Hyperactivity computer games link

Hyperactive children spend much longer playing computer games and watching TV than healthy children, researchers say.


They asked parents and teachers about the habits of children with attention-deficit hyperactivity disorder



Children with ADHD were more likely to play games based on fighting.



Researchers told the Faculty of Child and Adolescent Psychiatry conference in York children with ADHD may develop unnatural patterns of media use.



Researchers analysed 24 boys between eight and 12 with a clinical diagnosis of ADHD, a condition where children have problems of paying attention and impulsive behaviour.



Another group of children recruited from a youth centre and an asthma out-patients clinic.



All the children were interviewed and questionnaires were given to parents and teachers.



Sociability



Children with ADHD spent 11.3 hours a week playing computer games, double the time spent by the other group.



A third of those with ADHD preferred fighting-type video games while 59% preferred cartoons.



In the other group, one in 10 enjoyed fighting games and 40% liked cartoons.



Children with hyperactivity disorders were also found to watch television and videos for an average of 44.1 hours a week, compared with 36.4 hours a week for the other group.



Teachers reported poor social abilities, rather than hyperactivity, were linked to computer games.



They suggest children with ADHD may be prone to abnormal use of media which affects their social skills and how they respond to treatment.



Dr Justin Williams from the Department of Child Health at the University of Aberdeen, told BBC News Online: 'The children who spend longest playing computer games seem to be the ones who are the least sociable.



'They were the least socially able and the most technically able, which leads them to prefer computer games to social interaction.'



He said children with behavioural problems tended to prefer TV, particularly cartoons.



'It's very important that we don't forget about things like the family situation, where kids can feel alienated in their bedrooms watching TV.



'It's important for parents to be fully engaged in what their children are getting from their media diet.'



He added: 'It's possible to get a lot out of TV, and there are lots of good computer games to play.



'Parents should watch TV with their children, join in, rather than children being isolated.'

12-Month Study Demonstrated Tolerability And Efficacy Of Daytrana For ADHD

Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ) announced that DAYTRANA™ (methylphenidate transdermal system), the first and only non-oral medication approved for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 to 12 years, provided significant improvement in symptom control and tolerability, according to results of a 12-month open-label study presented at the American Psychiatric Association (APA) annual meeting in San Diego.



"We documented that children with ADHD experienced effective ADHD treatment with use of DAYTRANA for 12 months, sustaining the improvements in their ability to maintain focus and concentration," said investigator Oscar Bukstein, M.D., M.P.H ,Associate Professor of Psychiatry, University of Pittsburgh School of Medicine. "More importantly, Daytrana maintained a favorable safety profile, meeting the study's primary endpoint, and demonstrating an incidence of adverse events that is consistent with previous trials and other stimulants in this class."



Shire's DAYTRANA is the first and only patch medication approved by the U.S. Food and Drug Administration (FDA) to treat the symptoms of ADHD in children aged 6 to 12 years. DAYTRANA is available in four dosage strengths - 10 mg, 15 mg, 20 mg and 30 mg - all designed for once-daily use. When worn for the recommended nine hours, efficacy has been demonstrated from the first time point measured (two hours) through the 12-hour time point. Because DAYTRANA is a patch, physicians may recommend that patients shorten the wear time if shorter duration of effect is desired or to help manage the potential for late-day side effects.



Bukstein added, "DAYTRANA's novel patch delivery system offers physicians and parents of children with ADHD a convenient, non-oral option to individualize ADHD treatment to meet their children's changing schedules."



This study was an open-label extension of four clinical trials. Those children not optimized on DAYTRANA from the previous trials entered a four-week stepwise DAYTRANA dose-optimization phase. All children then entered an 11-month DAYTRANA dose maintenance phase. DAYTRANA was applied each morning to the hip area and worn for approximately nine hours daily. During the dose-optimization phase, titration to a higher dose was permitted after a minimum of three days. Tapering to a lower dose was permitted throughout the dose optimization period and dose adjustments were also permitted during the dose maintenance period.



All of the children in this open-label, flexible-dose trial participated in one of four trials in which the children previously received DAYTRANA, OROS methylphenidate or a placebo. All of the children previously used DAYTRANA for at least a minimum of three days and a maximum of 37 months. While this study evaluated the safety and effectiveness of DAYTRANA for up to 12 months, DAYTRANA has not been studied versus placebo for longer than 7 weeks. Physicians, who prescribe DAYTRANA for long-term use, should periodically re-evaluate patients to assess the usefulness of DAYTRANA for the individual patient.
















Children were diagnosed with ADHD using DSM-IV-TR criteria. Researchers assessed safety and tolerability, through physical exams, skin evaluations, laboratory tests, and monitoring of vital signs, including ECGs throughout the study.



The ADHD-RS-IV assesses 18 individual symptoms of ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), a publication of the American Psychiatric Association.



Of the 327 children enrolled, 157 completed the study. Investigators used data from the intent-to-treat population (324 children) for the efficacy evaluations. Of the safety population (326 children) 7 percent withdrew due to skin irritation at the patch application site, and 9 percent withdrew due to adverse events. The highest percentage of discontinuations were due to withdrawn consent or lost to follow-up (12 percent and 11 percent, respectively).



The most commonly reported treatment-emergent adverse events reported throughout the study (?‰?10 percent) included decreased appetite, headache, upper respiratory tract infection, cough, pyrexia and decreased weight. Most (98 percent) adverse events were mild or moderate in severity and consistent with known effects of methylphenidate. Three serious adverse events were reported and all were considered unrelated to DAYTRANA use.



