ADHD medication associated with reduced risk for motor vehicle crashes

In a study of more than 2.3 million patients in the United States with attention-deficit/hyperactivity disorder (ADHD), rates of motor vehicle crashes (MVCs) were lower when they had received their medication, according to a new article published by JAMA Psychiatry.

About 1.25 million people worldwide die annually because of MVCs. ADHD is a prevalent neurodevelopmental disorder with symptoms that include poor sustained attention, impaired impulse control and hyperactivity. ADHD affects 5 percent to 7 percent of children and adolescent and for many people it persists into adulthood. Prior studies have suggested people with ADHD are more likely to experience MVCs. Pharmacotherapy is a first-line treatment for the condition and rates of ADHD medication prescribing have increased over the last decade in the United States and in other countries.

Zheng Chang, Ph.D., M.Sc., of the Karolinska Institutet, Stockholm, Sweden, and coauthors identified more than 2.3 million U.S. patients with ADHD between 2005 and 2014 from commercial health insurance claims and identified emergency department visits for MVCs. Analyses compared the risk of MVCs during months when patients received their medication with the risk of MVCs during months when they did not.

Among the more than 2.3 million patients with ADHD (average age 32.5), 83.9 percent (more than 1.9 million) received at least one prescription for ADHD medication during the follow-up. There were 11,224 patients (0.5 percent) who had at least one emergency department visit for an MVC.

Patients with ADHD had a higher risk of an MVC than a control group of people who didn’t have ADHD or ADHD medication use. The use of medication in patients with ADHD was associated with reduced risk for MVC in both male and female patients, according to the results.

“These findings call attention to a prevalent and preventable cause of mortality and morbidity among patients with ADHD. If replicated, our results should be considered along with other potential benefits and harms associated with ADHD medication use,” the article concludes.

Limitations of the study include that it cannot prove causality because it is an observational study. Medication use also was measured by monthly filled prescriptions. Also, the study used emergency department visits due to MVCs as its main outcome so some MVCs that did not require medical services (for example less severe crashes or some fatal ones) were not included in the study.

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Materials provided by The JAMA Network Journals. Note: Content may be edited for style and length.

Antidepressant use in early pregnancy does not increase autism, ADHD risk in kids

A study led by Indiana University suggests that mothers’ use of antidepressants during early pregnancy does not increase the risk of their children developing autism or attention deficit hyperactivity disorder, conditions previously associated with these medications.

The research, reported today in the Journal of the American Medical Association, found significant evidence for only a slight increase in risk for premature birth in the infants of mothers who used antidepressants during the first trimester of pregnancy.

After controlling for multiple other risk factors, the researchers did not find any increased risk of autism, ADHD or reduced fetal growth among exposed offspring. The risk for premature birth was about 1.3 times higher for exposed offspring compared to unexposed offspring.

“To our knowledge, this is one of the strongest studies to show that exposure to antidepressants during early pregnancy is not associated with autism, ADHD or poor fetal growth when taking into account the factors that lead to medication use in the first place,” said Brian D’Onofrio, professor in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences, who led the study.

“Balancing the risks and benefits of using antidepressants during pregnancy is an extremely difficult decision that every woman should make in consultation with her doctor,” he said. “However, this study suggests use of these medications while pregnant may be safer than previously thought.”

The analysis, conducted in collaboration with researchers at Karolinska Institute in Sweden and Harvard T.H. Chan School of Public Health, drew upon data on all live births in Sweden from 1996 to 2012. It also incorporated data reporting the country’s antidepressant prescriptions in adults, autism and ADHD diagnoses in children, genetic relationships between parents and children, parents’ age and education levels, and other factors.

With over 1.5 million infants, the study comprises one of the largest and most comprehensive populations ever analyzed to understand the impact of antidepressant use during pregnancy.

The increased risk for premature birth was found after controlling for other factors that affect health, such as a mother’s age at childbearing, in siblings whose mothers used antidepressants during one pregnancy but not during another pregnancy.

“The ability to compare siblings who were differentially exposed to antidepressants in pregnancy is a major strength of this study,” D’Onofrio said. “Most analyses rely upon statistical matching to control for differences in factors such as age, race and socioeconomic status. But it’s difficult to know if you’ve made a perfect match because you can’t be certain you have all the relevant measures to control for these differences.”

