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.

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.

Antidepressants in water trigger Autism genes in fish

Low levels of antidepressants and other psychoactive drugs in water supplies can trigger the expression of genes associated with autism, in fish at least.

The use of antidepressants has increased dramatically over the past 25 years, says Michael Thomas of Idaho State University in Pocatello. 

Around 80 per cent of each drug passes straight through the human body without being broken down, and so they are present in waste water. In most communities, water purification systems cannot filter out these pharmaceuticals. 

"They just fly right through," says Thomas, which means they ultimately find their way into the water supply.

The concentration of these drugs in drinking water is very low – at most, they are present at levels several orders of magnitude lower than the prescription doses. 

But since the drugs are specifically designed to act on the nervous system, Thomas hypothesised that even a small dose could affect a developing fetus.

Thomas's group created a cocktail of the anti-epileptic drug carbamazepine and two selective serotonin uptake inhibitor (SSRI) antidepressants, fluoxetine and venlafaxine, at this low concentration. 

They exposed fathead minnows (Pimephales promelas) to the drugs for 18 days, then analysed the genes that were being expressed in the fishes' brains.

Although the researchers had expected the drugs might activate genes involved in all kinds of neurological disorders, only 324 genes associated with autism in humans appeared to be significantly altered. Most of these genes are involved in early brain development and wiring.

The finding fits with previous research which had found that pregnant women who take SSRIs are slightly more likely to have autistic children. (Archives of General Psychiatry, DOI: 10.1001/archgenpsychiatry.2011.73).

To test whether these changes actually altered the fish's behaviour, the researchers did an experiment in which they startled the fish. Fish exposed to the drugs tended to panic and behave differently from a control group of fish.

Thomas emphasises that the research is very preliminary – there's no need for pregnant women to worry about their drinking water yet, he says. The researchers next plan to study whether the drugs have a similar effect in mammals. 

They are testing this by lacing the drinking water of pregnant mice with the low-concentration cocktail. 

They are also studying water supplies in areas around the country where there are particularly high concentrations of drugs to determine whether the fish – and people – in these areas have autism-like gene expression patterns.

Journal reference: PLoS One, DOI: 10.1371/journal.pone.0032917

Painkiller Addiction Increasingly Common In Newborns

When you picture a person going through painkiller withdrawals, a baby crying in his crib is usually not the first image that comes to mind. But the number of babies born with withdrawal symptoms has skyrocketed since 2000, according to a new study.

In 2000, approximately 4,300 babies were born with neonatal abstinence syndrome, a condition that occurs in some babies that were exposed to opiates such as heroin, Vicodin and oxycodone in the womb, according to the study. In 2009, the number jumped 300 percent to 13,000.

"That's about one baby per hour," Dr. Stephen Patrick, lead author of the study and postdoctoral researcher at the University of Michigan, told CNN. "We were surprised by it. That's a startling increase."

Opiates used by an expectant mother during pregnancy pass through the placenta and into the baby. The babies' bodies become dependent on the drugs but no longer have access to them once they are born, triggering withdrawal. Between 55 percent and 94 percent of babies exposed to the drugs before birth show signs of withdrawal once they are born, according to the American Academy of Pediatrics.

Signs of withdrawal unique to infants include a distinct, high-pitched cry and an aversion to light and sound. They may also show symptoms similar to adult withdrawal patients, such as insomnia, diarrhea and vomiting.

Doctors use methadone, a drug used by addicts looking to kick the habit, to wean the babies off of the drugs slowly. Making them go cold-turkey could lead to seizures and possibly death, according to the study.

Getting the babies over their addiction could take weeks or even months and often requires long-term hospitalization. The cost of treating drug-addicted babies increased from $190 million in 2000 to $720 million in 2009, according to the study, published in the Journal of the American Medical Association on Monday.

The increase in opiate-addicted babies is a product of growing numbers of adults who abuse painkillers.. More than two-thirds of patients prescribed painkillers abuse them by taking them too often or by taking them in conjunction with other painkillers not prescribed to them, according to research published by Quest Diagnostics.

