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.

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.

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 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.

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:

 

 

 

Atlanta ADHD News: New Indication for Vyvanse

The  FDA has approved Vyvanse (lisdexamfetamine dimesylate) as maintenance therapy for adults with attention deficit hyperactivity disorder (ADHD).

The  approval is based on results from a randomized study designed to evaluate the efficacy of the drug in 123 adults aged 18 to 55 years who were receiving treatment with Vyvanse for a minimum of 6 months before enrolling in the study and who were responsive to the drug.  8.9% of patients in the active treatment group experienced a relapse of symptoms compared with 75% of those in the placebo group during the 6-week double-blind withdrawal phase of the study Shire, the drug’s manufacturer, stated in a press release that “Vyvanse is the first medicine both proven to work and approved to maintain efficacy in adults with ADHD.” The FDA approval included the proviso that Vyvanse should be used as part of a total treatment program that may include counseling or other therapies. The FDA also noted that physician who elects to use Vyvanse for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.The bottom line is that Vyvanse, while previously approved for Adult ADHD, now has been definitely shown to be effective for the long term treatment of this condition. For more information on the Atlanta Center for Adult ADHD, please visit www.Atlanta-ADHD.com

 

ADHD Treatment in Atlanta Update on Vyvanse

At the Atlanta Center for Adult ADHD, one of the most common medications patients try is Vyvanse (lisdexamphetamine). Vyvanse has an FDA indication (approval) for childhood, adolescent and adult adhd/add. Vyvanse has the advantage of an exceptionally long duration of action, up to 13 hours. This is due to the novel way Vyvanse is metabolized. Lisdexamphetamine is a prodrug which is inactive until metabolized in the body to dextroamphetamine, which in turn is responsible for increasing the release of dopamine and norepinephrine between neurons in the brain. This increase in neurotransmitters produces the improvement in ADHD symptoms that patients usually experience with Vyvanse.

Vyvanse may be taken with or without food (which is always more convenient). The medication is started at 30mg and may be increased up to 70mg as needed. However, many patients do well at the starting dose and no upward titration is needed. One drawback to Vyvanse is the cost and this medication is sometimes not covered under health insurance plans. Because of its long duration of action, Vyvanse is usually one ofthe first medications tried by adults in our practice. All patients who are started on amphetamine medications are carefully evaluated for any health issues such as underlying cardiovascular disease to ensure the medication can be taken safely.

For more information on the Atlanta Center for Adult ADHD, please visit Atlanta-ADHD.com or call 770-753-9898

Update on Complementary and Alternative Treatments For ADHD

 

Our patients (and their parents) often ask what treatments besides medications can help ADD/ADHD.

Most of the scientific studies exploring this subject have examined effects on children rather than adults, but I would expect the effects on teenagers and adults would be similar.

There is one large randomized controlled study in 2009 finding a significant benefit of neurofeedback for children with ADHD. (The goal of neurofeedback is to teach individuals to be able to control certain brain wave patterns and increase brain activity associated with good attention states. Specifically, patients learn to reduce activity in the theta band of the electroencephalogram (EEG) (4–8 Hz) and to increase activity in the beta band (13–20 Hz).)

In the 2009 study,  the effect was found to be “moderate”. There were some methodological issues with this study as well as with other past studies of neurofeedback to treat ADHD and government sponsored research into this area is ongoing. Still, neurofeedback appears to be one of the most promising complementary treatments available.

The following treatments have not been scientifically shown to be helpful for Adult ADHD: acupuncture, zinc/magnesium/iron supplements, polyunsaturated fatty acids (including fish oil), Ginko Bilobum, and St. Johns Wort. Elimination diets are generally not helpful. However, I strongly believe that eliminating monosodium glutamate and other glutamates from foods (ie, natural flavor, natural flavoring, malted barley, hydrolyzed protein, yeast extract, etc.) in individuals sensitive to these chemicals helps can help ADHD symptoms tremendously.

Atlanta Center for Adult ADHD Opens

We are happy to announce the opening of the Atlanta Center for Adult ADHD at our Roswell office, offering state of the art medical and behavioral treatment for this condition. Dr. Banov is especially interested in ADHD and has participated in FDA regulated ADHD trials as a Clinical Investigator. Attention Deficit Disorder is a common condition among children and adolescents and has been diagnosed with increasing frequency among adults as well. Research shows that up to 60% of children with ADHD continue to have symptoms through adolescence and into adulthood. In addition, studies have shown that individuals with untreated ADHD have a much higher rate of substance abuse problems. Here at Atlanta-adhd, we have seen a high rate of untreated ADHD in our patients being seen for substance or addiction problems. Symptoms of Adult ADHD can include difficulty paying close attention to details, making careless mistakes, finding it hard to organize activities or finish a task, having difficulty following instructions or conversations and being forgetful in daily activities as well as frequently losing things. Some adults with ADHD are quite restless and fidgety. ADHD diagnosis involves clinical evaluation, behavioral testing and the Quotient ADHD System, a computerized device that accurately measures motion and shifts in attention. The test takes 20 minutes for adolescents and adults. Treatment of ADHD usually involves medication, either stimulant (such as Dexedrine or methyphenidate) or non-stimulant (such as amoxetine). We also offer ADHD coaching and cognitive therapy. We look forward to helping many adults in the Atlanta area dramatically improve their quality of life with effective ADHD treatment at our new center.