Category — ADHD: Treatment

ADHD does not seem to be a condition like pregnancy where one is either pregnant or one is not. Rather it is a matter of degree. Some children and adults range from mildly inattentive to profoundly inattentive. The degree seems to be directly affected by a variety of environmental factors including divorce, parenting skills, etc. More frequently than not, drugs are prescribed to allay the symptoms. Obviously, they do not affect core issues that affect the child like divorce, marital discord, or learning disabilities.

Study finds divorce increases Ritalin use in children

HELEN BRANSWELL
Canadian Press
June 4, 2007 at 8:46 PM EDT

TORONTO — Children whose parents divorce are nearly twice as likely to be prescribed Ritalin in the aftermath of the split, a Canadian study reports.

But the author, a sociologist from the University of Alberta, cautioned against concluding that children of divorce are over-prescribed the drug, which is used to treat Attention Deficit and Hyperactivity Disorder, or ADHD.

Lisa Strohschein said the data she used can only identify the phenomenon and cannot reveal why Ritalin use rates are double when children of divorced parents are compared to children whose parents stay married.

“I’ve got the what, but not the why,” Ms. Strohschein said from Edmonton.

Ms. Strohschein suggests there may be a variety of answers. Some kids may need the drug to cope with the stress of the split, some kids may have ADHD and some kids may be getting a drug they don’t really need.

“The problem is I can’t be clear about it,” she said.

“I mean, I would love to be able to say ‘Yes, it’s divorce. That’s the problem,’ But it’s not necessarily so. It could just be our perceptions about divorce — and that’s the thing that makes me really cautious here.”

“(But) I don’t want to come out on the other side, either and say ‘Ritalin is bad’ because I think it clearly does help some kids.”

The psychiatrist-in-chief of the Hospital for Sick Children in Toronto said the study should serve as a reminder to doctors to move cautiously when prescribing Ritalin or other methylphenidate-based drugs to children in these circumstances.

“What we need is a deeper understanding of this issue, at the level of the primary care practitioners,” said Dr. Abel Ickowicz.

“Because . . . if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing.”

The study, published in the Canadian Medical Association Journal, used data gathered by Statistics Canada through its National Longitudinal Survey of Children and Youth. The survey, which was first conducted in 1994, is completed every two years; Ms. Strohschein used data collected between 1994 and 2000.

Previous researchers had identified the fact that children who live in a household with only one parent or with a parent-step-parent combination were more likely to be on Ritalin than children growing up in households with both parents.

But it wasn’t clear whether the increased use was among all children in a single-parent household — in other words, children whose parents had divorced, children who had lost a parent to death and children born to a single mother — or whether some subset of these children was more heavily prescribed the drug.

Ms. Strohschein compared prescription rates among 4,151 children whose parents hadn’t divorced and 633 children who had. She found that 3.3 per cent of children in the two-parent families were prescribed Ritalin; among the children whose parents had divorced, that figure rose to 6.1 per cent.

The study notes a number of potential explanations for the doubling of the usage rate.

One possibility is that the stress of the divorce aggravated a child’s existing behavioural problems to the point where Ritalin would actually be helpful, she hypothesized.

It is known that ADHD can run in families. In addition to passing on the condition to their children, parents with ADHD-type behaviour might be more likely to divorce — a theory that points towards appropriate use of the drug.

Another possibility is that in divorce, the natural emotions children experience — anxiety, sadness, anger — may manifest themselves in behaviour that is mislabeled as ADHD-like, or that parents and doctors may be anticipating problematic behaviour because of the stress of divorce. The study suggested this type of rationale would reflect inappropriate use.

Dr. Anton Miller, a developmental pediatrician and child health researcher at the University of British Columbia’s Centre for Community Child Health Research, said it’s possible no single answer applies across the board for these children.

“None of them is an outlandish kind of suggestion. They probably all have some validity,” he said.

“It’s certainly possible in some instances that ADHD might have been prematurely diagnosed…. But I would caution anybody (against) saying ‘Well that’s why all these children are getting medication.’ “

“But there is a possibility that in a proportion of the cases we need to try and figure out how much that does happen in the real world and try and advocate … for children to have thorough and really in-depth assessments for these kinds of behaviour and emotional problems.”

Ms. Strohschein agreed: “I think the take-home message is just to be careful not to make that broad assumption that kids must necessarily be doing poorly when their parents divorce. Some kids will do better, some kids will do worse.”

