Category — ADHD: Health

The November issue of the medical journal Pediatrics published research from Dr. Robert Kahn et al regarding the relationship between tobacco smoke, lead concentrations, and ADHD.

Kahn, a physician and researcher at Cincinnati Children’s Hospital Medical Center, Ohio, found that two risk factors: 1) exposure to tobacco in the womb and 2) exposure to lead in childhood significantly increased the likelihood of ADHD developing  in children.

The researchers used data from the National Health and Nutrition Examination Survey. Tobacco exposure in the womb was measured by reports of cigarette use during pregnancy, and childhood lead exposure was assessed by blood levels. Of the 2588 cases they reviewed, the researchers determined that children aged 8 – 15 who were exposed to tobacco smoke in the womb were 2.4 times more likely to have ADHD. Children with lead blood levels in the top third of the population had a 2.3-fold increased likelihood of ADHD diagnosis.

Lead researcher, Tanya E. Froehlich, MD, cited that the combination from both lead and tobacco smoke created a synergistic effect, an even greater effect than smoke or lead alone. Children who were exposed to  both tobacco smoke in the womb and higher lead levels had a more than eightfold increased chance of having ADHD compared to children who weren’t exposed to either.

The study does have limitations; the researchers analyzed data on smoking that was derived from the mothers’ answers on a questionnaire. The data did not include the number of cigarettes smoked. And while the researchers found a link between tobacco, lead and ADHD, they did not prove that these factors actually caused the disorder. This is similar to previously published research on prenatal tobacco smoke and lead levels.

Curiously, smoking tobacco is twice as popular in the adult ADHD population compared to the non-ADHD adult population.  Columbia University researchers established a study to determine if smoking ameliorated ADHD symptoms in adults back in 2006.  If tobacco smoke truly increases the risk of developing ADHD, the popularity of smoking among ADHD adults may create a cycle of producing more ADHD children if smoking is done prenatally.

While a strong genetic link is still the likely cause of ADHD, environment still plays a significant role in brain development. The researchers assert that perhaps up to 35 per cent of cases of ADHD in youngsters aged between 8 and 15 could be reduced by getting rid of both prenatal exposure to tobacco and childhood exposure to lead.

Obviously, being pregnant can be stressful in itself, but current research shows that stress can affect fetal development which may lead to long-term problems including ADHD.

Dr. Vivette Glover of Imperial College London, surveyed pregnant women at her hospital. Of these, nearly one quarter felt anxious and depressed due to stressors including work, money, arguing with spouse, and moving to accommodate a larger family. When compared to their non-stressed counterparts in this research, the babies of the stressed mother had lower birth weight, lower IQ, slower cognitive development, and more anxiety. Lower birth weight has been an indicator for coronary heart disease in later life.

In 2007, research in the Journal of the American Academy of Child and Adolescent Psychiatry indicated that being stressed during pregnancy is as detrimental for the baby’s development as smoking or being obese. Glover’s research reveals why and how this happens: stress produces the hormone cortisol. An abundance of stress can actually diminish the barrier enzyme that inhibits cortisol from reaching the fetus. Costisol impacts fetal brain development.

According to Glover, “People used to think that if something was congenital, apparent at birth, it had to be genetic. In fact it can be an in-vitro reaction of genes and environment.”

Glover also contends that her research shows stress greatly increases the likelihood of a child having ADHD (attention-deficit hyperactivity disorder), cognitive delay, autism , anxiety and depression. 

Glover’s research reinforces previous data from the UK where stress was shown to increase the risk for development of ADHD. In that research, the women who experienced the most stress doubled the chances of developing ADHD.

“The organs are forming during the first trimester of pregnancy, but the brain is developing all the way through,” Glover explains. “The organs are sensitive while they are forming and, once formed, they are harder to change.”

“In evolutionary terms, stress perhaps prepares the child for survival in a stressful environment. If a child is anxious and has attention deficiency, it will be very alert to danger. This may once have been adaptive, beneficial for the child, but it isn’t any more,” Glover says.

Significantly, Glover’s research implies that the changes may be on a genetic level so that it may be passed on generation to generation.

