self-esteem. Early intervention and appropriate support can significantly improve outcomes for individuals with ADHD.

In conclusion, while ADD is an outdated term, it is important to recognize the inattentive type of ADHD, which shares many similarities with what was once called ADD. By understanding the different types and symptoms of ADHD, individuals and families can better navigate the challenges and seek appropriate support and treatment.

Stay informed and seek professional advice if you suspect that you or someone you know might have ADHD. Proper understanding and management can make a significant difference in the quality of life for those affected by this condition.

Posted on ADHD

Does Getting ADHD Medication Through Telehealth Increase Addiction Risk?

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Over the past few years, people with ADHD have had the convenient option of getting their stimulant medications prescribed via telehealth. However, with the rules that made this possible and set to expire soon, questions about the safety of virtual ADHD care are in the spotlight.

A new study from the University of Michigan, published in Health Affairs, sheds light on this issue. It reveals that individuals aged 12 to 64 who started their stimulant medication through telehealth were slightly more likely to develop a substance use disorder (SUD) within a year compared to those who started with in-person care. However, when accounting for pre-existing mental health conditions, such as depression, the increased risk largely disappeared—except for a specific age group.

Key Findings

The study found that the risk of developing SUD was 3.7% for those who started ADHD medication via telehealth versus 3.2% for those who started in-person. When mental health conditions were considered, the increased risk vanished for most age groups, except for adults aged 26 to 34. This group still showed a higher risk of SUD, which might be linked to their newfound independence in managing their medication without parental oversight.

Implications for Telehealth ADHD Care

The findings suggest the need for better screening and ongoing monitoring for addiction risk, especially for young adults. As Joanne Constantin, Ph.D., the study’s lead author, points out, screening for addiction risk and monitoring for signs of SUD should be included in future telehealth policies for ADHD care.

Current Telehealth Rules and ADHD Medication

Currently, federal telehealth rules allow behavioral health care without an in-person visit until December 31. To prescribe stimulants for ADHD, clinicians need to be licensed by the U.S. Drug Enforcement Agency and often check state prescription drug monitoring programs. However, there are no specific guidelines for screening for SUD risk at the start of treatment or ongoing monitoring for SUDs.

The Role of Telehealth Companies

In recent years, several companies have started offering standalone ADHD care entirely via telehealth, especially during the COVID-19 pandemic. Some of these companies have faced legal issues due to alleged lack of oversight of how stimulants are used.

Study Details

The study used anonymous health insurance records from people with private insurance or Medicaid coverage. It included 77,153 individuals who had not received ADHD stimulant medication or an SUD diagnosis in the past year and started on a stimulant in 2021. Over 21,000 of these patients started via a telehealth visit, while the rest began with in-person visits. The researchers accounted for differences in mental health conditions and other factors in their analysis.

Conclusion

Telehealth has proven to be an essential way to access care, but balancing access with safety remains crucial. This study highlights the importance of guidelines for providers about screening and follow-up to ensure safe and effective ADHD care.

As policies evolve, it’s vital to keep in mind the need for comprehensive screening and monitoring to protect all patients, especially young adults, from potential risks associated with telehealth-based ADHD care.

Posted on ADHD, Pain Management

High Rates of Prescription Drug Misuse Among Adults with Disabilities

Pills

People with disabilities that include difficulty with cognition or caring for themselves are at greater risk of misusing prescription painkillers, tranquilizers and stimulants, a WVU study shows. Credit (WVU Photo/Jake Stump)

A recent study conducted by West Virginia University has revealed a concerning trend: Adults with disabilities are nearly twice as likely to misuse prescription drugs compared to adults without disabilities. The research, led by Jeanette Garcia, an associate professor at the WVU College of Applied Human Sciences, highlights the pressing need to address prescription drug misuse in this vulnerable population.

The study analyzed data from the 2021 National Survey on Drug Use and Health, encompassing responses from 47,100 adults, of whom approximately 10.9% reported having at least one disability. These disabilities ranged from difficulties with vision, hearing, movement, cognition, self-care, to communication. The findings, published in the American Journal of Preventive Medicine, showed that nearly 10% of individuals with disabilities reported misusing prescription drugs within the past year, compared to just 4.4% of individuals without disabilities.

Garcia emphasized the urgency of these findings, stating, “We saw the highest rates of drug misuse among adults with cognitive disabilities and young adults, with pain relievers being the most misused drugs.”

The researchers tracked the misuse of prescription stimulants (e.g., amphetamines), tranquilizers (e.g., benzodiazepines), and pain relievers (e.g., opioids), all of which have high addictive properties and potentially dangerous side effects. The results were clear: adults with disabilities, especially those younger than 30, had significantly higher rates of misuse across all three drug categories.

The study underscores the importance of early prevention efforts, particularly for adolescents and young adults with disabilities. Garcia noted that adolescents with cognitive difficulties are particularly vulnerable to prescription drug misuse, which can exacerbate cognitive impairment as they transition into adulthood.

Individuals with disabilities are more likely to experience risk factors for prescription drug misuse, such as chronic pain, heightened anxiety, major depression, and poor physical health. They are also more likely to receive prescription medications but less likely to receive adequate counseling on the dangers of misuse. Communication barriers and the challenge of finding specialists who understand their complex health conditions further exacerbate the issue.

JeanetteGarcia

Jeanette Garcia, associate professor, WVU College of Applied Human Sciences  Credit(WVU Photo)

For every category of prescription drug examined—stimulants like Adderall, tranquilizers like Xanax, and pain relievers like Oxycontin—misuse was highest among those with cognitive and self-care disabilities. The most alarming statistic was a 27% misuse rate of pain relievers among adults aged 30-49 with cognitive disabilities.

Garcia explained that cognitive and self-care difficulties often indicate chronic conditions like traumatic brain injuries, which increase the risk of painkiller misuse due to chronic pain and limited impulse control. Additionally, individuals with cognitive disabilities frequently suffer from sleep issues and mental health disorders, such as anxiety and depression, which are linked to tranquilizer abuse. ADHD, characterized by poor concentration and lack of self-care, is correlated with stimulant misuse.

While misuse rates for stimulants and tranquilizers were similar for young adults with and without disabilities, a stark difference emerged regarding pain relievers. Older adults with disabilities had significantly higher rates of pain reliever misuse compared to their non-disabled counterparts. Garcia speculated that this could be due to chronic pain from disabilities worsening with age and higher rates of physician-prescribed pain medications for older adults.

Given the marked increase in pain reliever misuse among adults with disabilities across all age groups, Garcia believes medical providers should consider alternative pain treatments. “Physicians and policymakers need to be aware of the high rates of prescription drug misuse we’re seeing, especially among adults with cognitive and self-care difficulties,” she said. “An important next step will be exploring the extent to which the severity of someone’s disability or the presence of an additional condition like anxiety affects the likelihood of misuse.”

This research is a crucial step in understanding and addressing the complex issue of prescription drug misuse among adults with disabilities, paving the way for targeted interventions and improved healthcare practices.

Posted on ADHD, Autism, Diet

The Link Between Western Diet During Pregnancy and ADHD in Children

Autism and Pregnancy
ADHD and Pregnancy

New research from Denmark sheds light on the impact of a mother’s diet during pregnancy on the risk of neurodevelopmental disorders such as ADHD and autism in children. The study reveals that a Western dietary pattern, high in fat and sugar and low in fresh ingredients, may increase this risk. This discovery emphasizes the importance of targeted dietary interventions during pregnancy to potentially reduce these risks.

The Study and Its Findings

A comprehensive clinical study conducted by the University of Copenhagen and the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) at the Danish Paediatric Asthma Centre has found a significant association between maternal diet during pregnancy and the development of ADHD and autism in children.

Dr. David Horner, MD, PhD, the lead author, explains, “The greater a woman’s adherence to a Western diet in pregnancy – high in fat, sugar, and refined products while low in fish, vegetables, and fruit—the greater the risk appears to be for her child developing ADHD or autism.” The study identified this Western dietary pattern using data-driven analysis, showing that moderate shifts towards a Western diet significantly increase the risk. Small dietary adjustments away from this pattern could reduce the risk of neurodevelopmental disorders.

Extensive Analysis

To reach these conclusions, researchers analyzed dietary patterns, blood samples, and ADHD diagnoses across four large independent cohorts in Denmark and the United States, encompassing over 60,000 mother-child pairs. Metabolomics was used to analyze blood samples, providing insights into the biological mechanisms linking diet to neurodevelopmental disorders and validating the results.

The link between Western dietary patterns and ADHD was observed across all four cohorts and validated using three different methods. This reinforces the study’s credibility, according to David Horner. The study draws on a robust dataset where nearly 600 children were clinically assessed for neurodevelopmental disorders at age 10. Despite accounting for a range of factors, including genetics, a clear association between a maternal Western diet and the risk of ADHD and autism remained.

Publication Details

The study, titled “A Western dietary pattern during pregnancy is associated with neurodevelopmental disorders in childhood and adolescence,” has been published in the prestigious journal Nature Metabolism. You can access the full study here.

