ADHD Research Meeting in Philadelphia

This past weekend Dr Banov participated in an research meeting in
Philadelphia involving a new FDA-regulated clinical trial studying the prevalence
of certain genetic markers that may help researchers develop innovative drugs
for ADHD. Studying genotype/phenotype has already led to the development  of life saving drugs for Cystic Fibrosis, Pulmonary Hypertension and other serious medical disorders.  This is a very exciting area of clinical research and Dr. Banov will continue to monitor potential ADHD medications currently in the “Pipeline” which may ultimately receive FDA approval and become available to our patients.

Aerobic Exercise Improves ADHD symptoms

At the Atlanta Center For Adult ADHD, we are often asked about natural approaches to help manage ADHD. An important study was published this year that analyzed the effect of aerobic exercise on ADHD using rating scales and functional magnetic resonance imaging. Aerobic exercise was found to improve clinical  symptoms as well as cognitive function in adolescents with ADHD. Brain activity in areas affected by ADHD such as the right frontal and temporal cortices was increased as well.

Recent ADHD Treatment Study Announced

 

 

Fewer than half of individuals with ADHD seek treatment, according to a study published in August in Psychiatric Services.

Researchers used the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2004 to 2005 follow-up survey. The NESARC is a nationally representative sample othe adult US population. A total study sample of 34,653 adults had face-to-face interviews.

Approximately 46% of those with lifetime ADHD reported having sought treatment for the disorder.

The estimated median delay to treatment seeking from ADHD onset is longer than 20 years. The study did not look at undiagnosed Adult ADHD which clearly remains a huge public health issue.

At the Atlanta Center for ADULT ADHD, we are striving to improve patient access to ADHD diagnostic and treatment services in our metro area.

New Guidelines Address Adult ADHD Diagnosis

 

The American Psychiatric Association’s Diagnostic and Statistical Manual,Fifth edition(DSM-5), is used
by mental health professionals to help diagnose ADHD. It was released last spring
and replaces the previous version, the text revision of the fourth edition
(DSM-IV-TR), which was difficult to use when making a diagnosis of adult (as opposed to childhood) ADHD.

There were some changes in the DSM-5 for the diagnosis of ADHD: symptoms can
now occur by age 12 rather than by age 6; several symptoms now need to be
present in more than one setting rather than just some impairment in more than
one setting; new descriptions were added to show how symptoms might appear at
older ages; and for adults and adolescents age 17 or older, only 5 symptoms are
needed instead of the 6 needed for younger children.

Below are the new DSM-5 guidelines:

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or
development:

  1. Inattention: Six or more
    symptoms of inattention for children up to age 16, or five or more for
    adolescents 17 and older and adults; symptoms of inattention have been
    present for at least 6 months, and they are inappropriate for
    developmental level:

    • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
    • Often has trouble holding attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often
      does not follow through on instructions and fails to finish schoolwork,
      chores, or duties in the workplace (e.g., loses focus, side-tracked).
    • Often has trouble organizing tasks and activities.
    • Often
      avoids, dislikes, or is reluctant to do tasks that require mental
      effort over a long period of time (such as schoolwork or homework).
    • Often
      loses things necessary for tasks and activities (e.g. school materials,
      pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
      telephones).
    • Is often easily distracted
    • Is often forgetful in daily activities.
  2. Hyperactivity
    and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for
    children up to age 16, or five or more for adolescents 17 and older and
    adults; symptoms of hyperactivity-impulsivity have been present for at
    least 6 months to an extent that is disruptive and inappropriate for the
    person’s developmental level:

    • Often fidgets with or taps hands or feet, or squirms in seat.
    • Often leaves seat in situations when remaining seated is expected.
    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
    • Often unable to play or take part in leisure activities quietly.
    • Is often “on the go” acting as if “driven by a motor”.
    • Often talks excessively.
    • Often blurts out an answer before a question has been completed.
    • Often has trouble waiting his/her turn.
    • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several
    symptoms are present in two or more setting, (e.g., at home, school or
    work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
  • The
    symptoms do not happen only during the course of schizophrenia or
    another psychotic disorder. The symptoms are not better explained by
    another mental disorder (e.g. Mood Disorder, Anxiety Disorder,
    Dissociative Disorder, or a Personality Disorder).

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

At the Atlanta Center for Adult ADHD, the DSM-5 guidelines serve as an important tool to assure making an accurate diagnosis in accordance to current APA concensus.

In Kids With ADHD, Stimulants May Help Protect Against Drug Abuse

A  study published in July in the British Journal of Psychiatry has shown that adolescents with ADHD who were not treated with a stimulant medication had a doubling of their risk of developing subtance abuse problems compared to  untreated individuals. The study also found that children who start stimulant medications at a younger age are better protected.  Physicians treating ADHD have known for some time that there is an association between addiction and ADHD. In my clinical experience at the Atlanta Center for Adult ADHD, patients with ADHD  receiving addiction treatment have significantly more difficulty in recovery and a higher relapse rate if their ADHD is not properly managed.

ADHD Treatment May Lower Driving Risk

During their initial evaluation at the Atlanta Center for Adult ADHD, individuals-both young and old-often report problems with driving.These issues include close calls from changing lanes without checking for nearby cars, hitting curbs, “fender-benders”, rear-end  collisions and worse.