Therefore, it’s important to realize that taking care of ourselves during pregnancy is more important now than ever. Small efforts like seeking health services early, meditating, eating a balanced diet, taking pre-natal vitamins, and laughing are good practices.

Minimizing stress by maintaining a consistent schedule both at work and at home is a good idea.

Researchers, Dr. Zylowska, et al from the University of California-Los Angeles conducted a feasibility study of an 8-week mindfulness training program for adults and adolescents with ADHD. Their report was published in The Journal of Attention Disorders (2008 May;11(6):737-46. Epub 2007 Nov 19).

The researchers sought to inquire whether mindfulness meditation could improve attention, reduce stress, and improve mood. The researchers recruited 34 adults and 8 adolescents. Study participants were given a weekly training session. They were also required to practice daily starting with 5 minutes of meditation per day and gradually increasing to 15 minutes per day.

The majority of participants (after dropouts) reported improvements in self-reported ADHD symptoms. Independent tests on tasks measuring attention and cognitive inhibition also indicated improved symptom outcomes. Improvements in anxiety and depressive symptoms were also observed.

In yet another pilot study conducted by Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist, a group of middle school students with ADHD were required to meditate twice a day in school. After three months, researchers found over 50 percent reduction in stress and anxiety and improvements in ADHD symptoms.

"The effect was much greater than we expected," said Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist and lead researcher on the study. "The children also showed improvements in attention, working memory, organization, and behavior regulation."

Due to the neuroplasticity of the brain, better attention can be attained through meditation. Buddhist monks have been doing it for centuries. This seems to be true of ADHD persons as well. However, it is quite apparent that attention difficulties are just the tip of the ADHD iceberg. Other skills including organization, filtering out distractions, memory, time on-task, motor skills, visual tracking, etc, are typically diminished in ADHD persons. A complete program like Play Attention is required to teach these skills.

As for meditation, it is likely a good supplement to training in the aforementioned skill areas, but given the nature of the cited studies, a controlled clinical study is warranted.

In the wake of the deaths of 20+ children taking ADHD stimulant medication, the American Heart Association (AHA) cautioned this week that children should be screened for heart problems with an electrocardiogram(EKG) before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder.

The National Institute of Mental Health estimates that between 5% and 7% of children have ADHD. They speculate that about 2.5 million American children and 1.5 million adults take medication for ADHD to control behavior and increase focus.

Stimulant drugs like Concerta, Adderall, Ritalin, etc. are classified as schedule II drugs –the same category as cocaine. They can increase blood pressure and heart rate which is problematic for children with heart conditions. It could result in vulnerability to sudden cardiac arrest — an erratic heartbeat that causes the heart to stop pumping blood through the body — and other heart problems.

After review of these implications by the FDA, the FDA mandated that these medications carry warnings of possible heart risks in those with heart defects or other heart problems.

The AHA is now recommending children receive a thorough exam, including a family history and an EKG, before children are put on the ADHD drugs to insure that they don’t have any undiagnosed heart issues.

“We don’t want to keep children who have this from being treated. We want to do it as safely as possible.” said Dr. Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation.

American Heart Association

AHA recommendations: http://www.americanheart.org/presenter.jhtml?identifier=3055953
http://www.americanheart.org/presenter.jhtml?identifier=3055974

The American Heart Association’s (AHA) recent recommendation that children be screened for possible heart problems before taking ADHD stimulant medication has spurred great anxiety among parents and professionals. The recommendation was given as a response to a number of deaths due to heart failure associated with ADHD stimulant medication.

In response to the AHA’s recommendation, the Pediatric Cardiology Division at the University of Virginia Children’s Hospital will begin offering electrocardiograms (ECG or EKG) for ADHD children taking stimulant medications for the disorder.

According to Dr. George McDaniel, director of the Pediatric Electrophysiology Program at UVA Children’s Hospital, this exam is important because not all children show obvious signs of a heart condition or abnormality.

The AHA also recommends that ADHD children receive a thorough family history and an EKG by their healthcare providers to screen for problems before they may arise.

Experts at UVA Children’s Hospital say the recommendations are conservative but the information is worth knowing.