Dr. Lawrence H. Diller’s book, The Last Normal Child: Essays on the Intersection of Kids, Culture, and Psychiatric Drugs, is a fascinating and provocative work. As an experienced developmental/behavioral pediatrician, Diller examines the current trend to quickly diagnose attention deficit hyperactivity disorder (ADHD) and the perfunctory prescription of stimulant drugs even when there is scarce evidence regarding academic improvement, social improvement, or long-term efficacy.

Diller’s perspective is quite evenly balanced; he prescribes stimulant medication for ADHD when indicated, but only as part of thorough assessment and comprehensive management program.

It is clear that Diller believes that ADHD is being over diagnosed. He states that over the last 15 years brand name stimulant production has increased by an astounding 1700% and generic stimulants by more than 3000%!

The number of U.S. children taking psychotropic drugs has doubled over the last ten years. We currently have more than 4.5 million children under 18 taking psychotropic drugs – mostly stimulants. Perhaps even more alarming are the percentages of ADHD children being reported by the Centers for Disease Control (CDC): typically common rates between 5% to 7% are reported in children in Colorado and 5.5% in California. However, as many as 10.5% of children in Louisiana are diagnosed with ADHD as are 11% of children in Alabama.

Diller suggests that the rampant diagnosis and pharmacological treatment of ADHD might be related to the fact that, “The drug industry hijacked American psychiatry in the 1990s….Insurance companies structure doctors’ reimbursement so as to reward short visits, ones in which a prescription brings the session to a definite conclusion.”

Diller also suggests that the Individuals with Disability Education Act of 1990, actually accelerated pharmacological treatment as well as the ADHD diagnosis because its amendment in 1991 now included ADHD as a diagnosis that makes a child eligible for special services and accommodations in public schools. As parents quickly learned, an ADHD diagnosis could gain their child special services and testing accommodations.

The pharmaceutical industry parleyed this trend by targeting parents with direct ADHD drug advertising. Parents, having diagnosed their child via the effects of the advertising campaign, could now approach their family practitioner to request stimulant drugs as a remedy. Diller suggests that many parents welcomed a brain-focused diagnosis that relieved them of responsibility for problem behavior.

The book encompasses far more than I’ve described here and is well worth reading. It is an excellent, balanced perspective that provides insight into the staggering $3 billion juggernaut known as ADHD.

The Global Market For ADHD Medications

The University of California, Berkeley reports that ADHD has more than tripled worldwide since 1993. Researchers at UC, Berkeley found that the United States, Canada, and Australia “presented higher-than-expected rates of ADHD medication use between 1993 and 2003 – based on predictions from per-capita GDP indicators – a country-by-country analysis showed increases in ADHD drug consumption in countries ranging from France and Sweden, to Korea and Japan.” The US still leads the world in dollars spent on ADHD medication at $2.7 billion in 2006.

The University of California at Berkeley study was published in the journal, Health Affairs.  Researchers reviewed data on ADHD medication use among 5-19 year-olds in countries belonging to the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations.

The researchers stated that one in twenty-five children is taking medication for ADHD in the US. However, their research also suggests that the diagnosis of ADHD and subsequent use of medications to control it is now spreading worldwide.

Dr. Richard Scheffler, a UC Berkeley distinguished professor of health economics and public policy Overall thinks the study reflects global trends. “Given the global diffusion of ADHD medications, as well as the prevalence of this condition, ADHD could become the leading childhood disorder treated with medications across the globe,” Scheffler said. “We can expect that the already burgeoning global costs for medication treatment for ADHD will rise even more sharply over the next decade.”

The Berkeley researchers also cite that “Growth trends indicate that other countries are following in its tracks. For example, global spending on ADHD medications increased nine-fold among OECD countries during the time period studied. This increase is largely due to the advent and availability of more costly and long-acting medications such as Concerta™, Strattera™ and Adderral XR™”.

The use of medications outside of the US is still primarily short acting amphetamines. However, the pharmaceutical industry is well aware that they cannot reach the estimated $3.4bn by 2015, unless it is led by the launch of drugs with novel delivery mechanisms such as improved durations of action and anti-abuse profiles as media are raising the abuse flag significantly. These custom drugs will help differentiate these pipeline drugs from the current established ADHD therapies and increase market share.