New reseach suggests that treating ADHD effectively  may help improve driving performance in young people with the condition. (It is well know that this age group has high rates of automotive crashes and speeding tickets.)

A simulated driving program, completed within a simulated automotive environment, was recently administered to participating  young adults at the Massachusetts Institute of Technology AgeLab.

Participants treated with Vyvanse (lisdexamfetamine dismesylate) for 5 weeks reacted 9% faster to startle events and were 67% less likely to have a collision during a driving simulation than those who received placebo.

This research is very consistent with our own clinical experience. In fact, we encourage patients that prefer to take medication only during the daytime  to consider  taking additional medication to cover evening/night hours if they plan to be driving during these times.

ADHD and Driving Safety

Patients often mention that their ADHD causes them to get speeding/red light violations and to become involved in fender-benders and other accidents.  In fact, individuals with ADHD often have trouble staying “in the moment” and have a much higher risk of driving incidents as their minds begin to wonder behind the wheel.  While attention during driving is usually improved with medications, driving mishaps can still persist.

The following is a simple technique that I developed to help my patients deal with this problem.

Here’s how it works: First turn off your car radio, IPod, etc. Every few minutes, quietly speak aloud your destination, the road or highway you are on, the direction you are travelling, and your general location. For example, you might say “I am focusing on driving to the airport. I am going North on I-95 and just passed exit 35.” You also can take notice of the traffic immediately around you and describe it out loud every few seconds as well to help you stay focused on your driving.  You might say, for example, “There is a white van ahead of me and a blue Volkswagen to the right”.  In addition, before you make a lane change, check for traffic on all sides and then say out loud, “Left lane is clear” or Right lane is clear” before actually moving into the next lane over. Finally, you can get used to saying, “Clear to back up” before backing out of a parking space to help ensure you actually check for other cars and pedestrians behind you.

In addition to helping you drive more safely, the above technique can be an effective mental exercise to improve focus in general.

ADHD Medications: How Can You Tell They Are Working?

 

Often patients at the Atlanta Center for Adult ADHD will ask “what to look for” after they take their medication for the first time. In other words, what symptoms will immediately improve?  Prompt improvement of three symptoms often takes place: disorganized thinking, procrastination and lack of focus in reading and listening. Individuals whose thoughts seem to be “pinging” around their brain in random fashion can experience a slowing down of thoughts and a more logical progression of one thought to another. ADHD patients often have difficulty getting started on tasks they find uninteresting, difficult/unfamiliar and/or requiring organized steps to complete (for example, balancing the checkbook.) With medication, they may find that they can “attack” or “engage” these tasks more readily. Furthermore, they may be able to work on them for a longer period of time with fewer interruptions due to inattention or distraction.Finally, patients often find they can read easier with less “re-reading” and listen better with less effort and more immediate comprehension. It should be kept in mind that the degree of improvement is usually related to finding the optimal medication and dosage.Symptoms such as poor organization, prioritization and time management issues usually take longer to resolve. Counseling and coaching, in addition to the right medication and dose, can be extremely helpful in these areas.

When Adult ADHD Is Combined With Other Psychiatric Conditions

 

At the Atlanta Center for Adult ADHD, significant importance is placed on identifying other psychiatric conditions that influence affect diagnosis and treatment of ADHD. The 2007 National Co-Morbidity Replication Study (NCRS) found that adults 18 to 44 years of age with ADHD experienced higher rates of major depression (18.6% vs 7.8% in non-ADHD adults), bipolar disorder (19.4% vs 3.1% in non-ADHD adults), and dysthymia (12.8% vs 1.9% in non-ADHD adults). Depression may result in part from untreated ADHD due to situational/adjustment factors and mild mood depression (dysthymia) often improves considerably when ADHD is treated with a stimulant medication alone.  For major depression in adult ADHD patients, bupoprion is often a good option since it can treat both conditions simultaneously. Since bupoprion is typically not as “robust” as stimulants in treating ADHD, stimulant medications often can used as well (with periodic monitoring of blood pressure/pulse).  Medications used to treat ADHD may cause worsening of manic symptoms in bipolar patients and must be used cautiously. In adult adhd, anxiety often improves considerably when stimulant medications are used as patients are able to better cope with anxiety-provoking thoughts and situations. Selective Serotonin Reuptake Inhibitors (SSRI’s) for generalized anxiety disorder may be used along with stimulant medications. Counseling, especially cognitive behavioral therapy (CBT) is usually very helpful in treating all of the above conditions. For more information on the Atlanta Center for Adult ADHD, please visit www.Atlanta-ADHD.com.

Is ADHD Still Affecting Your Child Even After Treatment?

Atlanta-ADHD Research News:

Northwest  Behavioral Research Center, in north metro Atlanta (Alpharetta)  is currently recruiting children and teenagers (6-17) to take part in an investigational research study to better understand and possibly treat attention deficit hyperactivity disorder (ADHD).

Study qualifications include:

1. Children between 6-17 years of age.

2. Diagnosed with ADHD

3. Have tried one ADHD treatment and continue to have symptoms.

If interested in learning more about this trial please call 678-992-0109, visit www.psychatlanta.com or contact us with the form below: