I spent most of my Sunday afternoon reviewing and editing reports of child neuropsychological evaluations. Most of them were for children who came to our clinic for a comprehensive ADHD diagnostic evaluation. At the end of these reports we always include a large number of individualized recommendations for home and school accommodations and interventions. Within this list, we often, if not always, encourage parents to consult with their pediatrician or child psychiatrist regarding the appropriateness of medication for the treatment for their child’s ADHD. But such recommendation is only one of more than a dozen. In our approach to treatment, medication is one small component of a multi-pronged strategy. Why? Because medication alone is unlikely to be enough to help the child successfully navigate the multiple obstacles imposed by his/her condition. So I was not surprised when I read the results of one of the largest studies of community-based medication interventions for elementary school children with ADHD. The result? Medication alone works, but not as much as we’d like. Read More

The current issue of the journal Pediatrics includes a large epidemiological analysis of the association between prenatal exposure to tobacco and later risk for ADHD. The analysis was relatively simple and elegant. They examined a national representative sample of 2,588 US adolescents. Three variables were of interest: 1) whether the teen was exposed to tobacco before birth as determined by the mother’s self-report of cigarette smoking during pregnancy; 2) the teens’ current blood levels of lead; and 3) whether the child had ADHD as determined by a structured psychiatric interview. This last point is key because some have argued that ADHD has been overdiagnosed due to the use of informal and arguably inappropriate assessment procedures (e.g., a pediatrician asking a few questions). Thus, the use of a this diagnostic interview would improve the accuracy of the diagnoses. Finally, in addition to these 3 main variables, the authors examined a number of variables that could provide alternative explanations of the findings. These variables included: the sex of the child, income of the family, age, race, the mother’s age at birth, birth weight, birth complications (Neonatal Intensive Care Unit admission), post-natal cigarette smoke exposure, and whether the kid went to preschool. Read More

A recent article in the Journal of child Psychology and Psychiatry examined the long term course of ADHD and co-morbid diagnoses among boys and girls as they transitioned from childhood into adolescence. The vast majority of research on ADHD has been done with boys, mostly due to the sex difference in the rates of ADHD. The few studies that have included girls have shown significant differences between boys and girls in a number of domains, including the physiological correlates of the condition, cognitive function, and co-morbidities. Yet, we know little of the longitudinal progression of ADHD in girls. Specifically, it is unknown whether the course of ADHD is similar in boys and girls or whether they have similar co-morbid conditions throughout childhood and adolescence. Read More

Maternal obesity during pregnancy is not one of the usual suspects of risk factors for ADHD. Yet, it seems that there is some preliminary evidence associating maternal obesity and ADHD. The latest study showing this link was published in the last issue of the Journal of Child Psychology and Psychiatrist by Alina Rodriguez from the Uppsala University in Sweden and Imperial College in London.

1. In this new study the author first presented 4 issues that remain unresolved from previous research linking maternal obesity and ADHD
2. Since obesity is associated with distress, is it possible that it is the distress during pregnancy that increases the risk for ADHD rather than the obesity?
3. It is possible that maternal obesity and child ADHD are simply related to a common genetic factor. In such a case, it would be the genetic factor, and not the obesity that increases the risk for ADHD
4. Maternal obesity is associated with small birth weight due to fetal growth restrictions, and some studies have linked small birth size to ADHD, possibly through its effects on emotional regulation. Thus, is small birth size the possible link between maternal obesity and ADHD?
5. Maternal obesity is also associated with childhood obesity. Is it possible then than the increased risk for ADHD is due to childhood obesity? Read More

The totality of the available data on the short term effects of ADHD stimulant is relatively consistent: these medications are safe and result in significant improvement in symptoms, especially for children with severe forms of the disorder. However, little previous research on the long term effects of these medications has been used by critics of psychiatric medications to argue against the use of these drugs. Fortunately, as children who participated in the initial ADHD medication clinical trials (and similar studies) become young adults, a series of studies are finally providing much needed data on the long term safety and effects of stimulant use.

In the latest issue of Pediatrics, a team led by Dr. Joseph Biederman from Harvard Medical School published an examination of the association between ADHD medication and future psychiatric conditions. For this study, the researchers followed 112 children age 6 to 17 for approximately 10 years. All of these children had a diagnosis of ADHD. 73% of these children had a life time use of stimulant medication and 27% had never used the medication. The authors compared the probability of having a co-morbid psychiatric disorder 10 years after the start of the study among kids who had used medication against those who never used medication. Read More