It is important to note that although ADHD drugs have demonstrated efficacy in improving the three main symptoms of ADHD – inattention, hyperactivity and impulsivity – none have shown efficacy in treating the cognitive deficits of ADHD.

Drug makers are likely to increase the costs of these novelty release (e.g. long acting) drugs globally as they become more prevalent outside the U.S. in order to reach the estimated $3.4bn target in 2015.

Back to Berkeley, using the IMS Health MIDAS™, an international pharmaceutical database, researchers looked at data and found that between 1993 and 2003, “the number of countries using ADHD medications rose from 31 to 55, with the U.S. share of global market decreasing from 86.8 percent to 83.1 percent. Meanwhile, countries with traditionally low and moderate consumption of ADHD drugs were showing steady upswings.”

Stephen Hinshaw, who is frequently approached by the media to comment on ADHD, is chair of UC Berkeley’s Department of Psychology was a co-author of the study. Commenting on this study, Hinshaw states, “The results temper some key criticisms of ADHD. A common misconception is that ADHD only exists in the U.S. and that the pharmaceutical firms are getting bigger sales because of the ‘creation’ of the disorder in the U.S. Yet cross-cultural research has shown that ADHD exists in nearly any culture that has compulsory education. Clearly, ADHD–which has a substantial genetic liability–is not just a figment of American doctors’ imaginations.”

In a nutshell, here’s Hinshaw’s argument: The use of stimulant
medication in wealthy member nations of the OECD outside of the U.S. is
growing, therefore, “ADHD is not just a figment of American doctors’
imaginations.” I’m not arguing that ADHD is real or not real. I am
simply citing that pharmaceutical marketing dollars greatly contribute
to the rise in use of stimulant medications in these nations. For
example, when adult ADHD medication was marketed heavily in the U.S.,
sales of the drug skyrocketed. Did the number of diagnosed cases
increase? Yes. Did that mean more people had the disorder? No. If this
poor logic and poor research is the best Berkeley and Hinshaw can
produce, then the students that are graduated from Berkeley are doomed!
But, wait, that’s also a non causa pro causa!

Hinshaw has essentially committed a non causa pro causa (false cause). He’s co-authored a study of data from a pharmaceutical database and citing that the number of persons outside the U.S. in the Organization for Economic Cooperation and Development (OECD), whose members are largely economically fit North American, European and Northeast Asian nations. The pharmaceutical industry has spent many millions of dollars over the past few years to increase their profit in these nations in an effort to obtain their estimated goal of $3.4bn by 2015.

What can be clearly gleaned is that the Berkeley study is meaningless. It might have some teeth if the researchers actually correlated the marketing dollars spent by the pharmaceutical manufacturers to the numbers of persons using their medications in the OECD. It would be interesting to see the data on usage in third world countries who cannot afford it. I’d wager that they have far fewer cases of ADHD and use far less medication.

New research shows it takes one part of the brain to start concentrating and another to be distracted.

This discovery could help scientists develop better treatments for attention deficit disorder .

The study, Top-down versus bottom-up control of attention in the prefrontal and posterior parietal cortices, performed at Massachusetts Institute of Technology (MIT) and published in of the journal Science, reveals that attention may have two forms: willful and reflexive. While this information is not new – cognitive psychologists have written about this for many years – the study finds that these two types of attention are controlled by distinct areas of the brain. Willful attention seems to be controlled by the frontal region of the brain in the prefrontal cortex while reflexive attention seems to be activated by the parietal cortex toward the back of the brain.

Put simply, if one is reading a book, then likely the prefrontal cortex is engaged in commanding attention like the conductor of an orchestra. If, while reading, a firecracker explodes nearby, your reflexive attention will activate from the parietal cortex command center shifting control away from the prefrontal cortex.

“This ability to willfully focus your attention is physically separate in the brain from distracting things grabbing your attention,” said Earl Miller, a neuroscientist at the Massachusetts Institute of Technology. “Now we know these two things are separate, it raises the possibility that we can fix them independently,” Miller said.

RESEARCH

MIT’s research sheds a little more light on the subject of attention because until now researchers have examined only one region at a time. Studying both regions allows us to examine their collaborative interactions, functions, and purposes.

Miller used EEG electrodes connected to the heads of monkeys to examine the complex interplay between the prefrontal cortex and parietal regions during tests of attention and bursts of reflexive attention.