DAYTRANA Demonstrated Significant Improvements in ADHD-RS-IV, CGI-I and PGA Scores



In the study, the children experienced a significant overall mean reduction in their ADHD Rating Scale-IV (ADHD-RS-IV) total score. When the study began, the mean total score on the ADHD-RS-IV was 25.0. When using Daytrana, the mean ADHD-RS-IV total scores declined, with children averaging 15.4 at study end. The overall mean change in ADHD-RS-IV total score from study start to end was -9.3 (+/- 16.29) and was statistically significant (p

Simplicity Of Working Memory Study Could Help With ADD And Other Attention Difficulties

A mind is a terrible thing to waste, but humans may have even less to work with than previously thought. University of Missouri researchers found that the average person can keep just three or four things in their "working memory" or conscious mind at one time. This finding may lead to better ways to assess and help people with attention-deficit and focus difficulties, improve classroom performance and enhance test scores.



"Most people believe the human mind is incredibly complex," said Jeff Rouder, associate professor of psychology in the MU College of Arts and Science. "We were able to use a relatively simple experiment and look at how many objects can be maintained in the human conscious mind at any one time. We found that every person has the capacity to hold a certain number of objects in his or her mind. Working memory is like the number of memory registers in a computer. Every object takes one register and each individual has a fixed number of registers. Limits in working memory are important because working memory is the mental process of holding information in a short-term, readily accessible, easily manipulated form where it can be combined, rearranged and stored more productively."



"We know that this kind of memory is really important in daily life," said co-author Nelson Cowan, psychology professor at Mizzou and an expert in working memory theory. "If a person is trying to do a math problem, there are partial results to keep in mind as that person solves the problem. When people are going to do any tasks in the house - like remembering the location of keys, turning off the stove, combining ingredients for a cake or recalling a phone number - they use working memory to keep in mind all the different aspects of the tasks."



Rouder said that to remember a series of items, people will use "chunking," or grouping, to put together different items. It can be difficult for someone to remember nine random letters. But if that same person is asked to remember nine letters organized in acronyms, IBM-CIA-FBI, for example, the person only has to use three slots in working memory. The difficulty in measuring working memory capacity is assuring that each item presented cannot be grouped together with others to form a larger chunk.



The researchers conducted a simple experiment involving an array of small, scattered, different-colored squares, to test their theory of working memory. The participant saw two, five or eight squares in the array, depending on the trial. The array was then "wiped out" by another display consisting of the same squares, minus the colors. Finally, the participant was shown a single color in one location and was asked to indicate whether the color in that spot had changed from the original array.



"How an individual does this test depends on working memory," Cowan said. "The results indicating that people have a fixed capacity provide evidence of simplicity in the mind. Many other theorists have suggested that the amount of working memory is circumstance-dependent, depends on a particular test, that there is nothing general we can get out of it, and that it's complex. We found the mind to be less complex in this case and that should be of great use in the future."



Working memory is closely related to attention because it requires attention to hold a number of items in mind at once. People with high working memory capacity have more focus. Those with a lower attention span are more easily distracted. This fact may help researchers help people with attention deficit disorders.



The researchers emphasized that the unique result of their study was that "the data were explained to surprising accuracy by a very simple mental model in which participants either used a register of working memory or, if all registers were full, guessed randomly."







Rouder and Cowan's study, "An assessment of fixed-capacity models of visual working memory," was published this month in the Proceedings of the National Academy of Sciences. Other members of the research team are Richard Morey, Christopher Zwilling, Candice Morey and Michael Pratte.



Source: Bryan E. Jones


University of Missouri-Columbia

Investigational Nonstimulant Guanfacine XR Significantly Improved Child, Adolescent ADHD Symptoms

Shire plc (LSE: SHP, NASDAQ: SHPGY, TSX: SHQ) has announced the positive results of studies of the investigational medication guanfacine extended release (GXR, previously referred to as SPD503), a selective alpha-2A-adrenoceptor agonist. These data from two short-term phase III placebo-controlled studies and two long-term phase III open-label studies, presented at the 2007 American Psychiatric Association (APA) annual meeting, demonstrated that GXR significantly improved all core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children aged 6 to 17 years.



"Guanfacine extended release, the first selective alpha-2A-adrenoceptor agonist to be tested in well-controlled studies as a treatment for ADHD, holds potential based on the significant improvements in ADHD symptoms documented in four studies of this investigational drug," stated co-author Joseph Biederman, M.D., lead investigator, chief of clinical and research program in pediatric psychopharmacology at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School. "Moreover, these data presented at this medical conference add evidence that GXR when dosed once daily may continue to control children's ADHD symptoms for up to 24 months."



GXR, a nonstimulant, is not a controlled substance and does not appear to have a mechanism for potential abuse or dependence. Shire submitted a New Drug Application (NDA) for GXR on August 24, 2006, which is currently under FDA review. The NDA provided data on GXR 1 mg to 4 mg taken once daily for the treatment of children and adolescents with ADHD.



GXR Yielded Significant Reductions in ADHD-RS-IV Scores in Two Short-Term Trials



Results from two short-term, double-blind, randomized phase III clinical trials presented at this medical conference, demonstrated that GXR significantly controlled all core symptoms of ADHD, including inattention, hyperactivity and impulsivity in children aged 6 to 17 years previously diagnosed with ADHD, as measured by several standardized tests when compared to placebo treatment.



In the two short-term trials, the primary endpoint was a reduction in ADHD symptoms as measured by the ADHD Rating Scale (ADHD-RS-IV). ADHD-RS-IV is a standardized, validated test for assessing symptoms of ADHD in children and for assessing their response to treatment. This scale, which contains 18 items, is based on the ADHD diagnostic criteria as defined in the APA's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.



