Common pesticide may increase risk of ADHD

Mice exposed to a commonly used pesticide in utero and through lactation exhibited several features of ADHD, including dysfunctional dopamine signaling in the brain, hyperactivity, working memory, attention deficits and impulsive-like behaviour.

A commonly used pesticide may alter the development of the brain's dopamine system, responsible for emotional expression and cognitive function, and increase the risk of attention deficit hyperactivity disorder in children, according to a new Rutgers study.

The research published Wednesday in the Journal of the Federation of American Societies for Experimental Biology (FASEB J.), by Rutgers scientists and colleagues from Emory University, the University of Rochester Medical Center, and Wake Forest University discovered that mice exposed to the pyrethroid pesticide deltamethrin in utero and through lactation exhibited several features of ADHD, including dysfunctional dopamine signaling in the brain, hyperactivity, working memory, attention deficits and impulsive-like behaviour.

Attention deficit hyperactivity disorder most often affects children, with an estimated 11 percent of children between the ages of 4-17, about 6.4 million, diagnosed as of 2011.

Boys are three to four times more likely to be diagnosed than girls. While early symptoms, including an inability to sit still, pay attention and follow directions, begin between the ages of 3 to 6, diagnosis is usually made after the child starts attending school full time.

Importantly, in this study, the male mice were affected more than the female mice, similar to what is observed in children with ADHD.

The ADHD-like behaviours persisted in the mice through adulthood, even though the pesticide, considered to be less toxic and used on golf courses, in the home, and on gardens, lawns and vegetable crops, was no longer detected in their system.

Although there is strong scientific evidence that genetics plays a role in susceptibility to the disorder, no specific gene has been found that causes ADHD and scientists believe that environmental factors may also contribute to the development of the behavioural condition.

Using data from the Centers for Disease Control, National Health and Nutrition Examination Survey (NHANES) the study analyzed health care questionnaires and urine samples of 2,123 children and adolescents.

Researchers asked parents whether a physician had ever diagnosed their child with ADHD and cross-referenced each child's prescription drug history to determine if any of the most common ADHD medications had been prescribed.

Children with higher pyrethroid pesticide metabolite levels in their urine were more than twice as likely to be diagnosed with ADHD.

These findings provide strong evidence, using data from animal models and humans, that exposure to pyrethroid pesticides, including deltamethrin, may be a risk factor for ADHD, says lead author Jason Richardson, associate professor in the Department and Environmental and Occupational Medicine at Rutgers Robert Wood Johnson Medical School and a member of the Environmental and Occupational Health Sciences Institute (EOHSI).

"Although we can't change genetic susceptibility to ADHD, there may be modifiable environmental factors, including exposures to pesticides that we should be examining in more detail," says Richardson.

Young children and pregnant women may be more susceptible to pesticide exposure because their bodies do not metabolize the chemicals as quickly.

This is why, Richardson says, human studies need to be conducted to determine how exposure affects the developing fetus and young children.

"We need to make sure these pesticides are being used correctly and not unduly expose those who may be at a higher risk," Richardson says.

More information: "Developmental pesticide exposure reproduces features of attention deficit hyperactivity disorder." FASEB J fj.14-260901; published ahead of print January 28, 2015, doi: 10.1096/fj.14-260901

Neurodiversity: Unleashing the Advantages of Your Differently Wired Brain

Neurodiversity

This material is based upon Dr Thomas Armstrong's book The Power of Neurodiversity:  Unleashing the Advantages of Your Differently Wired Brain. The Neurodiversity Strengths Checklist for Children.

Neurodiversity:  A Concept Whose Time Has Come

Over the past sixty years, we’ve witnessed a phenomenal growth in the number of new psychiatric illnesses.

The American Psychiatric Association’s Diagnostic and Statistical Manual, first published in 1952, originally listed about 100 categories of illness.

By the year 2000, that number had tripled.  We’ve become accustomed to hearing in the news about “learning disabilities,” “ADHD,” “Asperger’s syndrome,” and other conditions that were virtually unheard of fifty years ago.

A report from the National Institute of Mental Health indicates that about one-fourth of the American population suffers from a psychiatric disorder in any given year, and an article in the Archives of General Psychology suggested that over the course of a lifetime, approximately half of all people may suffer from a mental illness sometime during their lives.

Add to this the observation by Harvard Medical School professor John Ratey that many people have milder versions of psychiatric conditions (he calls them “shadow syndromes”), and we come to the conclusion that when all is said and done, nearly every individual in the country may have a psychiatric illness to one degree or another.

This epidemic in the growth of mental illness suggests that there is a crisis in the making.  How much longer can we continue to add new psychiatric illnesses to the list, before it becomes apparent that we have moved too far in pathologizing a sizeable chunk of the American populace?

There is, however, an answer to this crisis.  The concept of neurodiversity provides a paradigm shift in how we think about mental functioning.

Instead of regarding large portions of the American public as suffering from deficit, disease, or dysfunction in their mental processing, neurodiversity suggests that we instead speak about differences in cognitive functioning.

Just as we talk about differences in bio-diversity and cultural diversity, we need to start using the same kind of thinking in talking about brain differences.

We don’t pathologize a calla lily for not having petals (e.g. petal deficit disorder), nor do we diagnose an individual with brown skin as suffering from a “pigmentation dysfunction.”

Similarly, we ought not to pathologize individuals who have different ways of thinking, relating, attending, and learning

The word neurodiversity was coined in the late 1990’s by two individuals: journalist Harvey Blume, and autism advocate Judy Singer.

Blume wrote in the September 1, 1998 issue of The Atlantic:  “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment?

Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind.” Singer in a 1999 book chapter titled:  “Why Can’t You Be Normal For Once in Your Life?” observed:  “For me, the key significance of the ‘Autistic Spectrum’ lies in its call for and anticipation of a politics of Neurological Diversity, or what I want to call ‘Neurodiversity.’

The ‘Neurologically Different’ represent a new addition to the familiar political categories of class/gender/race and will augment the insights of the social model of disability.

”The Wikepedia defines neurodiversity as:  “…an idea which asserts that atypical (neurodivergent) neurological development is a normal human difference that is to be recognized and respected as any other human variation.”  

The online Double-Tongued Dictionary characterizes neurodiversity as:  “the whole of human mental or psychological neurological structures or behaviours, seen as not necessarily problematic, but as alternate, acceptable forms of human biology.”

By using the concept of neurodiversity to account for individual neurological differences, we create a discourse whereby labeled people may be seen in terms of their strengths as well as their weaknesses.

Dyslexics, for example, can be seen in terms of their visual thinking ability and entrepreneurial strengths.  People with ADHD can be regarded as possessing a penchant for novel learning situations.

