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.

ADHD: Single dose of Ritalin (MPH) can reduce fall risk in older adults

Ben-Gurion University of the Negev (BGU) researchers have discovered that a single dose of Ritalin (methylphenidate or MPH), used to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, helps to improve balance control during walking, hence reducing the risk of falls among elderly adults.

Falls in older adults are the leading cause of hip fractures and other injury-related visits to emergency rooms and of accidental death. Age-related deterioration in gait and balance is a major contributor to falls in older adults.

According to a study published in The Journals of Gerontology, the BGU researchers found that a single dose of MPH improves walking by reducing the number of step errors and the step error rate in both single and dual tasks.

"Our results add to a growing body of evidence showing that MPH may have a role as a therapeutic option for improving gait and reducing fall risk in older adults," said Itshak Melzer of BGU's Schwartz Movement Analysis and Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences.

"This is especially true in real-life situations, where the requirement to walk commonly occurs under more complicated, 'dual task' circumstances with cognitive attention focused elsewhere (e.g., watching traffic, talking) and not on performing a specific motor task."

The study participants were 30 healthy older adults who were at least 70 years-old and had the ability to walk 70 feet (20 meters) without personal assistance or an assistive device.

The participants were given a single dose (10 mg.) of MPH and were assessed under four task conditions of single and combined motor and cognitive tasks.

"The enhanced attention that comes about as a result of MPH may lead to improved balance control during walking, especially in dual task conditions," Meltzer explains.

"Our findings that MPH improves gait can be explained not just by its effect of attentional improvements, but also by indications that it has a direct influence on areas of the brain that deal with motor and balance control."

More Information: "Effect of Single Dose Methylphenidate on Walking and Postural Stability Under Single- and Dual-Task Conditions in Older Adults—A Double-Blind Randomized Control Trial"

ADHD: Research shows how Ritalin affects Children's brains

Ritalin activates specific areas of the brain in children with attention-deficit/hyperactivity disorder (ADHD), mimicking the brain activity of children without the condition, a new review says.

"This suggests that Ritalin does bring the brain [of a child with ADHD] back to the brain the typically developing kid has," said study author Constance Moore, associate director of the translational center for comparative neuro-imaging at the University of Massachusetts Medical School.

Analyzing data from earlier studies that looked at how children's brains were affected by doing certain tasks that are sometimes challenging for kids with ADHD, the researchers found that Ritalin (methylphenidate) was having a visible impact on three areas of the brain known to be associated with ADHD: the cortex, the cerebellum and the basal ganglia.

Constance Moore

The study could be helpful in diagnosing and treating children with ADHD, Moore said. "It may be helpful to know that in certain children, Ritalin is having a physiological effect in the areas of the brain involved with attention and impulse control," she said.

The research was published recently in the Harvard Review of Psychiatry.

Nine studies analyzed by the researchers used functional MRI to evaluate brain changes after children had taken a single dose of Ritalin.

The children were involved in different types of tasks that tested their ability to focus and inhibit an impulse to act.

For example, to observe the brain's reaction during a test of what is called "inhibitory control," a child was told that every time he saw a zero show up on a screen, he should push the button on the right; every time he saw an X appear, he should push the left button.

The children would then be asked to flip their responses, pushing the left button when they saw a zero.

"That's hard to do," Moore said, "because you've developed the habit [of pushing the other button], so you have to suppress your impulse.

If you do 20 zeros and keep pressing and then you see an X, most kids with ADHD will hit the wrong button."

In three out of five of the inhibitory control studies, Ritalin at least partially normalized brain activation in ADHD children.

To note how the brain reacted to a selective attention test, Moore said, children would first be asked, for example, what word they were seeing.

The word would be "red," and the colour of the type also would be red. Then they would be shown the word "red," but the colour of the type would be green.

In several studies, Ritalin affected activation in the frontal lobes during such inhibitory control tasks. Most of the studies included in the review were performed in the United States or the United Kingdom.

The majority of participants were adolescent boys, and all studies compared their results to healthy children of the same approximate age.

Because none of the studies looked at the correlation between ADHD symptoms and whether the child was taking Ritalin, there is no way to link the changes in brain activation with clinical improvement, Moore said.

"It's possible that kids who are not responsive to Ritalin may have brain changes too," she said. ADHD affects between 3 percent and 7 percent of school-aged children in the United States, according to the American Psychiatric Association.

Boys are more likely to have ADHD than girls. One expert was not surprised by the results.

Andrew Adesman

"The review article shows there is a consensus of well-designed imaging studies showing that [Ritalin] has an impact on the frontal cortex of the brain, where we have long believed these patients have issues," said Dr. Andrew Adesman, chief of developmental and behavioural pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York, in New Hyde Park.

Adesman wondered if Ritalin may play a role in helping the brain mature. "Their data provides partial support for that," he said.

"But if anything, the medicine seems to help the brain look more normal and doesn't seem to do anything bad to it."

More information: Learn more about ADHD from the U.S. Centers for Disease Control and Prevention.