In the first trial, 301, investigators compared 2 mg, 3 mg or 4 mg GXR doses to placebo during an eight-week treatment period. The participants randomized to GXR all began at the 1 mg dose. At weekly visits, doses were titrated in 1 mg increments over the first four weeks to achieve the randomized dose. Then, doses were tapered down weekly so that all participants randomized to GXR received the 1 mg dose at week eight.
















Participants achieved overall significant mean reductions from baseline in ADHD-RS-IV total scores by study end, -16.7 points vs. -8.9 for placebo (P

New Study Suggests Pediatric Ritalin Use May Affect Developing Brain

Use of the attention deficit/hyperactivity disorder (ADHD) drug Ritalin by young children may cause long-term changes in the developing brain, suggests a new study of very young rats by a research team at Weill Cornell Medical College in New York City.



The study is among the first to probe the effects of Ritalin (methylphenidate) on the neurochemistry of the developing brain. Between 2 to18 percent of American children are thought to be affected by ADHD, and Ritalin, a stimulant similar to amphetamine and cocaine, remains one of the most prescribed drugs for the behavioral disorder.



"The changes we saw in the brains of treated rats occurred in areas strongly linked to higher executive functioning, addiction and appetite, social relationships and stress. These alterations gradually disappeared over time once the rats no longer received the drug," notes the study's senior author Dr. Teresa Milner, professor of neuroscience at Weill Cornell Medical College.



The findings, specially highlighted in the Journal of Neuroscience suggest that doctors must be very careful in their diagnosis of ADHD before prescribing Ritalin. That's because the brain changes noted in the study might be helpful in battling the disorder but harmful if given to youngsters with healthy brain chemistry, Dr. Milner says.



In the study, week-old male rat pups were given injections of Ritalin twice a day during their more physically active nighttime phase. The rats continued receiving the injections up until they were 35 days old.



"Relative to human lifespan, this would correspond to very early stages of brain development," explains Jason Gray, a graduate student in the Program of Neuroscience and lead author of the study. "That's earlier than the age at which most children now receive Ritalin, although there are clinical studies underway that are testing the drug in 2- and 3-year olds."



The relative doses used were at the very high end of what a human child might be prescribed, Dr. Milner notes. Also, the rats were injected with the drug, rather than fed Ritalin orally, because this method allowed the dose to be metabolized in a way that more closely mimicked its metabolism in humans.



The researchers first looked at behavioral changes in the treated rats. They discovered that -- just as happens in humans -- Ritalin use was linked to a decline in weight. "That correlates with the weight loss sometimes seen in patients," Dr. Milner notes.



And in the "elevated-plus maze" and "open field" tests, rats examined in adulthood three months after discontinuing the drug displayed fewer signs of anxiety compared to untreated rodents. "That was a bit of a surprise because we thought a stimulant might cause the rats to behave in a more anxious manner," Dr. Milner says.
















The researchers also used high-tech methods to track changes in both the chemical neuroanatomy and structure of the treated rats' brains at postnatal day 35, which is roughly equivalent to the adolescent period.



"These brain tissue findings revealed Ritalin-associated changes in four main areas," Dr. Milner says. "First, we noticed alterations in brain chemicals such as catecholamines and norepinephrine in the rats' prefrontal cortex -- a part of the mammalian brain responsible for higher executive thinking and decision-making. There were also significant changes in catecholamine function in the hippocampus, a center for memory and learning."



Treatment-linked alterations were also noted in the striatum -- a brain region known to be key to motor function -- and in the hypothalamus, a center for appetite, arousal and addictive behaviors.



Dr. Milner stressed that, at this point in their research, it's just too early to say whether the changes noted in the Ritalin-exposed brain would be of either benefit or harm to humans.



"One thing to remember is that these young animals had normal, healthy brains," she says. "In ADHD-affected brains -- where the neurochemistry is already somewhat awry or the brain might be developing too fast -- these changes might help 'reset' that balance in a healthy way. On the other hand, in brains without ADHD, Ritalin might have a more negative effect. We just don't know yet."



One thing was clear: 3 months after the rats stopped receiving Ritalin, the animals' neurochemistry largely had resolved back to the pre-treatment state.



"That's encouraging, and supports the notion that this drug therapy may be best used over a relatively short period of time, to be replaced or supplemented with behavioral therapy," Dr. Milner says. "We're concerned about longer-term use. It's unclear from this study whether Ritalin might leave more lasting changes, especially if treatment were to continue for years. In that case, it is possible that chronic use of the drug would alter brain chemistry and behavior well into adulthood."



This work was funded by the U.S. National Institutes of Health.



Co-researchers included Dr. Annelyn Torres-Reveron, Victoria Fanslow, Dr. Carrie Drake, Dr. Mary Ward, Michael Punsoni, Jay Melton, Bojana Zupan, David Menzer and Jackson Rice -- all of Weill Cornell Medical College; Dr. Russell Romeo of The Rockefeller University, New York City; and Dr. Wayne Brake, of Concordia University, Montreal, Canada.


Weill Cornell Medical College


Weill Cornell Medical College -- Cornell University's Medical School located in New York City -- is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer, psychiatry and public health -- and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College -- in its commitment to global health and education -- has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Salzburg, and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the world's first clinical trial for gene therapy for Parkinson's disease, and, most recently, the first indication of bone marrow's critical role in tumor growth.

med.cornell


View drug information on Ritalin LA.

Guidelines Include Strattera as a First-Line ADHD Therapy Option

The American Academy of Child and Adolescent Psychiatry (AACAP), the leading professional organization for child and adolescent psychiatry, today issued guidelines that highlight the importance of accurate diagnosis and appropriate treatment of Attention-Deficit/Hyperactivity Disorder (ADHD).