When the monkeys voluntarily concentrated, the so-called executive center in the front of the brain – the prefrontal cortex – was in charge. But when something distracting grabbed the monkeys’ attention, that signal originated in the parietal cortex, toward the back of the brain.

ADHD IMPLICATIONS

Miller concluded that once the prefrontal and parietal regions signaled each other (see my blogs on neural networks), the electrical activity in these two areas began vibrating in synchrony. However, as EEG specialists have known for quite some time, willful concentration involved lower-frequency neuron activity. Distraction occurred at higher frequencies. This again lends credence to EEG training to produce better attention.

While the study sheds a little more light on the subject of concentration, it examined only two portions of the brain. I contend that the entire brain is involved in concentration. The brain seems to work as an orchestra works. While the conductor is not in command, the players tune and rehearse each of their own will. When the conductor steps to the stage, taps his baton, all the individual players each snap to attention and begin to play in synchrony. It is a metaphor for brain function – our brains are formed of many different parts that perform jobs independently of each other. When necessary, a conductor taps his baton and attention is achieved as the individual parts work in synchrony.

For a person with an attention problem or AD/HD, the conductor is not controllable at-will unless the object of attention is highly stimulating like a three ring circus. A little attention may be sustained if the object of attention is only moderately stimulating, but the other conductor responsible for reflexive attention quickly takes command and distraction ensues.

ADHD persons don’t have at-will command over either conductor responsible for willful attention or reflexive attention. Do we know why this is so? No, it may be caused by a variety of factors. Can they be taught to control these conductors? Absolutely. The brain is very flexible and can compensate. All educational systems are built upon this foundation. So, let’s take this out of the realm of medical mystery and dysfunction. Let’s place it back in the realm where it is a skill that can be improved like any other.

WSJ Article Excerpts:

By ANNA WILDE MATHEWS
Staff Reporter of THE WALL STREET JOURNAL
August 24, 2005; Page A1

DOWNEY, Calif. – When Eli Lilly & Co. wanted to get the big California health-maintenance organization Kaiser Permanente to use its new antidepressant, it ran straight into Debbie Kubota.

As the cost of drugs in the U.S. approaches $250 billion a year, pharmaceutical companies are running up against a growing breed of detective trained to see through marketing spin. Working for insurers, state Medicaid programs and nonprofit bodies, these detectives cast a wary eye on published studies in medical journals, once considered an unimpeachable source. They search for subtle aspects of clinical-trial design that might show the drugs are not all they’re cracked up to be.

“You could be duped,” says Siri Childs, who oversees pharmacy policy for the Washington state Medicaid program. “We know now that just because it’s published in a medical journal, that doesn’t assure its quality.”

The Cochrane Collaboration, a nonprofit that analyzes the quality of studies and collects the ones it considers good into broader analyses, has a volunteer corps of about 7,500 reviewers, mostly doctors and academics. That’s up from about 2,800 five years ago. Another player is the Drug Effectiveness Review Project, an effort by an Oregon nonprofit. It issues reports summarizing all the studies in a particular treatment area and often criticizes individual studies for failings such as inadequate controls and high dropout rates.

Some journals are trying themselves to help readers discover marketing messages slipped in amid the scientific data. Last year BMJ, a British journal, published a piece called “Users’ guide to detecting misleading claims in clinical research reports,” which came with a picture of a reader dumping salt on a medical journal. One piece of advice: Beware when the authors break out one subgroup of patients and claim benefits from the treatment that weren’t evident in the whole group.

Dr. Kubota, a 26-year Kaiser veteran who holds a doctor of pharmacy degree from the University of Southern California, is based in the industrial city of Downey, southeast of Los Angeles, across the street from an abandoned movie set. Kaiser tries hard to keep her and her colleagues away from the influence of the companies whose products they evaluate. Before meeting with Dr. Kubota, a representative of a drug company must fill out a form indicating who will be coming, what they plan to discuss and why the information can’t be relayed in written form. No gift pens, mugs or other trinkets are allowed. Dr. Kubota’s business card doesn’t show her direct phone number.

When Dr. Kubota started her current job in 1997, she says she “would just read the abstract,” the summary at the beginning of a study. “I guess I was naive,” she says. “You kind of assume everything is there for you in the abstract.” Today, she quickly homes in on details that aren’t mentioned in the abstract and generates a 6-inch stack of papers studded with Post-it notes for each drug.