ADHD medication needs a addition of child-friendly message

More than half a million prescriptions for methylphenidate, a stimulant medicine to treat ADHD, sold under the brand names Ritalin, Concerta, and Equasym, are dispensed each year in England.

Up until now, however, the patient information leaflet included with every box has been written with only adults in mind.

Read the full Report here

Following an agreement with drug companies, the Medicines and Healthcare products Regulatory Agency (MHRA) decided that a youth-friendly section should be included in all brands of methylphenidate prescribed and dispensed in the UK.

The work was undertaken by researchers at the  University of Leeds in collaboration with the Leeds-based company Luto Research.

As reported in Pharmaceuticals Journal, the revised patient information leaflet now includes a section called “Information for children and young people” that provides clear and simple information about the consequences of possible side effects, using examples that may be relevant to children and teens.

For example, when advising users to avoid certain activities if they feel dizzy, it refers to horse riding, climbing trees, and riding a bike. The section also offers advice to youngsters who may be sexually active.

“Children and young people are the main consumers of these medicines,” says Theo Raymor, professor of of pharmacy at the University of Leeds.

“It is important that they have the opportunity to know why they have been given this drug treatment and how it can help them. The revised leaflet now gives them a chance to read about their medication in an easy and informative way.”

Words and phrases in the youth friendly section were tested by adults and teenagers, as well as children as young as 10 who read the leaflet with a parent. Feedback from this testing helped ensure that the messages on safety and side effects were clear to a wide range of ages.

“We gave particular thought to the layout of the text, as well as the content,” Raynor says. “Simple changes, such as making headings bolder, using bulleted lists, and dividing long sentences into shorter ones can make a real difference when writing for all people, including children.

“This is the first time that children and teens have had a chance to comment on the information that goes into medicine packs, and it has proven to be very successful.

“We are now hoping that this approach can be taken for other medicines that are used widely by children, perhaps medicines for asthma or epilepsy.”

The work was co-ordinated by the MHRA as part of its drive to help people of all ages understand the medicines they are taking.

“It’s vital that both children and adults understand the medication they are taking,” says MHRA Head of Patient Information Quality, Jan MacDonald.

“Children and young adults with ADHD will be better informed about their healthcare from the new style of patient information.”

More news from University of Leeds: www.leeds.ac.uk/news

Can ADHD be diagnosed in children as young as 4?

Can children as young as 4 be diagnosed and treated for attention deficit hyperactivity disorder (ADHD). Yes, according to updated guidelines from the American Academy of Paediatrics.

Previous guidelines covered ADHD in kids 6 through 12. The latest ones address children ages 4 to 18, because there is additional research on that age range, says Mark Wolraich, chair of the committee that prepared the report, released Sunday at the American Academy of Paediatrics National Conference in Boston.

Earlier treatment can help the children and reduce family stress, he says. "These children may have been kicked out of preschool programs or they may have parents who are really getting angry at them much of the time."

ADHD occurs in about 8% of children and teens, he says.

The guidelines recommend that primary-care providers initiate an evaluation for ADHD in any children ages 4 to 18 who appear with symptoms of inattention, hyperactivity or impulsivity, says Wolraich, professor of paediatrics at the University of Oklahoma Health Sciences Center in Oklahoma City.

The first line of treatment for preschool children who have ADHD lies with parents. Through behaviour therapy, parents need to learn to be consistent in giving positive reinforcement for appropriate behaviours and ignoring or punishing inappropriate ones, he says.

If the young children do not show significant improvements with these behaviour techniques and they have moderate to severe ADHD symptoms, physicians can consider prescribing Ritalin, but doctors should start with low doses and go slowly, he says.

"We know that early intervention makes a difference — the sooner ADHD is identified and treated, the better for the child," says Ruth Hughes, chief executive officer of CHADD, Children and Adults with Attention-Deficit/Hyperactivity Disorder.

Research Claims Ritalin Improves Ability to Learn

Research Claims Ritalin Improves Ability to Learn

Ritalin (methylphenidate), a drug prescribed for millions of children who have attention deficit hyperactivity disorder (ADHD), appears to improve the ability to learn by enhancing the speed of learning. Currently, Ritalin is prescribed to help inhibit impulsive behaviour, which in turn can improve a child’s ability to focus on tasks.

The new finding is the result of research by investigators at the University of California, San Francisco (UCSF). It is significant because it lets scientists know that Ritalin impacts and improves behaviour through two specific types of neurotransmitter receptors rather than just one. Neurotransmitters are chemicals that act as messengers to allow neurons to communicate with each other.

Previously experts knew that Ritalin enhanced the activity of the neurotransmitter dopamine receptor known as D2, which controls the ability to stay focused on a task. The new research shows that another dopamine receptor called D1, which is involved in the ability to learn and learning efficiency, is also affected by Ritalin. Apparently the drug produces these benefits by strengthening the ability of the neurons to communicate with each other at their meeting points, called synapses.

These new findings may allow researchers to develop more efficient drugs to treat ADHD and to improve the ability to focus and learn more efficiently, according to Antonello Bonci, MD, principal investigator at the Ernest Gallo Clinic and Research Center and professor of neurology at UCSF.