When comparing unrelated children and controlling for related risk factors, the researchers found a slightly higher risk for all four conditions: 1.4 times higher odds for premature birth, 1.1 times higher odds for low fetal growth and 1.6 times higher risk for autism and ADHD.

In an uncontrolled analysis — which did not take these factors into account — antidepressant use in early pregnancy was associated with 1.5 times higher odds for premature birth, 1.2 times higher odds for fetal growth, 2.0 times higher risk for autism and 2.2 times increased risk for ADHD.

The majority of the antidepressants examined in the study — 82 percent — were selective serotonin reuptake inhibitors, or SSRIs, the most common type of antidepressants. Commonly used SSRIs include fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa).

In addition to the use of these medications during early pregnancy, the study looked at concurrent antidepressant use in fathers, as well as mothers’ use of antidepressants before but not during pregnancy.

These uses were associated with increased risk for autism, ADHD and poor fetal growth — providing evidence that family factors, such as genetics or environmental factors, influence these outcomes, as opposed to antidepressant use during pregnancy.

“The additional comparisons provide further evidence that other factors — not first-trimester exposure to antidepressants — explain why women who took these medications during early pregnancy were more likely to have offspring with these pregnancy and neurodevelopmental problems,” D’Onofrio said.

Benefits of long-term use of ADHD medications questioned

In a study that followed more than 500 children with attention-deficit/hyperactivity disorder (ADHD) into adulthood, extended use of stimulant medication was linked with suppressed adult height but not with reduced symptoms of ADHD.

The findings suggest that short-term treatment of ADHD with stimulant medication is well justified by benefits that outweigh costs, but long-term treatment may be associated with growth-related costs that may not be balanced by symptom-related benefits.

“The most recently published guidelines (American Academy of Pediatrics, 2011) recommend expanding the diagnosis and treatment beyond school-aged children and using stimulant medication as first-line treatment for adolescents as well as school-aged children,” wrote the authors of The Journal of Child Psychology and Psychiatry study. “Since this would increase the average duration of treatment and cumulative ME dose of medication in some individuals, the findings suggest growth-related costs may increase.”

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Harnessing ADHD for business success

The symptoms of ADHD foster important traits associated with entrepreneurship. That conclusion was reached in a study conducted by an international team of economists, who found that entrepreneurs with ADHD embrace new experiences and demonstrate passion and persistence. Their intuitive decision making in situations involving uncertainty was seen by the researchers as a reason for reassessing existing economic models.

Poor concentration, hyperactivity, a lack of self-regulation — at first glance, the symptoms of ADHD would seem to lower performance. On the other hand, successful entrepreneurs are frequently reported to have ADHD. “We noticed sometime that some symptoms of ADHD resemble behaviors commonly associated with entrepreneurship — in a positive sense,” says Prof. Holger Patzelt of the Entrepreneurship Research Institute at the Technical University of Munich (TUM).

In cooperation with Johan Wiklund, professor at the Syracuse University, and Dimo Dimov, professor at the University of Bath, Patzelt asked 14 self-employed people with ADHD about their diagnoses, their careers and their personal background. The study shows that important symptoms of ADHD had a decisive impact on the subjects’ decision to go into business and on their entrepreneurial approach:

Impulsiveness

People with ADHD are quick to lose their patience. Several of the participants in the study cited boredom in their previous jobs as a reason for setting up their own company, where they could follow up on their own ideas whenever they wanted. One woman reported that she had introduced 250 new products within just a few years. In situations that would be highly stressful for others, such as difficult meetings with important customers, many of those surveyed felt at ease and stimulated. “Their impulsiveness, resulting from ADHD, gives them the advantage of being able to act under unforeseen circumstances without falling into anxiety and paralysis,” says Patzelt.

Most of those surveyed act without thinking, even when making far-reaching decisions. One of the entrepreneurs described buying a friend’s company over lunch. He only learned of the friend’s plan to retire during the meal. Other participants reported that they make investments with no strategy and commit large sums of money to projects with highly uncertain outcomes. Some entrepreneurs believe that this kind of quick decision making is the only way to be productive, and are willing to live with setbacks as a result. Some have difficulty coping with structured activities.