Individuals along the autistic spectrum can be looked at in terms of their facility with systems such computer programming or mathematical computation.

Those with bipolar disorder can be appreciated for their creative pursuits in the arts.

While proponents of the concept of neurodiversity do not shirk from the realization that people with dyslexia, ADHD, autism, bipolar disorder, and other psychiatric conditions, often suffer great hardships, and that those hardships require a lot of hard work to overcome, they realize that until an individual’s strengths have been recognized, celebrated, and worked with, nothing substantial can be accomplished with regard to their difficulties.

 Eight Principles of Neurodiversity:

The Human Brain Works More Like an Ecosystem than a Machine.  Up until now, the most often used metaphor to refer to the brain has been a computer (or some other type of machine).

However, the human brain isn’t hardware or software, it’s wetware.  The characterization of the brain as an unbelievably intricate network of ecosystems is much closer to the truth than that of a complex machine.

We should devise a discourse that better reflects this new conception of the brain.

Human Brains  Exist Along Continuums of Competence. Rather than regarding disability categories as discrete entities, it’s more appropriate to speak of spectrums or continuums of competence.

Recent research, for example, indicates that dyslexia is part of a spectrum that includes normal reading ability.

Similarly, we use terms such as autistic spectrum disorders, to suggest that there are different gradations of social ability that merge ultimately with normal behavior.

This suggests that we are all somewhere along continuums related to literacy, sociability, attention, learning, and other cognitive abilities, and thus all of us are connected to each other, rather than being separated into "normal" and "those having disabilities."

Human Competence is Defined by the Values of the Culture to Which You Belong.  Categories of disability often deeply reflect the values of a culture.

Dyslexia, for example, is based upon the social value that everyone be able to read.

One hundred and fifty years ago, this wasn’t the case, and dyslexia was unknown.  Similarly, autism may reflect the cultural value that suggests that it’s better to be in relationship than to be alone.

We should recognize that diagnostic categories are not purely scientifically-based but reflect these deeper social biases.

Whether You are Regarded As Disabled or Gifted Depends Largely on When and Where You Were Born.  

In other times and other places, there have been different disability/ability diagnoses depending upon cultural values.

In pre-Civil War America, for example, there was a disorder called “drapetomania” said to afflict blacks.

Its meaning was “an obsession with the urge to flee one’s slave masters” and reflected its racist roots. In India, today, there are people who would be labeled in the West as schizophrenic, but who are regarded as holy beings by the local population.

We should not regard diagnostic labels as absolute and set in stone, but think, instead, of their existence relative to a particular social setting.  

Success in Life is Based on Adapting One’s Brain to the Needs of the Surrounding Environment.   Despite Principles 3 and 4, however, it's true that we don’t live in other places or times, consequently the immediate need is to adapt to our current contemporary culture.

This means that a dyslexic person needs to learn how to read, an autistic individual needs to learn how to relate to others socially, a schizophrenic individual needs to think more rationally and so forth.

Tools such as psychoactive medication or intensive remediation programs can help achieve these aims.

Success in Life Also Depends on Modifying Your Surrounding Environment to Fit the Needs of Your Unique Brain (Niche Construction).

We shouldn’t focus all of our attention on making a neurodiverse person adapt to the environment in which they find themselves, which is a little like making a round peg fit in a square hole.

We should also devise ways of helping an individual change their surrounding environment to fit the needs of their unique brain.

Niche Construction Includes Career and Lifestyle Choices, Assistive Technologies, Human Resources, and Other Life-Enhancing Strategies Tailored to the Specific Needs of a Neurodiverse Individual.

There are many tools, resources, and strategies for altering the environment so that it it meshes with the needs of a neurodiverse brain.

For example, a person with ADHD, can find a career that involves novelty and movement, use an iPhone to help with organizing his day, and hire a coach to assist him with developing better social skills.

Positive Niche Construction Directly Modifies the Brain, Which in Turn Enhances its Ability to Adapt to the Environment. In experiments with mice, neuroscientists have shown that a more enriching environment results in a more complex network of neuronal connections in the brain.

This more complex brain, in turn, has an easier time adapting to the needs of the surrounding environment.

In conclusion, the potential is great for the neurodiversity movement to create significant social transformation.

Already, for example, there are software firms that have recognized the special programming gifts of certain people with Asperger’s syndrome and others on the autistic spectrum, and have hired significant numbers of them to improve their productivity.

Similarly, more people are understanding that ADHD brings with it special abilities as well as difficulties, and that appropriate career selection can be an important part of determining whether one will be successful or unsuccessful in a particular job.

It is hoped that the concept of neurodiversity will help combat “abelism” or the belief that people who are “abnormal” should be discriminated against, condescended to, and ultimately kept out of the basic affairs of society.

Neurodiversity brings with it a sense of hope, that all individuals, regardless of how they read, think, feel, socialize, or attend, will be recognized for their gifts, and accorded the same rights and privileges as any other human being.  

The full article and references here

ADHD: Medication plus parent training may help kids with aggression

Combining two medications with parent training appears to improve anger, irritability and violent tendencies in children whose attention-deficit/hyperactivity disorder (ADHD) is coupled with severe aggression, a new study suggests.

"Augmented" therapy that consists of stimulant and antipsychotic drugs, along with parent training in behavioural management techniques, was rated more effective by parents than "basic" therapy pairing only the stimulant and parent training, researchers found.

"An important finding of this study was that at the end of nine weeks, approximately half of all children receiving basic therapy were still rated by their parents as being impaired... with symptoms interfering with school or social functioning," said study author Kenneth Gadow, a professor of psychiatry at Stony Brook University in New York.

"In the augmented group receiving three interventions for aggression, about one-quarter still, at the end of nine weeks, were rated by their parents as being impaired, and that suggests, even with highly effective therapies, that many of these children still have unmet treatment needs" " he added.

The drugs used in the study, published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry, included the widely prescribed ADHD stimulant Concerta (methylphenidate) and the antipsychotic Risperdal (risperidone).

Approximately 11 percent of American children aged 4 to 17 have been diagnosed with ADHD, which includes symptoms such as impulsivity, hyperactivity, and difficulty focusing and controlling behavior, according to the U.S. Centers for Disease Control and Prevention.

As many as half of children with ADHD also display significant, disruptive aggression, according to an editorial accompanying the new research.

"This is very common among kids with ADHD, but unfortunately it complicates the picture for treatment," said Erin Schoenfelder, a clinical psychologist at Seattle Children's Hospital and assistant professor of psychiatry and behavioural health at University of Washington.

"It really is staggeringly high."

In the new research, Gadow and his colleagues divided a group of nearly 170 children aged 6 to 12 with ADHD and aggression problems into two treatment groups, basic and augmented.

The basic group received Concerta and their parents underwent behavioral management training.

The augmented group received Concerta and parental training as well, but also took the antipsychotic Risperdal. Both groups were followed for nine weeks.

While both groups of children displayed marked reduction in symptoms, improvement ratings varied depending on whether parents or teachers were making the assessment.

Parents reported that children on augmented therapy were less likely to be impaired socially or academically by their anger and irritability than children on basic therapy.

On the other hand, teachers found few differences in these measures.

Instead, teachers of those on augmented therapy reported significant drops in ADHD symptoms, especially impulsiveness, compared with teachers of children on basic therapy.

Gadow and Schoenfelder agreed that the conflicting parent-teacher ratings demonstrate a familiar concept: that children's behaviours vary in different settings, whether or not they have ADHD.

"Just like adults, they adapt their behaviours to be more appropriate for the setting they're in," Gadow said.

"People do differ, however, in their ability to modify their behaviour from one setting to the next, and some children are much more variable [in this regard]."

Schoenfelder said long-term evidence is needed indicating that combining Concerta and Risperdal is safe in children, but "it appears from this study that the combination was well-tolerated and something practitioners could [adjust the dosage of] effectively."

"Folks trying this type of treatment should have close monitoring," she added. "This is a starting point. It's a combination doctors may try when they see this blend of aggressive and hyperactive behaviours. It certainly will require adjustment . . . but it's exciting to find something helpful for a significant proportion of the kids studied."

The study authors pointed out that their findings only apply to children with ADHD who exhibit severe irritability and peer aggression.

They noted that the study's findings are not an indication of the ADHD population as a whole.

More Information: "Risperidone Added to Parent Training and Stimulant Medication: Effects on Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Peer Aggression" http://www.jaacap.com/article/S0890-8567(14)00369-4/abstract

ADHD children make poor decisions due to less differentiated learning processes

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders among school children. Pupils with ADHD often make poorer decisions than their unaffected classmates.

Researchers from the University of Zurich now discovered that different learning and decision-making mechanisms are responsible for these behaviors, and localized the underlying impairments in the brain.

Which shirt do we put on in the morning? Do we drive to work or take the train? From which takeaway joint do we want to buy lunch?

We make hundreds of different decisions every day. Even if these often only have a minimal impact, it is extremely important for our long-term personal development to make decisions that are as optimal as possible.

People with ADHD often find this difficult, however. They are known to make impulsive decisions, often choosing options which bring a prompt but smaller reward instead of making a choice that yields a greater reward later on down the line.

Researchers from the University Clinics for Child and Adolescent Psychiatry, University of Zurich, now reveal that different decision-making processes are responsible for such suboptimal choices and that these take place in the middle of the frontal lobe.

Mathematical models help to understand the decision-making processes
In the study, the decision-making processes in 40 young people with and without ADHD were examined.

Lying in a functional magnetic resonance imaging (fMRI) scanner to record the brain activity, the participants played a game where they had to learn which of two images carried more frequent rewards.

To understand the impaired mechanisms of participants with ADHD better, learning algorithms which originally stemmed from the field of artificial intelligence were used to evaluate the data.

These mathematical models help to understand the precise learning and decision-making mechanisms better.

"We were able to demonstrate that young people with ADHD do not inherently have difficulties in learning new information; instead, they evidently use less differentiated learning patterns, which is presumably why sub-optimal decisions are often made", says first author Tobias Hauser.

Multimodal imaging affords glimpses inside the brain
To study the brain processes that triggered these impairments, the authors used multimodal imaging methods, where the participants were examined using a combined measurement of functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to record the electrical activity and the blood flow in the brain.

It became apparent that participants with ADHD exhibit an altered functioning in the medial prefrontal cortex, a region in the middle of the frontal lobe.

This part of the brain is heavily involved in decision-making processes, especially if you have to choose between several options, and in learning from errors.

Although a change in activity in this region was already discovered in other contexts for ADHD, the Zurich researchers were now also able to pinpoint the precise moment of this impairment, which already occurred less than half a second after a feedback, i.e. at a very early stage.

Psychologist Tobias Hauser, who is now researching at the Wellcome Trust Centre for Neuroimaging, University College London, is convinced that the results fundamentally improve our understanding of the mechanisms of impaired decision-making behaviour in people with ADHD.

The next step will be to study the brain messenger substances. "If our findings are confirmed, they will provide key clues as to how we might be able to design therapeutic interventions in future," explains Hauser.

More information: Tobias U. Hauser, Reto Iannaccone, Juliane Ball, Christoph Mathys, Daniel Brandeis, Susanne Walitza & Silvia Brem: Role of Medial Prefrontal "Cortex in Impaired Decision Making in Juvenile Attention-Deficit/Hyperactivity Disorder," in: JAMA Psychiatry, DOI: 10.1001/jamapsychiatry.2014.1093

MRI technique may help prevent ADHD misdiagnosis

This shows subgroup averages of parametric maps of MRI brain iron indices: magnetic field correlation (MFC: top row) and relaxation rates R2 (second row), R2*(third row), and R2' (bottom row). 

Parametric maps, masked for regions of interests (green): caudate nucleus (CN), putamen (PUT), globus pallidus (GP) and thalamus (THL), are shown for controls (n = 27), medication-naïve ADHD patients (ADHD-non-medicated; n = 12) and ADHD patients with a history of psychostimulant treatment (ADHD-medicated; n = 10). 

The ADHD-non-medicated subgroup displayed significantly reduced striatal (CN, PUT) and thalamic MFC compared to both controls and the ADHD-medicated subgroup. 

No significant differences were detected between the latter two groups. 

Credit: Radiological Society of North America 

Brain iron levels offer a potential biomarker in the diagnosis of attention deficit hyperactivity disorder (ADHD) and may help physicians and parents make better informed treatment decisions, according to new research published online in the journal Radiology.

ADHD is a common disorder in children and adolescents that can continue into adulthood. Symptoms include hyperactivity and difficulty staying focused, paying attention and controlling behavior. The American Psychiatric Association reports that ADHD affects 3 to 7 percent of school-age children.

Psychostimulant medications such as Ritalin are among the drugs commonly used to reduce ADHD symptoms.

Psychostimulants affect levels of dopamine, a neurotransmitter in the brain associated with addiction.

"Much debate and concern has emerged regarding the continual rise of ADHD diagnosis in the U.S. given that two-thirds of those diagnosed receive psychostimulant medications," said Vitria Adisetiyo, Ph.D., postdoctoral research fellow at the Medical University of South Carolina in Charleston, S.C.

"We wanted to see if we could identify brain iron as a potential noninvasive biomarker for medication-naïve ADHD to prevent misdiagnosis."

For the study, the research team measured brain iron levels in 22 children and adolescents with ADHD, 12 of whom had never been on medication for their condition (medication naïve), and 27 healthy control children and adolescents using a magnetic resonance imaging (MRI) technique called magnetic field correlation imaging.


The technique was introduced in 2006 by study co-authors and faculty members Joseph A. Helpern, Ph.D., and Jens H. Jensen, Ph.D. No contrast agents were used, and blood iron levels in the body were measured using a blood draw.

The results showed that the 12 ADHD medication-naïve patients had significantly lower brain iron levels than the 10 ADHD patients who had been on psychostimulant medication and the 27 children and adolescents in the control group.

In contrast, ADHD patients with a history of psychostimulant medication treatment had brain iron levels comparable to controls, suggesting that brain iron may increase to normal levels with psychostimulant treatment.

"Our research suggests that iron absorption into the brain may be abnormal in ADHD given that atypical brain iron levels are found even when blood iron levels in the body are normal," Dr. Adisetiyo said.

"We found no differences in blood iron measures between controls, medication-naïve ADHD patients or pscyhostimulant-medicated ADHD patients."

If the results can be replicated in larger studies, magnetic field correlation might have a future role in determining which patients would benefit from psychostimulants—an important consideration because the drugs can become addictive if taken inappropriately and lead to abuse of other drugs like cocaine.

"We want the public to know that progress is being made in identifying potential noninvasive biological biomarkers of ADHD which may help to prevent misdiagnosis," Dr. Adisetiyo said.

"We are currently testing our findings in a larger cohort to confirm that measuring brain iron levels in ADHD is indeed a reliable and clinically feasible biomarker."

More information: "Multimodal MR Imaging of Brain Iron in Attention Deficit Hyperactivity Disorder: A Non-invasive Biomarker that Responds to Psychostimulant Treatment?" Radiology, 2014.

ADHD: Language problems common in children with ADHD

Children who have attention-deficit/hyperactivity disorder are nearly three times more likely to have language problems than kids without ADHD, according to new research.

And those language difficulties can have far-reaching academic consequences, the study found.

The study, published online April 21 in Pediatrics, looked at 6- to 8-year-olds with and without ADHD in Australia.

"We found that 40 percent of children in the ADHD group had language problems, compared to 17 percent of children in the 'control' group," said Emma Sciberras, a clinical psychologist and post-doctoral research fellow at the Murdoch Children's Research Institute in Victoria, Australia.

"Rates of language problems were similar in boys and girls with ADHD," she added.

Emma Sciberras

Children with ADHD commonly have trouble with school performance and social functioning.

The impact that language problems might have on these factors hasn't been well-studied, the study authors noted.

"The differences in academic functioning between children with ADHD and language problems, compared to those with ADHD alone, were quite large and clinically meaningful," said Sciberras.

Language problems refer to spoken language—both receptive and expressive language. Receptive language is the ability to listen and understand what's being said; expressive is the ability to speak and be understood.

In a separate study in the same issue of the journal, Sciberras and her colleagues looked at almost 400 children with ADHD, aged 5 to 13, and found almost two-thirds had one or more anxiety disorders.

When children with ADHD had two or more anxiety disorders—this was true for one-third of the kids—their quality of life, behavior and daily functioning suffered, the researchers said.

"It is very common for children with ADHD to experience additional difficulties," said Sciberras. "Both of these studies demonstrate that the additional difficulties that go along with ADHD, in this case anxiety and language problems, can make daily functioning even harder for children with ADHD."

The language study included 179 children diagnosed with ADHD and 212 without the attention disorder. Fewer than half of the children with ADHD were taking medications to help control their symptoms.

After adjusting for sociodemographic factors and other conditions, such as autism spectrum disorders, the researchers found that the risk of language problems was 2.8 times higher in children with ADHD.

When the researchers looked at how those language problems affected school work, they found lower math, reading and academic scores.

However, the researchers didn't find that language problems had an impact on social functioning.

"We were surprised that language problems were not associated with poorer social functioning for children with ADHD," Sciberras said.

"It could be that children with ADHD are already experiencing poorer social functioning due to other factors including their ADHD symptoms or other associated difficulties."

However, Sciberras cautioned that language troubles might become more problematic as these kids get older because social relationships get more complex with age.

One outside expert said the study is a good reminder for parents and physicians.

Bradley Berg

"If a child has ADHD and they're struggling in school, even though their ADHD symptoms are well-controlled, in addition to getting tested for learning disabilities, they should also be looked at for language difficulties as well. And that's not something we always think of," said Dr. Bradley Berg, medical director of McLane Children's Pediatrics at Baylor Scott & White Healthcare in Round Rock, Texas.

Whether speech-language interventions will help the youngsters with ADHD isn't clear, however.

Berg also pointed out that this issue is a "chicken-and-egg" problem.

He said "We don't know if these kids have;

• a language disorder that's causing them to not understand what's going on at school 
• and that's making them restless and fidgety because they're bored
• Or do they have ADHD and that's causing difficulty understanding the language. 
• Or is there something going on in an area of the brain that creates both of these problems?

It's possible that the findings from this Australian study might not translate to a U.S. population.

For one thing, medication trends might differ, Berg said. For children with ADHD who also suffer anxiety, Sciberras said medications might help, and a type of psychotherapy called cognitive behavioral therapy could also be useful.

The researchers are currently conducting a study to treat anxiety in children with ADHD.

"If parents are concerned that their child with ADHD has anxiety, language or any other additional difficulties that are not currently being managed, we encourage them to discuss their concerns with their child's treating clinician," she said.

Autism: Diagnosis and Treatment

In the US April is National Autism Awareness Month.

The Child Development Clinic at Children's Hospital of Richmond at VCU (CHoR) provides comprehensive assessment for pediatric patients with developmental delays or disabilities, including those with autism spectrum disorders.

The medical, psychological, social work and educational testing offered by the clinic leads to a diagnosis and recommendations to help patients and their health care providers with care planning, referrals, follow-up care coordination and treatments.

Pasquale Accardo

We sat down with Pasquale Accardo, M.D., professor and chief of the Division of Developmental Pediatrics at CHoR, to learn more about autism, including symptoms, diagnosis and treatment.

What is autism?

Autism is a neurodevelopmental disorder, this means that it is a chronic brain problem, a difficulty that the brain has with processing certain kinds of information.

In the case of autism, typically the greatest difficulty is dealing with social interaction.

What are the common signs and symptoms of autism?

Common signs of autism vary with age:

• Young children often first present with language issues.
• Preschool and school-age children often exhibit attention deficit hyperactivity disorder (ADHD) symptoms and other challenging behaviours.
• Older children have significant socialization problems, repetitive and obsessive compulsive behaviours.

Symptoms of autism do change with time; certain delays are more common in younger children whereas socialization and processing problems are more common in older children and adults.

How is autism diagnosed?

Autism is diagnosed using a variety of approaches:

• A clinical history and examination may be sufficient.
• Formal testing can include a variety of questionnaires, including the Gilliam Autism Rating Scale, now in its 3rd edition (GARS-3) and the Childhood Autism Rating Scale, now in its 2nd edition (CARS-2) administered to the parents and teachers.
• Autism Diagnostic Observation Schedule (ADOS) testing is considered the gold standard.

How is autism treated?

Autism is best treated with a variety of Early Intensive Behavioural Interventions (EIBI); speech language therapy and occupational therapy can also be used.

Applied Behaviour Analysis (ABA) is considered the standard for behavioral intervention, but most other effective behavioral programs are variants on ABA.

ADHD/ADD: Confirmation of the neurobiological origin

In this image, marking shows the axons in retinal neurons (in red) that innervate the superior colliculus (in blue) in a "normal" mouse. 

Credit: Michael Reber / Institut des Neurosciences Cellulaires et Intégratives 

A study, carried out on mice, has just confirmed the neurobiological origin of attention-deficit disorder (ADD), a syndrome whose causes are poorly understood.

Researchers from CNRS, the University of Strasbourg and INSERM have identified a cerebral structure, the superior colliculus, where hyperstimulation causes behaviour modifications similar to those of some patients who suffer from ADD.

Their work also shows noradrenaline (Norepinephrine) accumulation in the affected area, shedding light on this chemical mediator having a role in attention disorders.

These results are published in the journal Brain Structure and Function.

Attention-deficit disorder (ADD/ADHD) affects between 4-8% of children. It manifests mainly through disturbed attention and verbal and motor impulsiveness, sometimes accompanied by hyperactivity.

About 60% of these children still show symptoms in adulthood. No cure exists at this time. The only effective treatment is to administer psychostimulants, but these have substantial side effects, such as dependence.

Persistent controversy surrounding the neurobiological origin of this disorder has hindered the development of new treatments.

The study in Strasbourg investigated the behaviour of transgenic mice having developmental defects in the superior colliculus.

This structure, located in the midbrain, is a sensory hub involved in controlling attention and visual and spatial orientation.

The mice studied were characterized by duplicated neuron projections between the superior colliculus and the retina. This anomaly causes visual hyperstimulation and excess noradrenaline in the superior colliculus.

The effects of the neurotransmitter noradrenaline (Norepinephrine), which vary from species to species, are still poorly understood.

However, we do know that this noradrenaline (Norepinephrine) imbalance is associated with significant behavioural changes in mice carrying the genetic mutation.

By studying them, researchers have observed a loss of inhibition: for example mice hesitate less to penetrate a hostile environment.

They have difficulties in understanding relevant information and demonstrate a form of impulsiveness. These symptoms remind us of adult patients suffering from one of the forms of ADD.

Currently, the fundamental work on ADD uses mainly animal models obtained by mutations that disturb dopamine production and transmission pathways. In mice with a malformed superior colliculus, these pathways are intact.

The changes occur elsewhere in the neural networks of the midbrain. By broadening the classic boundary used to research its causes, using these new models would allow a more global approach to ADD to be developed.

Characterising the effects of noradrenaline (Norepinephrine) on the superior colliculus more precisely could open the way to innovative therapeutic strategies.

More information: Chantal Mathis, Elise Savier, Jean-Bastien Bott, Daniel Clesse, Nicholas Bevins, Dominique Sage-Ciocca, Karin Geiger, Anaïs Gillet, Alexis Laux-Biehlmann, Yannick Goumon, Adrien Lacaud, Vincent Lelièvre, Christian Kelche, Jean-Christophe Cassel, Frank W. Pfrieger, Michael Reber. "Defective response inhibition and collicular noradrenaline enrichment in mice with duplicated retinotopic map in the superior colliculus." Brain Structure and Function, 2014; DOI: 10.1007/s00429-014-0745-5

Headstrong Nation: Inside the Hidden World of Dyslexia & ADHD

In Headstrong's first film, we provide an overview of dyslexia and attention deficit disorder while exploring the brave lives of diverse individuals persevering in a world not designed with them in mind.

Learn more about Headstrong Nation here

Learn basic facts about dyslexia, dyscalculia, dysgraphia and ADHD - Video

Learn basic facts about dyslexia, dyscalculia, dysgraphia and ADHD and visit LD.org for resources on how to get the most out of your relationship with your child's doctor.

Credit for video goes to the National Center for Learning Disabilities

Thirty percent of adults with ADHD report childhood physical abuse

Thirty percent of adults with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) report they were physically abused before they turned 18.

This compares to seven per cent of those without ADD/ADHD who were physically abused before 18. The results were in a study published in this week's online Journal of Aggression, Maltreatment, and Trauma.

"This strong association between abuse and ADD/ADHD was not explained by differences in demographic characteristics or other early adversities experienced by those who had been abused," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work.

"Even after adjusting for different factors, those who reported being physically abused before age 18 had seven times the odds of ADD/ADHD."

Investigators examined a representative sample of 13,054 adults aged 18 and over in the 2005 Canadian Community Health Survey including 1,020 respondents who reported childhood physical abuse and 64 respondents who reported that they had been diagnosed by a health professional with either ADHD or ADD.

"Our data do not allow us to know the direction of the association. It is possible that the behaviors of children with ADD/ADHD increase parental stress and the likelihood of abuse," says co-author Rukshan Mehta, a graduate of the University of Toronto's Master of Social Work program.

"Alternatively, some new literature suggests early childhood abuse may result in and/or exacerbate the risk of ADD/ADHD."

According to co-author Angela Valeo from Ryerson University, "This study underlines the importance of ADD/ADHD as a marker of abuse.

With 30 per cent of adults with ADD/ADHD reporting childhood abuse, it is important that health professionals working with children with these disorders screen them for physical abuse."

More information: "Establishing a Link Between Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder and Childhood Physical Abuse." Esme Fuller-Thomsona*, Rukshan Mehtaa & Angela Valeob. Journal of Aggression, Maltreatment & Trauma. Volume 23, Issue 2, 2014 pages 188-198. DOI: 10.1080/10926771.2014.873510

Pain killer Paracetamol (Acetaminophen) use in pregnancy linked to ADHD

Acetaminophen, also known as Paracetamol in UK or Tylenol in US, a common pain reliever considered safe for pregnant women, has been linked for the first time to an increased risk of attention deficit and hyperactivity disorder in children, said a study, published Monday.

More studies are needed to confirm the findings, but experts said the research points to a new potential cause for the worldwide rise in cases of ADHD, a neuro-behavioural condition which has no known cause and affects as many as five percent of US children.

Women who took acetaminophen, also known as Paracetamol, while pregnant had a 37 percent higher risk of having a child who would be later given a hospital diagnosis of hyperkinetic disorder, a particularly severe form of ADHD, said the study in February 24 edition of the Journal of the American Medical Association (JAMA) Pediatrics: doi:10.1001/jamapediatrics.2013.4914.

Compared to women who did not take Acetaminophen while pregnant, women who did also had a 29 percent higher chance of having children who were later prescribed medications for attention deficit hyperactivity disorder, and a 13 percent higher chance of exhibiting ADHD-like behaviours by age seven.

Previous research has suggested that Acetaminophen can interfere with normal hormone function and may affect the developing fetal brain.

The painkiller has also been linked to a slightly increased risk in boys of cryptorchidism, a condition in which the testicles do not descend.

The latest research was based on survey data on more than 64,000 Danish women from 1996 to 2002.

More than half said they took Acetaminophen at least once during pregnancy.

Peer group experts cautioned that; 'The observational findings do not prove that taking Paracetamol or Tylenol-like pain relievers causes ADHD, only that a preliminary link between the two has appeared and would need to be confirmed by further research.'

Miriam Cooper

"Findings from this study should be interpreted cautiously and should not change practice," said an accompanying editorial in JAMA Pediatrics by Miriam Cooper and colleagues at the Cardiff University Institute of Psychological Medicine and Clinical Neurosciences.

"However, they underline the importance of not taking a drug's safety for granted, especially during pregnancy."

The reasons the women took the painkillers could have also had a confounding effect on the outcome, they added.

The study was led by Zeyan Liew, of the University of California, Los Angeles, and was co-authored by Jorn Olsen of the University of Aarhus in Denmark.

Another study Claims effective reduction of ADHD 'Symptoms' using Vitamins

A recent study suggest that vitamins and minerals could be useful for treating the 'symptoms' of ADHD.

As we know, the condition itself is a neurological disorder with no effective cure or treatment.

The small scale study claims that adults with ADHD, given supplements for eight weeks had a "modest" improvement in their concentration span, hyperactivity, and other 'symptoms.'

"A wide range of nutrients, including vitamin D, iron and calcium, may improve brain function." said psychologists in New Zealand.

Another study claims to have found that medication reduced road accidents in men with ADHD.

As many as one in 20 adults has a form of ADHD (attention-deficit hyperactivity disorder), marked by symptoms such as lack of attention, concentration difficulties and impulsiveness.

A variety of medications are prescribed to treat the symptoms of ADHD, such as central nervous system stimulants, which affect brain function and allegedly, improves symptoms.

According to the research, published in The British Journal of Psychiatry (JAMA), taking a broad range of vitamins and minerals may also help reduce ADHD symptoms.

In the study, 80 adults with ADHD were given either supplements containing vitamin D, vitamin B12, folate, magnesium, ferritin, iron, calcium, zinc and copper, or a dummy pill.

After eight weeks of treatment those on supplements reported greater improvements in both their inattention and hyperactivity/impulsivity compared with those taking the placebo.

Julia Rucklidge

Psychologists from the University of Canterbury, in Christchurch, New Zealand, say the effects of vitamins and minerals (micronutrients) are more modest than medication but may be useful for some people, particularly those seeking alternative treatments.

"Our study may provide preliminary evidence of the effectiveness for micronutrients in the treatment of ADHD symptoms in adults," said Prof Julia Rucklidge, who led the study.

"This could open up symptom treatment options for people with ADHD who may not tolerate medications, or do not respond to first-line treatments."

Philip Asherson

Prof Philip Asherson, professor in molecular psychiatry at the Institute of Psychiatry, King's College London, was unconvinced.

He said the suggestion that vitamins and minerals improved brain metabolism was intriguing but needed further investigation.

"It's an interesting study, but it really needs replicating," he told reporters. "The mechanisms behind ADHD and its associated symptoms, remain unclear."

Road accidents
Meanwhile, a separate study on ADHD in Sweden suggests medication could save lives on the road.

Research indicated almost half of transport accidents involving men with ADHD could be avoided if they were taking medication for their condition.

Scientists from the Karolinska Institute studied 17,000 individuals with ADHD over a period of four years using data from health registers.

They found individuals with ADHD had a higher risk of being involved in serious transport accidents, such as car or motorcycle crashes, compared with those without ADHD.

Transport accidents were lower among men with ADHD who were on medication than among men with ADHD who did not take medication.

Calculations showed 41% of transport accidents involving men with ADHD could have been avoided if they had received medication and carried on taking it during the course of the study.

A similar effect was not found in women. It is known that ADHD and its associated symptoms affect men and women differently.

Henrik Larsson

"Even though many people with ADHD are doing well, our results indicate that this serious nerological disorder may have very serious consequences," said Henrik Larsson, associate professor at the Department of Medical Epidemiology and Biostatistics.

"Our study also demonstrates in several different ways that the risk of transport accidents in adult men with ADHD decreases markedly if their condition is treated with medication."

The effect of ADHD on road accidents research is published in the journal JAMA Psychiatry.

Landmark NIMH ADHD study backed drugs over therapy at a cost

Many children with attention-deficit hyperactivity disorder (ADHD) may have missed out on valuable counseling because of a widely touted study that concluded stimulants such as Ritalin or Adderall were more effective for treating the disorder than medication plus behavioral therapies, experts say.

That 20-year-old study, funded with $11 million from the U.S. National Institute of Mental Health, concluded that the medications outperformed a combination of stimulants plus skills-training therapy or therapy alone as a long-term treatment.

But now experts, who include some of the study's authors, think that relying on such a narrow avenue of treatment may deprive children, their families and their teachers of effective strategies for coping with ADHD.

"I hope it didn't do irreparable damage," study co-author Dr. Lily Hechtman, of McGill University in Montreal, stated. "The people who pay the price in the end [are] the kids. That's the biggest tragedy in all of this."

Professionals worry that the findings have overshadowed the long-term benefits of school- and family-based skills programs.

The original findings also gave pharmaceutical companies a significant marketing tool—now more than two-thirds of American kids with ADHD take medication for the condition.

And insurers have also used the study to deny coverage of psychosocial therapy, which costs more than daily medication but may deliver longer-lasting benefits.