The guidelines include new recommendations for treatment in which Strattera® (atomoxetine HCl) is a first-line therapy option for ADHD. This marks the first time AACAP has listed a nonstimulant as a first-line therapy option for ADHD.


Strattera works differently than stimulants as it is a norephinephrine reuptake inhibitor. It is the only medication indicated specifically for the treatment of ADHD in children, adolescents and adults. Strattera provides full-day symptom control without insomnia in most children and adolescents.


"Strattera is an excellent means by which to treat this chronic and impairing disorder
effectively and safely," says David Duesenberg, M.D., a member of AACAP, staff psychiatrist at St. John's Mercy Medical Center, and affiliated with St. Louis University. "AACAP's decision to place Strattera as a first-line therapy option will have a positive impact on the lives of many patients and their families who struggle with the disorder."


"Strattera offers a different treatment option and this option has a lot of potential benefits," explained Albert J. Allen, M.D., Ph.D., Lilly Research Laboratories. "The fact that AACAP approved a nonstimulant as a first-line therapy option has shifted the paradigm, helping us to refocus ADHD treatment from a 'one-medication-fits-all' strategy to matching the medications to each patients' needs."


To date, health care providers have written more than four million prescriptions and more than one million patients have taken Strattera.


About ADHD


ADHD affects 3 to 7 percent of school-age children and manifests itself in levels of attention, concentration, activity, distractibility, and impulsivity that are inappropriate to the child's age.1 In addition, 60 percent of children with the disorder carry their symptoms into adulthood.2 Experts estimate 4 percent of adults in the United States, more than 8 million people, have ADHD.3,4


About Strattera


The U.S. Food and Drug Administration approved Strattera on Nov. 26, 2002, for the treatment of ADHD in children, adolescents and adults.


Strattera, a selective norepinephrine reuptake inhibitor, works differently than other FDA-approved treatments for the disorder, all of which are stimulants.

It is not known precisely how Strattera reduces ADHD symptoms, but scientists believe it works by blocking or slowing reabsorption of norepinephrine, a chemical in the brain considered important in regulating attention, impulsivity and activity levels.














This keeps more norepinephrine at work in the spaces between neurons in the brain. Improved efficiency in the norepinephrine system is associated with improvement in symptoms of ADHD (Pliska, 1996).


Strattera should not be taken at the same time as, or within two weeks of taking, a monoamine oxidase inhibitor, or by patients with narrow angle glaucoma. Patients with a history of high or low blood pressure, increased heart rate, or any heart or blood vessel disease should tell their doctor before taking Strattera. Strattera has not been tested in children less than 6 years of age or in geriatric patients. Some children may lose weight when starting treatment with Strattera. As with all ADHD medications, growth should be monitored during treatment.


Most people in clinical studies who experienced side effects were not bothered enough to stop using Strattera. The most common side effects in children and adolescents in medical studies were upset stomach, decreased appetite, nausea and vomiting, dizziness, tiredness and mood swings.

In adults, the most common side effects were constipation, dry mouth, nausea, decreased appetite, dizziness, problems sleeping, sexual side effects, problems urinating and menstrual cramps.
Quick Links for the News Media


For an online media kit for Strattera, please visit
lillymedia/rep_guides/Strattera.html


About Lilly


Lilly, a leading innovation-driven corporation, is developing a growing portfolio of best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers - through medicines and information - for some of the world's most urgent medical needs. More information about Lilly is available at lilly.


For full prescribing information visit strattera.


This press release contains forward-looking statements about the potential of Strattera for the treatment of ADHD and reflects Lilly's current beliefs. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of commercialization. There is also no guarantee that the product will continue to be commercially successful. For further discussion of these and other risks and uncertainties, see Lilly's filings with the United States Securities and Exchange Commission. Lilly undertakes no duty to update forward-looking statements.


References 1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, Washington, D.C., American Psychiatric Association, 2000.


2. Schweitzer JB, et al. Attention-deficit/hyperactivity disorder. Med Clin of North Am. 2001; 85(3):757-777


3. Murphy K, Barkley, RA. J Atten disord. 1996; 1:147-161.


4. United States Census Summary File; 2000


View drug information on Strattera.

Speaking Up For Others - A New Initiative For People With Profound And Multiple Learning Disabilities, UK

National charity for people with learning disabilities, HFT, has teamed up with charity and voluntary agency, Onside Independent Advocacy, to launch a new initiative which will enhance support for people with profound and multiple learning disabilities.


In partnership with Onside Advocacy, HFT is piloting a project for service users and their families at its Clementi Court service, on the outskirts of Evesham, which is designed for people who have profound and multiple physical, and learning disabilities and who require a high level of support.


The objective of the programme is to enable people with complex needs to become more included in their local community and to improve their quality of life.


Onside is spending time with the people at Clementi Court to try and gain an insight and awareness to their feelings and wishes with a view to representing them to those providing services and support.


The organisation is recruiting local volunteers to help carry out this work and to make the project a success.


"Our volunteers are ordinary people of all ages and backgrounds who give their time to support people to ensure their voices are heard and their rights upheld", said Katy Buckle, development worker at Onside. "Advocates are independent and are not involved as professionals, carers or family members. They don't need formal qualifications but they need to be good listeners, open to others' views, non-judgemental, discreet and tolerant."

Onside offers volunteers a short, local training programme as well as mentoring and ongoing support.


Notes


HFT is a registered national charity for adults with a learning disability. Previously known as The Home Farm Trust the charity was re-branded and adopted the more modern name HFT which maintains its links with the past whilst emphasising its development and progression into the future.