When she reviewed Adderall, a stimulant now marketed by Shire Pharmaceuticals Group PLC to treat attention deficit hyperactivity disorder, she noted that one of the major trials included only people who had responded well to Ritalin, another ADHD drug. She thought the move likely improved the results. Dr. Kubota recommended leaving Adderall off Kaiser’s formulary. The physician committees partially overruled her, putting Adderall on the Northern and Southern California formularies but only for patients who failed to respond to another stimulant. Adderall later was added to the preferred list as a first-line treatment after a once-daily formulation went on the market.

A spokesman for Shire, Matt Cabrey, said that the designers of the trial, which was conducted when Adderall belonged to another company, felt that for ethical reasons they should give the drug to people with a “reasonable anticipated reaction.” James Swanson, the lead author of the article that described the trial’s results, said the trial was designed to show whether Adderall works faster than Ritalin.

M. ALEXANDER OTTO;
The News Tribune
September 13th, 2005

At a time when millions of children and adults are taking drugs for Attention Deficit Hyperactivity Disorder, the most comprehensive scientific analysis of the drugs to date has found little evidence that they are safe, that one drug is more effective than another or that they help school performance.

The 27 drugs studied included Adderall, Concerta, Strattera, Ritalin, Focalin, Cylert, Provigil, and others that, in some households, are well-known for their sometimes calming affects.

The 731-page report was done by the Drug Effectiveness Review Project, based at Oregon State University. The group analyzed 2,287 studies – virtually every investigation ever done on ADHD drugs anywhere in the world – to reach its conclusions

They found:

• “No evidence on long-term safety of drugs used to treat ADHD in young children” or adolescents.

• “Good quality evidence … is lacking” that ADHD drugs improve “global academic performance, consequences of risky behaviors, social achievements” and other measures.

• Safety evidence is of “poor quality,” including research into the possibility that some ADHD drugs could stunt growth, one of the greatest concerns of parents.

• Evidence that ADHD drugs help adults “is not compelling,” nor is evidence that one drug “is more tolerable than another.”

• The way the drugs work is, in most cases, not well understood.

The findings do not mean ADHD drugs are unsafe or unhelpful, just that sound scientific proof is lacking.

The Pharmaceutical Research and Manufacturers of America, the Washington, D.C.-based drug industry lobby group, had no comment on the report, but its senior vice president, Ken Johnson, said the benefits of most drugs “clearly outweigh the risks.”

ADHD is suspected when people have a harder time than others their ages paying attention, sitting still or controlling impulses. To be diagnosed, those tendencies must interfere with work, school or other activities.

Nationally, about 4.4 million kids between 4 and 17 fit the bill. Of those, more than 2.5 million take ADHD drugs. Up to 8 percent of kids in Washington state have been diagnosed with the condition.

The Drug Effectiveness Review Project was formed in 2003 to give consumers and state insurance plans trustworthy information about pharmaceuticals.

Industry studies, which researchers have shown sometimes are rigged for favorable outcomes, don’t give the confidence “many of us would like to decide whether or not we should be using a given medication,” said the project’s deputy director, Mark Gibson.

Complicating efforts to get reliable information, the U.S. Food and Drug Administration doesn’t require companies to compare new drugs to ones on the market. Most times, firms instead compare their wares to sugar pills because it is easier to show benefit and get approved for sale.

The problems leave insurers and patients in the lurch when they need to know what drugs work best. That’s where the Drug Effectiveness Review Project comes in. Its physicians and pharmacists analyze virtually every study on a given class of pharmaceuticals to find the best drugs.

The American Association of Retired Persons and Consumers Union, the publisher of Consumer Reports, use the project’s findings to tell people what drugs give the most for the money. Fourteen states, including Washington, also use its services to decide what drugs to cover for beneficiaries. Those states are the project’s chief funders.

For ADHD, the project analyzed published studies as well as unpublished data from the six leading makers of ADHD drugs. The group rejected 2,107 investigations as unreliable, and reviewed the remaining 180 to find superior drugs.

Instead, it found that evidence to choose one drug over another for safety or effectiveness is “severely limited” by a lack of studies measuring “functional or long-term outcomes.”

The project could not find a “good quality” study that tested the drugs against each other. It also could not find comparative evidence to determine which ADHD drugs are less likely to cause tics, seizures and heart and liver problems.

That evidence is needed. Canadian authorities have recently warned against using Adderall Extended Release in patients with heart problems. Cylert and Strattera have been linked to liver damage, the report said.

Until better research is done, the findings mean that choosing the right ADHD drug is largely a matter of trial and error. They also suggest some people might do as well or better on cheap generic Ritalin, sold by its scientific name methylphenidate, instead of far more expensive, newer options such as Concerta and Adderall.

In fact, in the few instances where the Oregon group could draw conclusions, it found Concerta “did not show overall difference in outcomes” compared to generic Ritalin, and proof that Adderall is better “lacking.” What little evidence there is comparing another newer expensive drug, Strattera, to generic Ritalin “suggests a lack of difference in efficacy.”

Gibson cautioned that his project’s latest report is still open for public comment and possible fine-tuning. But the overall results did not surprise Libby Munn, a nurse practitioner at Greater Lakes Mental Healthcare in Lakewood.

“I’ve never been aware of any evidence of any one being better than another,” said Munn, who treats patients for ADHD and other conditions. “That’s true of antidepressants and antipsychotics, too. Once you compare meds for a given disorder, there are often no proven differences.”

Tacoma psychiatrist Dr. Fletcher Taylor, an expert in adult ADHD at Rainier Associates, works with drug companies to develop new products. He said he stands by the effectiveness and safety of the drugs.

Still, he said, Adderall and Concerta are largely equal in their effect, though some people do better on one than another. Their greatest advantage over generic Ritalin is that people take fewer pills during the day.

ADHD DRUG COSTS*

• Methylphenidate (generic Ritalin) $15.69

• Ritalin (brand name): $27.79

• Amphetamine/dextroamphetamine (generic Adderall): $47.09

• Adderall (brand name): $94.49

• Concerta: $103.99

• Strattera: $123.99

• Focalin: $25.99

*Comparisons based on the lowest dose for 30 days.

Source: Walgreens Pharmacy

FIND THE RIGHT DRUG

These Web sites offer help comparing drugs to find what works best:

• The American Association of Retired Persons lets you compare drugs at www.aarp.org/health/comparedrugs/

• Consumers Union, the publishers of Consumer Reports, gives tips on the best drug buys for safety and effect at www.crbestbuydrugs.org/

• The consumer-advocacy group Public Citizen has a solid record of spotting problem drugs, calling, for instance, for the removal of Vioxx in 2001, when few knew there were problems. The group is now worried about the cholesterol pill Crestor. Public Citizen’s drug information site is www.worstpills.org/

• The Oregon State University Drug Effectiveness Review Project is online at www.ohsu.edu/drugeffectiveness/

M. Alexander Otto: 253-597-8616 alex.otto@thenewstribune.com

McNeil Consumer & Specialty Pharmaceuticals, a division of Johnson & Johnson (”J&J”), announced that an agreement with  Cephalon, Inc. to Co-Promote Modafinil for Attention-Deficit/Hyperactivity Disorder (Thursday September 1). McNeil currently manufactures and distributes Concerta for AD/HD.

Modafinil (coated tablet) is a form of Provigil which is used to alleviate excessive sleepiness  (narcolepsy) and other sleep disorders. Cephalaon and McNeil are awaiting U.S. Food and Drug Administration (FDA) approval for the treatment of attention- deficit/hyperactivity disorder (ADHD) in children and adolescents.

By combining sales forces totaling more than 700 sales reps between the two companies and by marketing heavily, the agreement may produce heightened sales figures for both companies in a competitive multi-billion dollar market. Cephalon will pay McNeil commission fees calculated as a percentage of annual net sales of Modafinil during the term of the agreement according to their press release.

Look for Shire Pharmaceuticals to market a new drug ostensibly in the same manner as J&J to compete.

In J&J’s press release they say that “Our company has extensive experience with ADHD and the pediatric medical community,” said Colin F. Watts, president, McNeil Consumer & Specialty Pharmaceuticals, a subsidiary of Johnson & Johnson. “We are excited about the prospect of collaborating with Cephalon on this new ADHD therapy.”

The most frequently reported adverse events in clinical trials with PROVIGIL were headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness and upset stomach.