Families should be reassured that there is no real urgency for a patient who is not having any difficulties,” said Dr. Paul Matherne, director of the Division of Pediatric Cardiology at UVA Children’s Hospital. “According to the guidelines parents should not stop their child’s medication and can have this screening done by their medical care provider at their next appointment.”

The Denver Post (www.denverpost.com) reports that Boulder police arrested three teens on felony charges of distribution and possession of a schedule II controlled substance. The incidence occurred on April 4 at Nevin Platt Middle School where the youth attended school.

Apparently one student had the drugs, gave one to another student who swallowed it and was taken ill. The sick student was then taken to the hospital and released. Other students were involved in the safekeeping of the drugs after they were brought to school.

The student that brought the drugs (Strattera and Concerta for treatment of ADHD) attempted to trade the drugs for alcohol.

The Denver Post says,

Two of the students have been charged with distribution and possession of a schedule II controlled substance and unlawful acts while the third was charged with possession of a controlled substance and unlawful act. Possession and distribution of a schedule II controlled substance is a felony, officials said.

While these students were apprehended, the incidence of ADHD drug sales and use is quite common among students at middle school, high school, and university.

The New York Times (www.nytimes.com) reported in 2005 in an article called The Adderall Advantage that:

At many colleges across the country, the ingredients for academic success now include a steady flow of analeptics, the class of prescription amphetamines that is used to treat attention deficit hyperactivity disorder [ADHD].

Since Ritalin abuse first hit the radar screen several years ago, the reliance on prescription stimulants to enhance performance has risen, becoming almost as commonplace as No-Doz, Red Bull and maybe even caffeine. As many as 20 percent of college students have used Ritalin or Adderall to study, write papers and take exams, according to recent surveys focused on individual campuses. A study released this month by the National Center on Addiction and Substance Abuse at Columbia found that the number of teenagers who admit to abusing prescription medications tripled from 1992 to 2003, while in the general population such abuse had doubled.

Dr. Robert A. Winfield, director of University Health Service at the University of Michigan, Ann Arbor, sees a growing number of students who falsely claim to be A.D.H.D. so they can get a prescription. At least once a week, a jittery, frightened, sleep-deprived student who has taken too many tablets for too many days shows up at his office. “Things have really gotten out of hand in the last four to five years,” he said. “Students have become convinced that this will help them achieve academic success.”

On campus, the drugs are either sold or given away by people with prescriptions, or they are procured by students who have learned to navigate the psychiatric exams offered by campus health centers, which usually provide the drugs at a discount. Unlike Ritalin, two newer members of the family of analeptics – Adderall and Concerta – come in time-release forms and can keep a patient medicated an entire day.

Louisiana State’s The Daily Reveille (www. media.www.lsureveille.com) reported that a survey documented in the journal Nature cites that one in five students used Adderall & Ritalin for a study booster.

Final exams traditionally have students studying long hours to cram for their final exams. But some students are now using a quick-fix for brain retention.

One in five respondents of adult professionals said they have used drugs to enhance brain power, according to a January survey in Nature journal. The online survey polled 1,400 people in 60 countries.

Ritalin and Adderall were the two drugs participants said they took.

Ritalin and Adderall are commonly used to treat attention-deficit hyperactivity disorder. They are also used to treat symptoms of narcolepsy and chronic fatigue syndrome. The stimulants are supposed to reduce impulsive behavior and facilitate concentration.

But people diagnosed with ADHD are not the only ones who can benefit from the drugs.

“It does work [for anyone]. We know that from lab studies,” said Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania, according to CNN.com

This is an international phenomenon. The reason is that low-dose stimulant medication is not a targeted approach to fixing ADHD. Instead, low-dose stimulant medication works the same for non-ADHD students. Here’s an example: if we have 50 ADHD students and 50 high functioning non-ADHD students, give them both a boring task, the both will perform better on that task.

Students know this and it helps the cram for exams. Will it help to prosecute all these students under felony charges? Not likely.

For years, parents have complained that certain artificial additives to brightly colored cakes, soft drinks, and candies, had caused their children adverse reactions such as hyperactivity, skin problems, mood volatility, headaches, etc. after consumption.

