ADHD Challenges Those Seeking a Driver’s License

The first time Jillian Serpa tried to learn to drive, the family car wound up straddling a creek next to her home in Ringwood, N.J.

Ms. Serpa, then 16, had gotten flustered trying to sort out a rapid string of directions from her father while preparing to back out of their driveway. “There was a lack of communication,” she said. “I stepped on the gas instead of the brake.”

On her second attempt to learn, Ms. Serpa recalled, she “totally freaked out” at a busy intersection.

It was four years before she tried driving again. She has made great progress, but so far has still fallen short of her goal: Two weeks ago she knocked over a cone while parallel parking and failed the road test for the fourth time.

Learning to drive is hard and scary for many teenagers, and driving is far and away the most dangerous thing teenagers do. But the challenges are significantly greater for young people who, like Ms. Serpa, have attention problems.

A number of cognitive conditions can affect driving, and instructors report a recent increase in the number of teenagers with Asperger syndrome seeking licenses.

But the largest group of challenged teenage drivers and the mostly closely studied, appears to be those with attention deficit hyperactivity disorder (ADHD, ADD).

A 2007 study, by Russell A. Barkley of the Medical University of South Carolina and Daniel J. Cox of the University of Virginia Health System, concluded that young drivers with ADHD are two to four times as likely as those without the condition to have an accident, meaning that they are at a higher risk of wrecking the car than an adult who is legally drunk.

Researchers say that many teenagers with attention or other learning problems can become good drivers, but not easily or quickly, and that some will be better off not driving till they are older or not at all.

The most obvious difficulty they face is inattention, the single leading cause of crashes among all drivers, said Bruce Simons-Morton, senior investigator at the National Institute for Child Health and Human Development in Bethesda, Md.

“When a driver takes his eyes off the road for two seconds or more, he’s doubled the risk of a crash,” he said.

Inexperienced drivers usually are distractible drivers. Dr. Simons-Morton cited a study on a closed course in which teenagers proved much more adept than adults at using cellphones while driving and missed more stop signs.

The situation isn’t helped by how “noisy” cars have become, with cellphones, iPods and Bluetooth devices, said Lissa Robins Kapust, a social worker and coordinator of a driving program at Beth Israel Deaconess Medical Center in Boston. “Driving is so busy on the inside and the outside of the car it’s the most complex thing we do.”

But ADHD involves more than distractibility (?). Its other major trait is impulsiveness, which is often linked to high levels of risk-taking, said Dr. Barkley.

“It’s a bad combination” for young drivers, he said. “They’re more prone to crashes because of inattention, but the reason their crashes are so much worse is because they’re so often speeding.” Many drivers with ADHD overestimate their skills behind the wheel, Dr. Barkley noted.

Read more in the NY Times

Does BPA make girls anxious, hyperactive, etc

Girls exposed before birth to high levels of the estrogen-like chemical BPA are more likely to be anxious, depressed and hyperactive at age 3, according to a study in today's Pediatrics.

Boys' behaviour was unaffected by BPA, the study says.

Scientists in recent years have linked BPA, or bisphenol A, to a wide variety of health problems, from breast cancer to diabetes. 

BPA is found in countless consumer products, from plastic bottles to dental sealants, medical equipment, receipt paper and the linings of metal food and drink cans.

Virtually everyone is exposed to BPA. Authors of the new study found BPA in the urine of more than 97% of the 240 pregnant women studied, as well as 97% of their children. 

Being exposed to high BPA levels after birth didn't appear to affect behavior, says study author, Joe Braun, a research fellow at the Harvard School of Public Health.

That could be because BPA, like lead and other toxins, causes the greatest harm before birth, when the fetal brain is developing, says pediatrician Philip Landrigan, a professor at New York's Mount Sinai School of Medicine, who was not involved in the new study. "Parents should be concerned about these findings," Landrigan says.

About 12% of boys and 6% of girls have been diagnosed with ADHD, or attention deficit hyperactivity disorder, according to the U.S. Census Bureau.

Girls are about twice as likely as boys to be depressed or anxious, Braun says. Few kids in the study were depressed or anxious enough to meet the requirements for a clinical diagnosis, says Braun, noting that only 2% to 3% of children this age are diagnosed with these problems. 

But Braun says the differences in behaviour between children in his study are comparable to the effects seen with high exposure to toxins such as lead, mercury and pesticides.

Steven Hentges, a spokesman for the American Chemistry Council, says the study's "conclusions are of unknown relevance to public health." He notes that regulators in Europe, Japan and the USA "have … reviewed hundreds of studies on BPA and repeatedly supported the continued safe use of BPA."