HFT provides services for over 1,000 people in supported living, registered care homes, advocacy, supported employment and day services.


The charity also runs a Family Carer Support Service (FCSS) which provides support each year for 4,000 family carers of adults with learning disabilities.

hft.uk


Onside Independent Advocacy


Onside is a registered charity which was established in 1993. Based in Worcester, it works across the county and in Evesham to provide independent advocacy support to people who are vulnerable or disadvantaged as a result of disability, ill health or old are and who are at risk of not having their rights as citizens/human beings upheld and respected.


Onside Independent Advocacy

Is ADHD Properly Diagnosed And Treated In Adults?

An editorial written by Professor Philip Asherson, a leading psychiatrist in adult ADHD (Attention Deficit Hyperactivity Disorder), at the Institute of Psychiatry, King??™s College London strongly recommends that general adult psychiatrists should diagnose ADHD in adults appropriately with stimulant drugs. It is published in the January issue of the British Journal of Psychiatry.


Although ADHD can be effectively treated with stimulant medication, and such treatment is widespread in the young, general adult psychiatry has not yet followed suit in identifying and treating substantial numbers of affected people.


ADHD is a common disorder affecting children and adults, and is a predictor of adult mental health problems. Symptoms include high levels of inattentiveness, impulsiveness and restless over activity, and are regarded as a source of disability in children and adolescents, as well as a risk to adult psychological adjustment.


Young people are entering adult life whilst still receiving medication for ADHD, and adult psychiatrists are needed to take over treatment when symptoms persist. Moreover, some adult patients with ADHD may be misdiagnosed and ineffectively treated for other disorders, such as depression and personality disorder.


Research suggests that between 15% and 65% of children diagnosed with ADHD still have symptoms of the disorder in adulthood. However, many children with ADHD go unrecognised, and may be diagnosed in adulthood for the first time.


A survey of schoolchildren with ADHD in the London Borough of Newham found that although levels of restless activity diminished between the ages of 7 and 17, the 17-year-olds showed a level of hyperactivity similar to that found in a group of normal 7-year-olds.


When the same people were followed up at the age of 26, they were found to have disabilities associated with high levels of psychiatric disorder, which were all the more significant because of increasing demands in adult life for self-organisation and the ability to plan ahead.


Adult behaviours linked to ADHD are associated with the childhood symptoms of motor hyperactivity, attention deficit, unfocused thinking, mood changes, disorganisation and impulsiveness.


They include - at the severe end of the spectrum - feelings of restlessness, difficulty in relaxing, feeling depressed when inactive, lack of concentration on detail, depression or excitability, poor time management, difficulties sustaining relationships and a tendency to make rapid and facile decisions without full analysis of the situation.


Psychiatrists diagnosing ADHD in adults need to be aware of the fact that people with this disorder often show decreased symptoms in a novel situation like a psychiatric evaluation. It is therefore important to base mental state evaluations on a typical week and a variety of normal situations.















Mood instability is very common in adult ADHD, and can lead to diagnoses of depression or personality disorder. Many adults with ADHD also have other problems, such as antisocial personality, alcohol and drug misuse, anxiety disorders and learning difficulties. ADHD in childhood may also lead to the development of antisocial behaviour.


Some symptoms of adult ADHD are similar to those of bipolar disorder, but ADHD tends to show a persisting trait of irritability and volatility, very different from the grandiose and euphoric symptoms of mania and the depression found in bipolar disorder.


Professor Philip Asherson comments: "Adults with untreated ADHD use more healthcare resources because of smoking-related disorders, increased rates of serious accidents, and alcohol and drug misuse. Further research is needed to quantify the contribution of ADHD to psychiatric disorders in adulthood."


Professor Asherson??™s editorial is published in the British Journal of Psychiatry, January 2007.


Institute of Psychiatry - The Institute of Psychiatry is part of King's College London and closely affiliated to the South London and Maudsley NHS Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis.


iop.kcl.ac.uk

Extended release stimulant effective for long-term ADHD treatment

A new study has found that an all-day, extended-release stimulant for treating attention-deficit hyperactivity disorder (ADHD) remains effective for up to two years without significant side effects. In the October issue of the Journal of the American Association of Child & Adolescent Psychiatry, a multi-institutional research team reports finding that treatment with Concerta, a once-daily form of the drug methylphenidate, successfully controlled ADHD symptoms in more than 200 children with ADHD. The study was supported by McNeil Pharmaceuticals, which manufactures Concerta.


"Although ADHD is recognized as a chronic disease, we've known very little about the effects of chronic treatment," says Timothy Wilens, MD, of the Massachusetts General Hospital (MGH) Pediatric Psychopharmacology Unit, lead author of the JAACAP report. "There have been concerns about whether the stimulant medications that are a mainstay of treatment continue to be effective, whether patients build up tolerance, or whether the drugs might have adverse effects on cardiovascular health or growth. This investigation sheds some important light on those questions."


The study initially enrolled more than 400 children, ages 6 to 13, who previously had participated in short-term, placebo-controlled trials of Concerta. In the new trial, all participants received the active medication at one of three dose levels. Dosage could be adjusted to improve effectiveness or reduce side effects. Participants' height and weight, blood pressure, heart rate and other clinical measures were taken at regular intervals during the study period. The children's parents and teachers were surveyed periodically regarding whether they believed treatment was effective in controlling ADHD symptoms


The entire, two-year study was completed by 229 participants, with others dropping out for a variety of reasons. Throughout the study period, measures of treatment effectiveness were consistent, with around 85 percent of parents and teachers reporting treatment results to be good or excellent. However, it was necessary to increase the children's dose by about 25 percent during the study, with most increases happening during the first year. All the children grew at rates considered normal for their age, and they gained only slightly less weight than would have been expected. In general, there were no clinically significant effects on blood pressure, heart rate, or other cardiac measures.


"We found these medications do continue to be effective in the long-term. While some particicipants did need to increase dosage beyond what could be attributed to their growth, any tolerance that developed seemed to be slight and limited to the first year," says Wilens. "We haven't seen any clinically meaningful problems with height and weight or any cardiovascular difficulties in this study, which also is the first to evaluate this kind of daylong treatment in a large group of children."


Wilens is an associate professor of Psychiatry at Harvard Medical School. The study's co-authors are Keith McBurnett, PhD, University of California at San Francisco; Mark Stein, PhD, University of Chicago; Marc Lerner, MD, University of California at Irvine; Thomas Spencer, MD, MGH; and Mark Wolraich, MD, University of Oklahoma.


Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $450 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology, stem cells and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.


Sue McGreevey



617-724-2764

Massachusetts General Hospital

harvard


View drug information on Concerta.

For Boys With Fragile X Sydrome And ADHD, New Hope Found In Non-Stimulant Medication

The most common hereditary form of hereditary mental retardation is
known as Fragile X syndrome (FXS), so dubbed for its characteristic
mutation on the X chromosome, or Escalante's syndrome. Manifestations
of this disease in patients usually include a characteristic long
facial pattern, tooth and jaw misalignment, musculoskeletal
abnormalities, or autism.



Additionally, many FXS patients also suffer from attention
deficit
and/or hyperactivity disorder (ADHD), a disorder that can make
functioning socially or professionally difficult. Stimulant
medications, such as Ritalin®, are often effective for ADHD patients
with mental retardation, but there are counterproductive side effects
such as irritability, diminished speech, and social withdrawal.



L-acetyle carnitine (LAC,) a variant of the amino acid carnitine,
showed promise in a previous study of reducing hyperactive behavior in
FXS boys with AHDH. They were treated with it for one year, with no
adverse side effects reported. The same authors have subsequently
performed a andomized,
double-blind, placebo-controlled study over multiple centers to
determine how effective LAC can be in a larger group. This study will
be published in the April 1, 2008 issue of American Journal of Medical
Genetics Part
A, which is available online via Wiley InterScience at the
following address: 
http://www3.interscience.wiley/cgi-bin/jhome/33129.



M. Giulia Torrioli and Giovanni Neri of the Universit?  Cattolica in
Rome led the study, which brought together 51 boys between the ages of
6 and 12 who had been diagnosed with FXS and ADHD. They were treated in
one of eight facilities in Italy, France, and Spain. The treatment, 500
milligrams of LAC or a placebo twice a day, was continued for 12
months. A team of child neuropsychiatrists and psychologists evaluated
each patient at the start of the study, after one month, 6 months, and
12 months. Neuropsychologicial tests were used to evaluate the effects
of the drug and the placebo.



Subjects in the LAC group showed reduced hyperactive behavior and
better attention. In this group there were also no side effects,
indicating that LAC provides a safe alternative to stimulant therapies.
The placebo group showed less hyperactive behavior as well, but not at
the magnitude of the LAC group. Additionally, LAC patients showed
improved social ability. While both groups took intelligence tests, LAC
did not appear to improve intellectual function.



"We propose that
LAC be recommended as a treatment of ADHD in FXS children," the authors
state, "since it effectively reduces hyperactive behavior and
improves social abilities without adverse side effects." They also
suggest that these results may be applicable to children with autism,
who also do not easily tolerate stimulants.



About Wiley InterScience



Introduced in 1997 and launched
commercially in January 1999, Wiley InterScience
(interscience.wiley)
is a leading international resource for
quality content promoting discovery across the spectrum of scientific,
technical, medical and professional endeavors. In nearly a decade,
Wiley InterScience has built its reputation by regularly adding new
content and functionality; offering sophisticated search and navigation
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Today, Wiley InterScience features must-have
content from more than 2,500 journals, books, reference works,
databases, laboratory manuals and the Cochrane Library, which is the
world's best-known resource for evidence-based medicine. More than half
of Wiley's journals on Wiley InterScience are digitized back to Volume
1, Issue 1 as part of the development of the journal backfile
initiative. 



About Wiley



Founded in 1807, John Wiley
& Sons, Inc. has been a valued source of information and
understanding for 200 years, helping people around the world meet their
needs and fulfill their aspirations. Our core businesses include
scientific, technical, medical, and scholarly journals, encyclopedias,
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wiley. The
Company is listed on the New York Stock Exchange
under the symbols JWa and JWb.



A
Double-Blind, Parallel, Multicenter Comparison of L-acetylcarnitine
with Placebo on the Attention Deficit Hyperactivity Disorder in Fragile
X Syndrome Boys

M. Giulia Torrioli, Silvia Vernacotola, Laura
Peruzzi, Elisabetta Tabolacci, Montserrat Mila, Roberto Militerni,
Sebastiano Musumeci, Feliciano J. Ramos, Mar?¬a Frontera, Giovanni
Sorge, Elisabetta Marzullo, Giusi Romeo, Louis Vallee, Edvige
Veneselli, Elena Cocchi, Eleonora Garbarino, Umberto Moscato, Pietro
Chiurazzi, Stefania D'Iddio, Menotti Calvani, Giovanni Neri

American Journal of Medical Genetics Part A, April
1st, 2008

DOI: 10.1002/ajmg.a.32268

Click
Here For Abstract



Written by Anna Sophia McKenney



View drug information on Ritalin LA.