An insured family might pay $200 a year for stimulants, while individual or family therapy can be time-consuming and expensive, reaching $1,000 or more.

About 8 percent of U.S. children are diagnosed with ADHD before the age of 18, according to the U.S. Centers for Disease Control and Prevention.

People with the condition may have trouble paying attention, often act without thinking and may be hyperactive, making school work and the acquisition of essential skills extremely difficult.

Drugs that improve attention make it easier for the children to learn, but when the drug wears off or if the users stop taking the drugs, benefits are less apparent.

Some experts today cite limitations of the original study, which looked at classic ADHD symptoms such as forgetfulness and restlessness over academic achievement and family and peer interactions.

This gave medication an edge over therapy from the get-go, several people involved with the study reported.

"When you asked families what they really liked, they liked combined treatment," said Dr. Peter Jensen, formerly head of child psychiatry at the National Institute of Mental Health (NIMH) who oversaw the study for the institute.

"They didn't not like medicine, but they valued skill training. What doctors think are the best outcomes and what families think are the best outcomes aren't always the same thing."

For the study, the NIMH enlisted more than a dozen experts to determine the best ADHD treatment.

Close to 600 children with ADHD, aged 7 to 9, received one of four treatments for more than a year: medication alone, behavioural therapy alone, a combination of both treatments, or nothing in addition to their current treatment.

The study authors concluded in a 1999 paper that medication was superior to behavioural treatment.

But when the children in the study were followed into adulthood, the study results looked less conclusive.

Use of any treatment "does not predict functioning six to eight years later," a follow-up paper from the study determined, the Times reported.

TOSCA Study: Concerta® and Risperdal®, help adolescents with ADHD, aggression

Prescribing both a stimulant and an antipsychotic drug to children with physical aggression and attention-deficit/hyperactivity disorder (ADHD), along with teaching parents to use behaviour management techniques, reduces aggressive and serious behavioural problems in the children.

This is the result of a study conducted by researchers at the Ohio State University Wexner Medical Center.

The study was conducted in conjunction with the University of Pittsburgh, Stony Brook University in New York and Case Western Reserve University in Ohio.

The findings published online this week ahead of publication in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Combination pharmacotherapy is becoming common in child and adolescent psychiatry, but there has been little research evaluating it," said first author Michael Aman, director of clinical trials at Ohio State's Nisonger Center and emeritus professor of psychology.

"Our findings may be considered somewhat controversial because they appear to support the use of two drugs over one for treating children with aggression and disruptive behaviour when things do not seem to be going well.

Many practitioners have been taught to 'Keep things simple and safe' in their medical training. In general, this is good advice."

For the "Treatment of Severe Childhood Aggression (TOSCA) Study," 168 children ages 6 to 12 who had been diagnosed with ADHD and displayed significant physical aggression were divided into two groups.

All study participants received a psychostimulant drug called OROS methylphenidate (Concerta®) and their parents received behavioural parent training for nine weeks.

The researchers called this treatment combination "basic" because both are evidence-based and have been shown to be helpful for improving both ADHD and aggression.

Researchers wanted to see if they could expand or augment this treatment by adding a second medication. If there was room for improvement at the end of the third week, a placebo was added for the "basic group," while the antipsychotic drug Risperidone (RISPERDAL®) was added for participants in the "augmented group."

Compared to the "basic group," the "augmented group" who received the stimulant drug and parent training plus risperidone showed significant improvement (on average with moderately better behaviour) on the Nisonger Child Behavior Rating Form (NCBRF) Disruptive-Total Scale, the NCBRF Social Competence subscale and the Reactive Aggression part of the Antisocial Behaviour Scale.

While there is always some risk with the addition of a second drug to the treatment package, the two drugs seemed to neutralize some of each other's potential side effects.

For instance, children in the augmented group did not seem to have as much trouble falling asleep, once the risperidone was added, Aman said.

"We conducted this study because we viewed the combination of ADHD and significant physical aggression – especially the aggression – as a serious situation," Aman said.

"It is not uncommon to use more than one medicine for other serious situations, such as when treating cancer or epilepsy for instance."

"Although doctors have often used stimulants and antipsychotics together in recent years, we did not have good evidence until now that they would work more effectively when carefully staged and given together."

More information: "Treatment of Severe Childhood Aggression (TOSCA) Study,"

Clinical histories reveal surprising evidence of multiple, distinct 'autisms'

Simple patterns can emerge from even the most chaotic, complex data.

Analyzing the electronic medical records of thousands of patients diagnosed with autism spectrum disorder, or ASD, a group of researchers at the Harvard Medical School Center for Biomedical Informatics found three distinct kinds of autism, which suggests that "autism" is perhaps an umbrella term comprising several illnesses with different genetic and environmental causes and different potential treatments.

Isaac Kohane

"Rather than there being one 'autism,' these findings show that there are several autisms, each with its own specific course," said Isaac Kohane, the Lawrence J. Henderson Professor of Pediatrics at Boston Children's Hospital, co-director of the Center for Biomedical Informatics and leader of the research team. The results appeared Dec. 9 in Pediatrics.

By separating diagnoses out in six-month segments over the first 15 years of each child's life, the researchers found one group of patients whose autism symptoms were associated with epilepsy and other seizure disorders.

In a second, ASD patients had increased rates of bowel and infectious ear and respiratory symptoms.

In a third, children had higher levels of psychiatric disorders, including ADHD, depression and schizophrenia.

NB: A fourth group of patients could not be further characterized due to statistical limitations of the available data.

The patterns of symptoms in the first three groups also correlated with different levels of expressive language disorder, timing of developmental delays and other core diagnostic measures for ASD.

Just as an understanding of the whole suite of symptoms that accompany a fever is crucial for determining whether a patient has strep or flu, Kohane said, it's crucial to understand the entire complex of symptoms associated with the different subsets of ASD in order to advance our understanding of what causes autism.

"Doing a genetic study of 'autism' is like studying fever and looking for a single cause," Kohane said.

Since most primary caregivers might see only a few ASD patients, and since the symptoms manifest differently at various periods of the child's development, having a massive, shareable database of clinical data in searchable electronic medical records was crucial to making sense of the complex picture of autism.

In a previous study, Kohane and colleagues used the Shared Health Research Information Network (SHRINE), a web-based query tool, to analyze 15,000 electronic health records of patients with ASD from HMS-affiliated hospitals.

They found that people with ASD suffer from a higher burden of seizures, psychiatric illness and gastrointestinal disorders than the general population.

While parents of children with autism and other patient advocates had long suggested that this was the case, the smaller population studies conducted without information infrastructure like SHRINE were not able to find evidence that incidences of these illnesses were significantly correlated with ASD.