The Food Standards Agency (“FSA”) recommended ministers call for manufacturers to remove six artificial colors by the end of 2009. The FSA also urged a European Union-wide ban. This reversed the FSA’s decision last month when it dismissed calls for action on the additives.

According to The Independent, “The FSA’s advice to parents will be strengthened to warn them about the dangers of the E-numbers tartrazine (E102), quinoline yellow (E104), sunset yellow (E110), carmoisine (E122), ponceau 4R (E124) and allura red (E129).”

The Independent further reports that, “These colors and the preservative sodium benzoate (E211) were linked to hyperactivity in a £750,000 study by Southampton University, which found they made primary school children become distracted and fail a computer attention test.

The researchers estimated that 30 per cent of cases of attention deficit hyperactivity disorder (ADHD) would be prevented if companies removed the colors used in the £13bn-a-year global additives industry.

If the ministers elect to have the dyes and additives banned, the UK’s biggest producers of confections, soft drinks, ice cream, and others will have to reformulate their products.

The Independent:

The Southampton researchers had warned the seven additives were as harmful as lead in petrol, which was banned after it proved to lower children’s IQ by five points. Their research, in The Lancet in September, was the evidence that artificial additives worsened the behavior of normal children as well as those diagnosed with ADHD.

Dame Deirdre Hutton, who chairs the Food Standards Agency, said: “It is the agency’s duty to put consumers first. These additives give color to foods but nothing else. It would therefore be sensible, in the light of the… study, to remove them.”

The board decided to take no action on sodium benzoate because it was “a preservative” rather than a color. E211, which is linked with other potential health problems, is found in many soft drinks including Diet Coke, Irn-Bru, Lucozade and Fanta, and its removal would pose a significant technological and financial challenge to drinks companies.

The FSA stressed that its decision “does not mean there is an immediate ban”.

Campaigners welcomed the first decisive move in the UK against additives, whose effect on hyperactive children were first identified in 1975. Richard Watts, of the Children’s Food Campaign, said: “This decision is good news for children and parents, who have known for many years that these additives affect children’s behavior.” Anna Glayzer, an Action on Additives campaigner, said the FSA had put the consumer first. “We will be keeping a close eye on the industry to see what effect the voluntary ban has.”

The Food and Drink Federation said the recommendation was “bizarre”, as manufacturers were already removing the additives. “[Most] products don’t contain these colors,” a statement said.

The six colorings facing a ban:

Tartrazine (E102)
Description: Synthetic yellow dye found in sweets, biscuits, mushy peas
Products: Disney Winnie the Pooh Cake Kit, Lidl orange jelly, Bacardi Breezer tropical lime, Asda mushy peas
Health effects: causes hyperactivity, linked to allergic reactions and migraine.

Quinoline Yellow (E104)
Description: Synthetic dye in sweets, pickles, smoked fish
Products: Aero orange, Galaxy Minstrels, M&Ms, Bassett’s Sherbet Lemons
Health effects: Causes hyperactivity and is linked to rashes. Banned in US.

Sunset Yellow (E110)
Description: synthetic yellow dye found in sweets, ice cream, fizzy drinks
Products: Cadbury Creme Egg, Haribo Jelly Beans, Irn-Bru
Health effects: causes hyperactivity and linked to stomach upsets and swelling of skin.

Carmoisine (E122)
Description: Synthetic red dye found in ready meals, sweets
Products: Love Hearts, Galaxy Minstrels, Cadbury Mini Eggs, various lollipops
Health effects: causes hyperactivity and is alleged to cause water retention in those allergic to aspirin. Banned in US.

Ponceau 4R (E124)
Description: synthetic red dye found in sweets, biscuits, drinks
Products: Bassett’s Pear Drops, Halls Blackcurrant Soothers, Supercook Alphabet Icing
Health effects: causes hyperactivity and is believed to cause problems for asthmatics. Banned in US.

Allura red (E129)
Description: synthetic red dye found in sweets, soft drinks, Turkish delight
Products: Fry’s Turkish Delight, Cadbury Mini Eggs, Maynards Wine Gums
Health effects: causes hyperactivity and may bring on allergic reactions.