New Research Evaluates The Impact Of Working Memory Training And Stimulant Medication On Kids With ADHD

A study to be published in the August 2009 edition of Applied Cognitive Psychology sheds new light on how Cogmed Working Memory Training and stimulant medication address working memory impairments in children with ADHD. Working memory, acknowledged as one of the core deficits in ADHD, represents the brain's ability to hold and process critical information related to the present moment. This study represents the latest findings from a team of independent UK researchers whose ongoing work examines the impact of Cogmed's software-based training program on individuals with disorders of memory and attention.


Conducted at the University of York, the research was led by Joni Holmes, Ph.D., and Susan Gathercole, Ph.D. The study evaluated the effects of both working memory training and medication on 25 children with ADHD. Each child performed a battery of tests to assess different aspects of working memory twice before training, once when the children were taking their medication for ADHD and once when they were not. Tests measuring the same aspects of working memory were also administered immediately after the Cogmed training program, as well as six months after training as a follow up.


The results show that stimulant medication significantly increases visuo-spatial working memory, but that Cogmed training leads to significant improvements in all four critical measures of working memory; verbal and visuo-spatial short-term and verbal and visuo-spatial working memory. The training effects remained six months after training.


"We're only just beginning to understand the different ways we can boost working memory. As we continue our work with children with ADHD and those with low working memory, it is very promising to see the magnitude and sustainability of gains following training," said Holmes.


"This recent study illustrates the important and lasting effects Cogmed training can have on the underlying issues in ADHD," said Jonas Jendi, Cogmed's CEO. "We are of course pleased to note that the study finds that the Cogmed training brings the working memory capacity of these children into the normal range, and that the findings hold for all of the six-month testing period. For a family struggling with ADHD and the school challenges that follow from the disorder, this is a finding that resonates."


The study adds to a growing body of research showing that Cogmed Working Memory Training can lead to a range of lasting improvements for anyone with a working memory impairment, spanning from pre-school children, adolescents, working adults and seniors.


For more information on the study, please visit here.


For more information about the University of York, visit york.ac.uk.


For a summary of this study, and on other Cogmed studies, visit cogmedresearch.


Source

Cogmed

Prenatal Pesticide Exposures Linked To Attention Disorders In Preschool Children

Exposure to organophosphate (OP) pesticides before birth can increase susceptibility to attention disorders such as attention deficit/hyperactivity disorder (ADHD), according to new research published in the journal Environmental Health Perspectives (EHP). The new study is part of a growing body of research indicating that exposure to OP pesticides can adversely affect brain development.


OP pesticides target the nervous systems of insects by affecting the activity of neurotransmitters including acetylcholine, which in humans plays a critical role in brain development and is involved in attention and short-term memory. Exposure to OP compounds may also disrupt DNA replication and the growth of nerve axons and dendrites. Infants and young children are much more vulnerable to OP exposures than adults are because their ability to produce the enzyme that detoxifies OP pesticides is still developing.


Mothers participating in the study were recruited during pregnancy by the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS). The Mexican-American women lived in the Salinas Valley, an area of intensive agriculture where more than 235,000 kg of pesticides are applied annually. The researchers analyzed six OP metabolites in urine samples collected from the mothers during pregnancy and from their children several times after birth. The presence of these metabolites indicated exposure to OP pesticides used in the Salinas Valley, such as chlorpyrifos, diazinon, and oxydemeton-methyl.


The children's behavior was assessed at the ages of 3 and a half years (n = 331) and 5 years (n = 323) using reports from the mothers and standardized psychological tests.


The results indicated that as the concentration of OP metabolites in the urine of pregnant women increased, so did the likelihood that their children's test scores would be consistent with a clinical diagnosis of ADHD. The association was stronger at age 5 years than at 3 and a half and was more pronounced in boys than in girls. Prenatal exposures had a greater association than did exposures after birth: A tenfold increase in levels of measured pesticide metabolites in the mother's urine during pregnancy correlated to about a 500% increase in the likelihood of attention issues in their 5-year-olds, whereas a tenfold increase in levels of metabolites in the children's urine at 5 years of age corresponded to a 30% higher likelihood.


By measuring prenatal exposures and focusing on participants likely to have higher exposures to OP pesticides than the general population, this study complements research published in the June 2010 issue of the journal Pediatrics. In that study, Maryse Bouchard and colleagues measured the same six OP metabolites in 1,139 children aged 8 to 15 years selected from the general U.S. population. They found associations between OP exposure and ADHD even though those children had lower average exposures than did the children in the CHAMACOS study.


The authors of the EHP study suggest that research should continue to investigate whether genetic differences in OP metabolism affect susceptibility to developmental disorders, including ADHD. They state that "given that attention problems of children interfere with learning and social development, finding potential causes that can be remediated are of great public health importance." A companion article, also released today in EHP, explores potential genetic mechanisms behind effects associated with OP exposure.


The authors of "Organophosphate Pesticide Exposure and Attention in Young Mexican-American Children" are Amy R. Marks, Kim Harley, Asa Bradman, Katherine Kogut, Dana Boyd Barr, Caroline Johnson, Norma Calderon, and Brenda Eskenazi. This research was funded by grants from the National Institute of Environmental Health Sciences, the U.S. Environmental Protection Agency, and the National Institute for Occupational Health and Safety. The article will be available here.


The authors of the companion paper, "PON1 and Neurodevelopment in Children Exposed to Organophosphate Pesticides in Utero," are Brenda Eskenazi, Karen Huen, Amy Marks, Kim G. Harley, Asa Bradman, Dana Boyd Barr, and Nina Holland. This research was funded by grants from the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency. The article will be available here.