“A marked willingness to try out new things and take risks is an important entrepreneurial trait,” says Patzelt. However, the respondents’ impulsive actions led to success only when they focused on activities essential to the development of their businesses. One disadvantage of their impulsiveness was mentioned by all of them: problems with routine tasks such as bookkeeping.

Hyperfocus

When people with ADHD have a strong interest in a task, they display an unusual level of concentration known as hyperfocus. One entrepreneur reported that he often becomes completely absorbed in crafting customer solutions. Another constantly keeps up with the new technologies in his industry to the point that he is now much in demand as an expert. “With their passion and persistence, and the expertise they acquire as a result, entrepreneurs can gain a substantial competitive advantage,” says Patzelt.

High activity level

Many of the entrepreneurs in the study work day and night without taking time off. That is due to the their hyperfocus, but also to the physical restlessness associated with ADHD. The entrepreneurs use this to fuel their workload. As their energy levels are not constant throughout the day, an advantage in running their own businesses is that they can set their own hours.

“Logic of people with ADHD symptoms is better attuned to entrepreneurial action.”

Summing up the results, Patzelt says, “ADHD was a key factor in their decision to go into business for themselves and decisively impacted important entrepreneurial traits: risk taking, passion, persistence and time commitment. Impulsiveness has a special role to play. For People with ADHD it is okay to make intuitive decisions even if the results are bad.”

Although one third of those surveyed failed in their business ventures or had little success, Patzelt sees the results of the study as vital for prompting a reassessment of prevailing assumptions in entrepreneurship research: “The way we evaluate entrepreneurial decisions is largely based on rationality and good outcomes. In view of the multitude of uncertainties, however, can such decisions always be rational? People with ADHD show us a different logic that is perhaps better suited to entrepreneurship.”

Household chaos makes bringing up children with ADHD more difficult

Researchers often observe inadequate parenting, a negative emotional climate and household chaos in families of children with ADHD. A research group at Goethe University Frankfurt and the universities of Bremen, Heidelberg, Tübingen and Kiel has now explored how these factors interrelate. The result is astounding.

“We assumed that the parents of children with ADHD found it difficult to maintain a structured family life and daily routines due to their children’s symptoms. In turn, household chaos has an adverse effect on emotional climate and parents’ behaviour,” explains Dr. Andrea Wirth, research associate at the Department of Educational Psychology of Goethe University Frankfurt.

The data of 84 children aged between 7 and 13 years was included in the study, of which 31 children were assigned to the ADHD group and 53 to the control group. Parental behaviour was assessed using a standardized questionnaire, which asked to what extent the parents looked after their children, praised or criticized them, how consistent they were in their parenting and whether they resorted to physical punishment. In order to document the emotional climate in the family, the psychologists asked one of the parents to talk about his or her child for five minutes and describe the child’s personality as well as his or her relationship to it. Household chaos was also recorded using a standardized test.

As expected, parenting by the parents of children with ADHD was less adequate, they criticized their children more often und reported more household chaos than the parents of the children in the control group. However and to the psychologists’ surprise, the parents of children with ADHD rated their relationship to their children more positively than the parents of children without ADHD. The researchers presume that a possible reason, amongst others, might be that some of the families involved were already undergoing therapy, since improvements in the parent-child relationship have already been proven both for interventions with medication as well as those based on behavioural therapy.

The exact relationship between the three constructs was examined with the help of statistical analyses (mediation analyses). “Household chaos seems to be some kind of mechanism through which the symptoms of children with ADHD have a negative impact on their parents’ behaviour towards them,” says Andrea Wirth. However, a chaotic environment does not appear to affect the emotional climate in the family. This contradicts earlier studies which had found a link between inadequate parenting and emotional climate. “A highly chaotic and unstructured household, to which the children’s ADHD symptoms are a contributing factor, makes it difficult for their parents to be authoritative in their upbringing. At the same time, it can be assumed that the parents — despite the prevailing chaos — are fond of their children, speak positively about them and enjoy spending time with them.”