This current study builds on Kohane's previous findings by showing that the related illnesses are not distributed randomly throughout the ASD population.

"The next step is to look at these subgroups to search for common genetic or environmental factors," Kohane said.

Electronic medical records shared in a flexible, open-source database like SHRINE provide a bird's-eye view of the medical system that offers researchers unique insights into disease and treatment.

"We spend tons of money to construct these databases and open record-sharing systems," Kohane said.

"We should take advantage of all that data not just to bill people for our services, but to better understand and treat disease."

More information: "Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis." Finale Doshi-Velez, PhDa, Yaorong Ge, PhDb, and Isaac Kohane, MD, PhDa. Pediatrics, December 9, 2013. DOI: 10.1542/peds.2013-0819

FDA warns of dangerous erections from ADHD drugs

The Food and Drug Administration is warning that a stimulant used in treatments for the childhood condition attention deficit-hyperactivity disorder can trigger painful, long-lasting erections in rare cases.

The federal agency says it is updating drug labels to include information about priapism, a condition that can permanently damage a patient's penis.

The stimulant, methylphenidate (meth-ihl-PHEN'-ih-dayt), is found in treatments including Ritalin, Concerta and Daytrana.

ADHD is a common childhood disorder that hampers a child's ability to pay attention and control behaviour.

The FDA says the median age of patients taking methylphenidate who had priapism was 12 and a half years old.

The FDA says people should talk to their doctors before halting the drugs. Parents should talk to boys taking the drug so they are aware of warning signs.

Breaking the link between ADHD and addiction

Dr Melanie White

Adult sufferers of ADHD are two to three times more likely to experience substance abuse or dependence, but a research project which will map the genetic markers of the condition will help sever ties with addiction and could lead to customised treatments.

Dr Melanie White from QUT's Institute of Health and Biomedical Innovation (IHBI) said testing for specific genes associated with actions of the reward centre of the brain involving dopamine - a neurotransmitter which plays a major role in reward-motivated behaviour - would give a better understanding of how the brain works in those with ADHD (Attention Deficit Hyperactivity Disorder).

"I'm looking at genetic markers of symptoms of ADHD in adulthood as well as whether people have used a range of different types of substances, and the interaction between these genetic markers and aspects of the environment," Dr White said.

"Given ADHD medication is typically a stimulant, I'll be investigating whether it improves their symptoms in the short term and the role of this medication in future substance use or symptoms."

Dr White, who was awarded a Churchill Fellowship to progress her research, said most children diagnosed with the neurodevelopmental disorder carried it into adulthood.

While symptoms, which include restlessness in work and relationships and impulsivity, can be adapted to fit in with the demands of life, the link between ADHD and substance abuse is impossible to ignore.

"One theory is that people are using substances to redress the chemical imbalance in their brain, or that the reward centre and dopamine activity is wired differently in those with ADHD versus the rest of the population," Dr White said.

"However, the theory I'll be investigating is whether early stimulant medication use when the brain is still developing, results in the brain responding differently when exposed to substance use later in life.

"There are diagnostic differences in terms of whether your symptoms are predominantly inattentive or hyperactive-impulsive, but I have no doubt there are several different genes that might lead to susceptibility to substance abuse on top of the risk for these ADHD symptoms."

Dr White carried out research at the Federal University of Rio Grande do Sul in Brazil, which has studied the largest group of adults with ADHD in the world.

However, she is looking for expressions of interest from Australian adults with ADHD for future studies.

"Hopefully in the future, this type of information will enable us to make customised plans based on people's specific genetic profile amongst other characteristics, often called 'personalised medicine'," she said.

"We hope to be able to effectively say 'this medication would be more effective for you because of your genetic makeup', or conversely 'we don't believe this medication would be a good idea because it may increase some risks for you down the track'."

Genetic discovery could increase understanding of ADHD

Scientists at Trinity College Dublin have discovered that a mutation in a single gene involved in the functioning of the brain's nervous system can lead to hyperactivity symptoms that are characteristic of Attention-Deficit Hyperactivity Disorder (ADHD).

Getting the nervous system wired up properly is a big job. The brain contains billions of different types of nerve cells, which all have to be connected in a very precise fashion.

This circuitry self-assembles as an embryo grows, based on a developmental programme involving the actions of thousands of different genes.

The scientists discovered that a mutation in a single mouse gene, 'Elfn1', can have a big effect.

Their new findings give impetus to discover whether mutations in Elfn1 in humans can give rise to similar symptoms and whether they might play a part in some patients with epilepsy and ADHD.

These two conditions occur together far more often than expected by chance.

In an article just published in the international journal, PLOS ONE, Associate Professor in Genetics at Trinity, Kevin Mitchell, and Research Technical Officer, Dr Jackie Dolan, investigated the importance of the function played by Elfn1 and the protein it produces when expressed.

They did this by experimentally removing it from some mice and comparing the effects against those seen in mice with the normal gene.

Although overall brain anatomy and patterns of connectivity remained normal, there was clear evidence of disturbance in brain function in individuals without Elfn1.

Seizures occurred in some, and these became more common over time and were easily triggered by human interaction.

Secondly, hyperactivity was observed, and this showed an unusual response to the stimulant, amphetamine.

Amphetamine normally causes hyperactivity in animals that have Elfn1 present, as it does in most humans. Here, it reduced the hyperactivity of the mice without the gene.

This is similar to the situation in patients with ADHD, where amphetamine and related drugs have a paradoxical, calming effect.

"These findings clearly show that removal of the Elfn1 gene affects brain circuits with multiple consequences for behaviour," said Dr Dolan.

The seizures likely relate to the function of Elfn1 in dampening the response of the nervous system to strong stimuli in key brain structures called the cortex and hippocampus.

However, the development of ADHD-like hyperactivity focused on a different brain structure, known as the habenula.

This structure is part of a system that integrates information from multiple regions of the brain and regulates the activity of nerve cells that produce mood-regulating chemicals such as dopamine and serotonin.

Professor Mitchell said: "We are at the beginning of this process of figuring out how this gene works and understanding the consequences when it is mutated but, these animals provide a unique model to investigate how subtle changes in brain development can ultimately result in aberrant brain function".

Elfn1 was first discovered by Dr Dolan, Professor Mitchell and colleagues in 2007. The protein it produces when expressed allows communication from one nerve cell to another. In a study published in Science last year, Emily Sylwestrak and Anirvan Ghosh, of the University of California, San Diego, showed that the Elfn1 protein determined what kind of connection was made onto those nerve cells.

More information: dx.plos.org/10.1371/journal.pone.008049