In addition, two million people in 2010 admitted to abusing prescription painkillers for the first time -- almost 5,500 per day, according to the Centers for Disease Control and Prevention.

Tennessee had the highest rate of painkiller abuse between 2007 and 2008, according to the National Survey on Drug Use and Health. It also has one of the highest rates of opiate-addicted newborns. At East Tennessee Children's Hospital, almost 50 percent of the babies in the neonatal intensive care unit are experiencing withdrawals.

"In Knox County, we're drowning," Susan Kovac, attorney for the Department of Children's Services in Tennessee, told CNN. "We've seen the number of children in foster care increase by almost 50 percent over the last few years, and that's just the tip of the iceberg because we're trying to keep the children out of foster care. We've got lots and lots of relatives who are raising drug-exposed infants."

Florida also experienced a surge in the number of addicted babies, which increased from 354 in 2006 to 1,374 in 2010, according to the study.

The researchers call for individual states and the Federal government to take action to reduce the amount of painkillers prescribed and say educating the public about the dangers of using the drugs while pregnant may also help. Cutting the number of prescriptions of opiates could drastically reduce the number of babies born with NAS, according to the study.

"Newborns with NAS experience longer, often medically complex and costly initial hospitalizations," the researchers wrote in the study. "The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce [in utero] exposure to opiates across the United States."

Drugs: Speed and Ecstasy Use Linked to Teen Depression

The use of speed and ecstasy by secondary school pupils appears to increase the risk of depression by up to 70 percent, a study claims.

Scientists at the University of Montreal carried out research on almost 4,000 secondary school pupils to explore concerns that the two drugs, which have spread from the clubbing scene into schools, could cause long-term damage.

The study, published in the Journal of Epidemiology and Community Health, found that those students who used either drug were between 60 and 70 percent more likely to exhibit heightened symptoms of depression.

The authors tracked the mental health of a sample of 3,880 teenagers from deprived areas in Quebec between 2003 and 2008, quizzing them on their drug use and later testing their mental health on a validated scale.

The use of speed (meth/amphetamine) was found to be more common, with 11.6 percent (451) admitting taking it, while 8 percent (310) admitted taking ecstasy (MDMA).

The use of both drugs was admitted by 6.7 percent of the sample. Teenagers in this group were found to be twice as likely to have depressive symptoms as those who used neither drug.

The authors claimed this pointed toward "additive or synergistic adverse effects of concurrent use".

"Our results provide, to the best of our knowledge, the first compelling evidence that recreational [ecstasy] and [speed] use places developing secondary school students at greater risk of experiencing depressive symptoms," the researchers concluded.

While they admit that the causative contribution of drug use itself to depression is "relatively modest", they caution that even a modest contribution can have "significant clinical implications from a population health perspective".

They propose that further research should be undertaken to look into whether depressive symptoms are an effect of neurological damage, which adolescent brains could be more susceptible to, and are keen to examine the differences between adults and adolescents in this area.

Speed, or amphetamine, is a widely used drug in the clubbing and rave scene. The drug make people more awake, overactive and chatty. it is generally followed by a long comedown and can put a strain on the user's heart. It can also lead to anxiety, aggression and paranoia.

Ecstasy is popular because it makes users feel energetic and happy, allowing them to stay up partying into the early hours. Its use has been linked to liver, kidney and heart problems, while its comedown often leads users to feel lethargic or depressed.

Medication is not a way for ADHD kids to cheat

We are students living with learning disabilities and attention deficit hyperactivity disorder. We disagree with the "Abuse of ADHD drugs creates uneven playing field" (Open Forum, March 16), which compared ADHD medication with performance-enhancing steroids in sports and asked: "Is ADHD (medication) use cheating as well?"

While the author rightly criticizes student use of any stimulant or ADHD drug by those who are not diagnosed with ADHD to enhance their performance, and points out that the drugs don't work unless one has ADHD, she suggests that drug use even by those diagnosed with ADHD somehow gives an unfair advantage.