The research group at the LOEWE centre IDeA, of which Andrea Wirth is a member, is drawing up recommendations for future research aimed at designing parent training which can help parents to plan family life better, establish fixed routines and rituals, and organize daily life more efficiently. These may include, for example, turning off the radio and the television when the child is doing its homework, leaving the room to make phone calls, only receiving guests at certain times and letting the child do its homework alone in a quiet room.

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Materials provided by Goethe-Universität Frankfurt am Main. Note: Content may be edited for style and length.

 

Mediterranean diet linked to a lower risk of attention-deficit/hyperactivity disorder

Dietary patterns of the Mediterranean diet can be related to a lower diagnose of the attention-deficit/hyperactivity disorder (ADHD), according to a study published in the journal Pediatrics, led by María Izquierdo Pulido, Professor at the Faculty of Pharmacy and Food Sciences of the University of Barcelona, and José Ángel Alda, Head of the area of Psychiatry at Sant Joan de Déu Hospital (Barcelona).

The study, which is the first scientific work dealing with the relation between the Mediterranean diet and ADHD in children and adolescents, evokes that some unhealthy eating habits could play a role in the development of this psychiatric disorder. However, new researchers are necessary to establish the causality between nutrient-poor eating habits and ADHD, according to the authors. Researchers Alejandra Ríos Hernández and Andreu Farran Codina, from the Faculty of Pharmacy and Food Sciences of the UB, and Estrella Ferreira García, from the Faculty of Psychology of the same University, have signed the study too.

One of the most common mental disorders among children and adolescents

The attention-deficit/hyperactivity disorder belongs to the field of neurobiology, and affects around 3,4% of children and adolescents worldwide. This is one of the most common mental disorders among children and teenagers, and its consequences can last until adulthood. The main symptoms are hyperactivity, impulsiveness and attention-deficit, which show more intensely in children of the same age who don’t suffer from this illness. So far, the most efficient intervention for ADHD is a combination of the psychological and pharmacological treatments with the intervention of an educational psychologist.

The mechanisms that link a low-quality diet and ADHD are still unknown. Previous scientific studies have associated some dietary patterns (diets with processed food and low in fruit and vegetables) with ADHD. However, it is known that an unbalanced dietary pattern can lead to deficiencies in essential nutrients (iron, zinc, magnesium, omega-3 fatty acids, etc.) for the cognitive and physical growth and they seem to play an essential role in the etiology of ADHD.

A total of 120 children and adolescents (60 diagnosed with ADHD and 60 controls) were studied in this study, which has been financially supported by the Instituto de Salud Carlos III (Institute of Health Carlos III). According to María Izquierdo Pulido, member of the Biomedical Research Center Red-Fisiopatología de la Obsidad y Nutrición (CIBERobn) of the Instituto Salud Carlos III “this new research doesn’t establish a cause-effect relation between dietary patterns and ADHD, but it can help determining specific dietary strategies to improve the quality of life for both the affected patients and their families.”

A vicious circle: impulsiveness, unhealthy diets and ADHD

The relation between an unhealthy diet and ADHD could also be an example of reverse causation. “We don’t know if these kids suffer from ADHD due an unhealthy diet -says José Ángel Alda, psychiatrist at Sant Joan de Déu University Hospital- or if the disorder makes them to eat an excess of fat and sugar to balance their impulsiveness or emotional distress. We believe this is a vicious circle: the impulsiveness of children with ADHD makes them to eat unhealthily; therefore they don’t eat the nutrients they need and it all worsens their symptoms.

Mediterranean diet: nutrition and health

Mediterranean diet, rich in fruits, vegetables and healthy fats, provides most of the nutrients in the right proportion. The new study doesn’t state that the Mediterranean diet could be a protection factor against ADHDF but it indicates that children and adolescents need healthy diets, since this is a moment when their bodies need the best nutrients to grow properly and reach a healthy life during adulthood. The authors of the study believe more studies are needed to determine if a change in dietary habits towards a healthy diet -such as the Mediterranean one- could serve to reverse or improve ADHD symptoms.

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Materials provided by Universidad de Barcelona. Note: Content may be edited for style and length.