Greatest Risk in Early Pregnancy

One of the study’s key strengths is the high quality of the biological samples, which included repeated metabolomic measurements throughout pregnancy and childhood. This allowed researchers to demonstrate that the association of diet on ADHD risk was strongest in early and mid-pregnancy.

Professor Morten Arendt Rasmussen from the University of Copenhagen explains, “When comparing across cohorts, we observed the strongest associations in the first and second trimesters, suggesting that brain development during this period is particularly sensitive to maternal nutritional influences.”

Metabolites and Dietary Influence

Researchers identified 43 specific metabolites in maternal blood linked to a Western diet that could help explain the connection between diet and neurodevelopmental disorders. Dr. David Horner notes, “We found that 15 of these 43 metabolites were particularly linked to the increased risk of ADHD. Many of these metabolites are derived from dietary intake and play key roles in regulating inflammation and oxidative stress—factors believed to be critical in early neurodevelopment.”

Implications for Dietary Guidelines

This study raises important questions about the adequacy of current dietary guidelines for pregnant women. In Denmark, dietary recommendations for pregnant women largely mirror those for the general population, emphasizing a balanced diet rich in vegetables, fruit, whole grains, and fish rather than red meat.

Dr. David Horner points out, “Our study highlights just how crucial dietary composition is for foetal development. While the Nordic diet is often considered healthy, our data show that many pregnant women follow dietary patterns that could be optimized to better support their child’s development. This study raises the question of whether existing dietary recommendations are sufficiently followed during pregnancy—and whether they have the desired impact on child health.”

He adds that the study not only demonstrates an association between diet and ADHD risk but also provides insights into specific nutrients and food groups that could play a vital role in foetal brain development. “By understanding how maternal diet influences foetal development, we can better identify the key nutrients and dietary adjustments needed to reduce the risk of neurodevelopmental disorders. This opens new possibilities for refining dietary recommendations and promoting healthier outcomes for future generations,” says David Horner.

Conclusion

The findings of this study underscore the critical importance of a balanced diet during pregnancy. As more research continues to unfold, it will be essential for healthcare professionals and expectant mothers to stay informed about the best dietary practices to support healthy foetal development.

Posted on ADHD, Parkinson's Disease

How ADHD Helps Us Understand Working Memory

Did you know that understanding how our brain manages short-term information can shed light on disorders like ADHD? Researchers from the Carney Institute for Brain Science at Brown University have unveiled new findings on how we optimize our working memory and what limits its capacity. These insights could help us better understand dopamine-related disorders such as ADHD, Parkinson’s, and schizophrenia.

Cracking the Code of Working Memory

Working memory allows us to juggle different pieces of information in short-term scenarios, like making a mental grocery list or remembering a phone number. Scientists agree that working memory has a limited capacity, but why is that?

Michael Frank, a professor at the Carney Institute, and Aneri Soni, a graduate student, developed a new computer model of the brain’s basal ganglia and thalamus. Their study, published in eLife, reveals that our brain’s capacity to manage multiple pieces of information at once is limited due to learning processes.

“The simulations show that if we tried to hold too many items at once, the brain would get confused and struggle to use the stored information,” explains Soni. “Our research demonstrates that when faced with these limitations, the brain learns to compress information to save space strategically.”

The Role of Dopamine

Dopamine, a neurotransmitter, is crucial in how learning relates to working memory. The findings shed new light on dopamine-related disorders like ADHD, where the brain’s ability to manage working memory is affected.

In 2018, Frank’s lab conducted an experiment showing that humans can “chunk” information together in working memory to save space. Soni built a brain-like computer model that replicated these results. Her model learned to compress information, similar to how humans do, by grouping related pieces together.

Soni’s simulations reveal that learning, rather than capacity, drives working memory. A component critical to this process is a mechanism that emulates the brain’s dopamine delivery system. When the model recalled more information by chunking it together, the dopamine system encouraged this strategy.

Implications for ADHD and Other Disorders

Soni altered the model’s dopamine delivery system to mimic what is known about dopamine levels in patients with ADHD, Parkinson’s, and schizophrenia. The results showed that without a healthy dopamine system, the model struggled to use its storage space efficiently.

“Take Parkinson’s disease, for example,” says Frank. “People think of it as a movement disorder, but patients also have changes in working memory. They are treated with drugs targeting the prefrontal cortex, but our findings suggest we should also consider drugs targeting the basal ganglia and thalamus.”

Understanding what happens in the brain’s basal ganglia and thalamus for people with dopamine-related disorders can help clinicians develop better treatment options.