It has always been a concern of mine that ventures like these will reap a large profit without addressing cognitive, behavioral, and social needs of the end user. The public’s current perception is that using these medications will indeed ‘fix’ their broken child. Unfortunately, and according to the National Institutes of Health, more than medication is needed to address the full needs of AD/HD children. So, as long as pharmaceutical companies keep marketing in a manner which encourages the public’s ‘fix’ perception, we’ll continue to have kids who historically remove themselves from medication whenever they can (usually upon emancipation) and carry their AD/HD into adulthood with no compensatory skills.

Bloomberg reports  Shire Says Canada Allows Sale of Adderall XR Again  after appealing Health Canada’s decision to pull Adderall XR from Canadian shelves.

h Canada’s decision was based on Adderall XR’s link to 20 deaths.

Bloomberg cites that “Adderall XR, used to treat attention deficit hyperactivity disorder or ADHD, will return Aug. 26, the Basingstoke, England- based company said today in an e-mailed statement. The medicine was taken from the market Feb. 9 at the request of Health Canada.

Shares of Shire fell 10 percent the day after the removal in Canada, which only accounted for $10 million of the product’s $606.7 million in 2004 sales. Adderall XR, which has about 25 percent of the hyperactivity market, is also facing patent challenges from companies including Barr Pharmaceuticals Inc. and Impax Laboratories Inc.”

Shire is the UK’s third largest pharmaceutical company.

ADHD haunts children into adulthood, study shows

Psychological Association published research from Dr. Mariellen Fischer, a psychologist with the Medical College of Wisconsin. Her study was co-authored by Dr. Russell Barkley. The results of her 13 year study show that if AD/HD is left untreated in childhood, children will carry their disorder into adulthood.

For thirteen years they monitored 147 children with ADHD by age 7, comparing them with 76 neighbor children who didn’t have the disorder. About one third dropped out of high school. This seemed significantly high as none of the neighbor children dropped out. Leaving school is quite likely due to the public school system’s inability to accommodate the needs of ADHD students as well as ADHD student inability to learn coping skills which are seldom taught in school or at home.

Interesting data about adults with AD/HD in this study:

• They are more likely than their peers to get fired
• They are more likely to shun birth control and become parents by age 21
• They are more likely to have higher credit card debt and fewer saving
• They took medication for AD/HD as children, but few were being treated by their early 20s
• They are more likely to start having sex a year earlier than classmates
• 1 out of 3 had become parents by their early 20s vs. 1 in 25 of the classmates
• They had less than half the savings of young adults they had grown up with and more debt

Dr. Fischer indicated that many children maintain their disorder into adulthood. The article is not clear whether this data was relevant to treated or untreated ADHD. However, clinical data suggests that perhaps 60% of ADHD children will carry their disorder into adulthood. This may be a conservative estimate.

While the data are compelling, the study is too small to conclude that ADHD alone causes these ill effects.

From the Kansas City Star by DIANE STAFFORD:

ADHD SUFFERERS FIND THEIR NICHE: Adults with Attention Deficit Hyperactivity Disorder Do Well on Deadline and Love a Challenge?

Can you say clueless? Stafford interviews Dr. William Dodson, MD who spoke to about 50 Hallmark Cards employees. His recommendation? If you want an employee who performs best on deadline, hire someone who has trouble staying on task. Dodson apparently specializes in treating with AD/HD. He said that adults with the neuropsychiatric condition generally respond well to urgency and fast pace. This seems true, meeting deadlines? That’s one of the greatest problems for adult AD/HD people.

“Workers with ADD need to be challenged or feel competitive,’’ Dodson generalized. “They like the new, the novel, the fleeting. They need ADD-friendly jobs – not accounting.’’

Sure they do. They are great in marketing. But don’t rely on them to get a job done on time. I’ve worked with many AD/HD adults. They’ll accept 20 jobs and finish none of them. Dodson truly seems clueless here.

Stafford also cites Blythe Gross, who has a doctoral degree in organizational psychology, also specializes in ADD treatment. After working with or interviewing hundreds of adult ADD patients, Gross wrote Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder. Gross has been in the trenches with hundreds of AD/HD adults. She’s much more realistic in her perspective. She indicates that adult AD/HD “symptoms can range from an inability to get started on a task, to an inability to follow through on a task, to perfectionism that makes a project drag on forever because it’s never good enough.” This statement is the antithesis of Dodson’s.

I’d go with Gross and recommend her book, Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder. With so many ‘experts’ on this subject, someone has to cry ‘baloney’ when nonsense like Dodson’s is put to press.