Wrong.

Accommodations and allowing the use of medication are legally required for students with disabilities. Accommodations are like supplying ramps for wheelchairs, assistive listening devices for the hearing-impaired, glasses for those who need them, or software that reads text aloud for the blind and dyslexic.

Accommodations give students with learning disabilities and ADHD an equal opportunity to succeed in an educational environment that caters to a narrowly defined learning style. They level the playing field. They keep us in school.

Medication is no "enhancer" for us. As one of our students with ADHD put it, those who do not have ADHD "only see the drug as a drug, and nothing else.

They don't see the fight that rages on inside me, my constant struggle to focus, my inability to stay organized, and my tireless efforts to complete tasks others would view as easy." For those with ADHD, medication is a tool, not a solution.

Attending school as a student with learning disabilities or ADHD is hard enough. Fighting the stigma is even harder.

Many students, fearful of the stigma, don't seek help, don't want to be identified and are fearful of being different.

Without good support, without the right accommodations (sometimes including medication), without understanding how we learn or discovering our strengths, we fail, we drop out, and society loses out on valuable contributors.

We now know that a disproportionate number of our most successful CEOs and entrepreneurs have dyslexia or ADHD. They think outside the box; standardized education and high-stakes testing does not hinder their brilliance.

So, please: Learning disabilities, including ADHD, are real. It's really hard to be a student with learning disabilities and ADHD. It's harder yet when people talk about us, not with us.

Malaria treatment: Impact on disease risk for babies

Mothers who receive treatment for malaria infection could pass on lower levels of natural immunity to their babies, a study has suggested.

Edinburgh University experts found mice treated with malaria infection drugs before they became pregnant passed on fewer antibodies to their young.

Full-blown malaria gives the immune system the chance to produce protective antibodies to pass on.

However, it is thought the drug treatment shortens the process.

The mothers benefit while children's immunity is decreased, putting them at greater risk.

The researchers said their results highlighted the need to look at how treatment might be tailored most effectively for women and their babies.

Malaria affects millions of people worldwide, mainly in developing countries. One child dies from the disease in Africa every minute.

Dr Vincent Staszewski, of Edinburgh University's school of biological sciences, said: "How an infection plays out in an individual can impact on the immunity of the next generation.

"Some treatments against disease before or during pregnancy might be beneficial for maternal health but impair infant survival."

The study, published in Proceedings of the Royal Society B, was funded by the Wellcome Trust and the Royal Society.

A Thousand and One Sleepless Nights

A Thousand and One Sleepless Nights - NYTimes.com

An interesting article full of good information and clear thinking.

If you need further information on sleep related issues, especially in babies and children of Northern Europe and the UK, click on this link to Dream Angus - Sleep Management website . Also available in Dutch

FDA Issues Warning on 4 Asthma Drugs

FDA issues warning on 4 common asthma drugs - USATODAY.com

The US government is taking steps to curb use of some long-acting asthma drugs taken by millions, issuing safety restrictions to lower an uncommon but potentially life-threatening risk that asthma could worsen, suddenly.

The Food and Drug Administration's warnings cover the drugs Advair, Symbicort, Foradil and Serevent. The FDA said they should be used only by asthmatics who can't control their lung disease with other medications — and then only for the shortest time possible.

"Our goal is to overall reduce the use of LABAs, to manage the risk while at the same time keeping them available for those patients who really need them," said Jenkins, a pulmonologist.

"The reality is the available options to treat asthma are not that great," he added. For patients not well-controlled by inhaled corticosteroids alone, "their options for additional therapy are, in and of themselves, drugs with a lot of risk."

Other warnings:

• Children and teens should be prescribed only the combination LABA drugs to ensure compliance with both medications. That mostly happens today, as pediatric use of the single-agent drugs has plummeted with publicity about the risk.

• Manufacturers also will be required to study whether combination LABA use indeed lowers the risk.