Yet Landrigan says studies like this are precisely why the FDA needs to act to protect people from BPA. In the meantime, he says pregnant women should try to reduce their exposure.

Callous-unemotional traits, conduct problems in children can lead to antisocial behavior in pre-teens

Research presented this week at the annual meeting of the American Association for the Advancement of Science highlights the importance of callous-unemotional traits (CU) in identifying children at risk of antisocial behaviour and other adjustment problems.

The research, presented by Indiana University Bloomington faculty member Nathalie M.G. Fontaine, finds that the emergence of CU traits in childhood is in most cases influenced by genetic factors, especially in boys.

However, environmental factors appear to be more significant for the small number of girls who exhibit high levels of CU traits.

In this first longitudinal study employing a group-based analysis to examine the connection between childhood trajectories of CU traits and conduct problems, researchers found that high levels of both CU traits and conduct problems were associated with negative child and family factors at age 4 and with behavioral problems at age 12.

CU traits, such as a lack of emotion and a lack of empathy or guilt, are exhibited by a small number of children and are associated with persistent conduct problems, which are experienced by 5 percent to 10 percent of children.

"The children with high levels of both CU traits and conduct problems between ages 7 to 12 were likely to present negative predictors and outcomes, including hyperactivity problems and living in a chaotic home environment," said Fontaine, assistant professor of criminal justice in the College of Arts and Sciences at Indiana University Bloomington. "If we could identify those children early enough, we could help them as well as their families."


The researchers examined data for more than 9,000 twins from the Twins Early Development Study, a data set of twins born in England and Wales between 1994 and 1996. Assessments of CU traits and conduct problems were based on teacher questionnaires when the children were 7, 9 and 12. Family-level predictors at age 4 were based on information from parents, and behavioral outcomes at age 12 were based on information from teachers.

Read more here

ADHD: The Background and insight into the condition

Background
The term attention deficit is often misleading. In general, the current predominating theories suggest that people with attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD), actually have difficulty regulating their attention.

Attention regulation
They have difficulty inhibiting or changing their attention away from nonrelevant stimuli. They have a talent for focusing too intensely on specific stimuli to the exclusion of other things, even if those other things are more relevant.

In one sense, rather than too little attention, many persons with ADHD (ADD) pay too much attention to too many things at once, leading them to have a reduced ability to focus on a particular task, or carry it through to the end.

Clinical Definitions
Three basic forms of ADHD (ADD) are described in the Diagnostic and Statistical Manual IV (DSM-IV), the reference manual for the American Psychiatric Association (APA). These forms are;

• 1) attentional;
• 2) hyperactive/impulsive; and
• 3) combined, which is most frequently a combination of attentional and hyperactive forms.

Neurotransmitter Imbalance
The 6 major tasks of executive function that are most commonly distorted with ADHD (ADD) include;

• 1) shifting from one mindset or strategy to another (ie, flexibility),
• 2) organisation (eg, anticipating both needs and problems),
• 3) planning (eg, goal setting),
• 4) working memory (ie, receiving, storing, then retrieving information within short-term memory),
• 5) separating affect from cognition (ie, detaching one's emotions from one's reason), and
• 6) inhibiting and regulating verbal and motoric action (eg, jumping to conclusions too quickly, difficulty waiting in line in an appropriate fashion).

ADHD (ADD) is not new
Contrary to some media accounts, ADHD (ADD) is not new, it simply went unrecognised and therefore undiagnosed. In the early 1900s, diagnosis emphasised the hyperactivity component. Today, hyperactivity, impulsivity, and inattention are the areas of focus.

Children with ADHD may have a greater likelihood for learning difficulties and adults may have anti-social or criminal tendencies. Both are of concern to a caring society.

Medical Recognition
However, throughout medical history, clinical reports have alluded to disorders involving hyperactivity, impulsivity, and inattention in conjunction with distractibility and inappropriate arousal patterns. Symptoms we recognise today as being part of ADHD

What is new?
The increased awareness and recognitionof ADHD (ADD). This has prompted new research and therefore greater collaborative efforts and sharing of research findings amongst the clinical community.

The addition of ADHD in the much aclaimed DSM took place in 1980, and this was a clear and positive sign of acceptance and growing interest, which is continuing today.

The future for ADHD sufferers should bring better and more effective treatment, based on greater understanding of this debilitating condition.

Should you have any comments or questions related to anything in this blog, lease contact us and we will be only too happy to respond to you.