Source:

Environmental Health Perspectives (NIEHS)

New Study Reveals That Coaching Helps College Students With ADHD Improve Ability To Learn, Succeed In College

The results of a new study being released this week at the Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) conference in Atlanta demonstrate the effectiveness of a new model of coaching, developed exclusively for and used by the Edge Foundation, to help college students with ADHD improve executive functioning, which is their ability to organize, set and achieve goals, and self regulate -- all critical for a successful post secondary education. Additionally, students who participated in the study felt that coaching helped them feel less stress, greater empowerment, increased confidence and have more balanced lives.


Researchers from Wayne State University in Michigan conducted the study over two years in 10 universities and community colleges throughout the country and tracked the progress of 110 students with ADHD. It is the largest and most comprehensive study of ADHD coaching conducted to-date. The research team measured students' progress through both quantitative and qualitative analysis and have determined, "This study demonstrated that the Edge coaching model was highly effective in helping students improve executive functioning and related skills as measured by the Learning and Study Strategies Inventory (LASSI; Weinstein & Palmer, 2002)."


Coaching has long been used by corporations to improve performance of CEOs and executives, but little research has been done until now on the impact this kind of intervention may have on populations with learning disabilities, like ADHD. While medication has been shown to improve academic productivity (better note-taking, scores on quizzes and worksheets, and homework completion), medication alone is not associated with skills students need to meet the demands of college which they must navigate more independently than in previous schooling.


Source: Edge Foundation

Autistic Children Get An Israeli 'Biohug'

For Raffi Rembrand, necessity was definitely the mother of his invention. An
Israeli engineer and father to a son with autism, Rembrand was well aware of
the difficulties of raising a child with severe autism.


He had devoured all the information about the well established treatment of
deep pressure touch to produce a calming effect in agitated individuals with
autism. However, he discovered that most existing devices were more like
straightjackets and weren't sensitive to changes in the patient's movement
and couldn't regulate the pressure based on the patient's needs or body
gauges.


An inventor by nature, Rembrand began tinkering in his home until he came up
with the idea of a light, wearable, vest-like calming device that's both
portable and non-restraining.


Working through a few prototypes of that 'home remedy' makeshift device has
resulted in the BioHug - a vest for both people with autism and and children
diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).


The BioHug delivers a mildly pulsating pressure through the use of
inflatable cells placed throughout the garment and includes a biofeedback
mechanism which automatically regulates the level of stimulation.


According to Center for Disease Control, one out of every 150 children in
the US suffers from a disorder which falls somewhere on the autism spectrum,
ranging from Asperger's Syndrome on one end to severe autism on the other.
ADHD is much more prevalent, however, with millions of children diagnosed
with the learning disorder.


"It was very much an improvisational exercise," says Rembrand, describing
how he developed the BioHug. "The idea of inflatable bubble cells is used
for people with pressure wounds to keep them from getting infected. I took a
little from here and a little from there. There wasn't any patent, it was
just a nice development,"


"I approached ALUT (the Israeli Society for Autistic Children) and said,
'here's a simple idea which might help the kids - I've tested it on my son,
and on other people with autism.'


They were so impressed that they implored Rembrand to take it out of the
'amateur' sphere and develop a scientifically tested, professional device
that could be made available to all people with autism. For expert advice,
he approached Dr. Einat Gal a clinical researcher at the University of
Haifa, who continues to collaborate on the development of the BioHug



Still Rembrand wasn't satisfied. "Everyone told me 'you know this invention
is way too simple'. It has a very low technological barrier, so I said OK if
this is what needs to be done, I'll add some technology to it - which is how
we came to include biofeedback."



According to Rembrand, the device measures the user's stress, and that
stress actually controls the BioHug's pressure and pulsation rate. A change
in the stress counter will cause adjustment to the pulsation rate and amount
of pressure.
















Earlier this year, Rembrand founded BioHug Technologies Ltd. to
commercialize the device and was accepted into the Chief Scientist of Israel
incubator program - via L.N. Innovative Technologies in Haifa.



He also found a kindred soul in Andrew Schiffmiller, a veteran manager and
consultant, who took up the position of CEO.



"The BioHug is unique among all other types of pressure-based devices for
people with autism because we solve the problem of habituation,"
Schiffmiller told ISRAEL21c.



"Try it yourself - gently pinch your wrist - you feel it, but if you keep
doing it, after a short while you don't feel it anymore. Your body gets used
to it. Through the pulsation feature on the BioHug, we reduce the
habituation so the sensation of pressure on the user will continue, because
it's always changing."



According to Schiffmiller, the original reason Rembrand - who acts as
BioHug's chief technological officer - invented the BioHug concept wasn't
just to keep his son calm, but to conduct tests on a theory he had
researched regarding hearing.



"There's a body of suggestive evidence that people with autism hear
differently than other people. When you put a shell to your ear and you
think you hear the ocean - it's called otoacoustic emissions - produced by
the inner ear itself which is thought to have some role in filtering out
background noise," Schiffmiller explained.



"The working theory was that there's a difference in the otoacoustic
emissions of people with autism - if that's true and you can quantify it,
then you can have a purely empirical way of diagnosing autism - even in
infants."



But the problem is, how do you get naturally fidgety people with autism to
sit till long enough to conduct an ear exam? And according to Rembrand and
Schiffmiller, the BioHug is the solution.



They're still revising the design of the BioHug before they actually begin
clinical testing, discussing issues of whether the compressor will be in the
vest or an accompanying backpack and other design issues. But according the
feedback they've received from students with autism who've tried the device
and from professionals in the field, they're on the right track.



"Every time we build a prototype, we go back to the Horsha school for
children with autism that Rafi has a good relationship with, we give it to
the staff, they play with, try it on and give us their suggestions," said
Schiffmiller. "Since these are people that work with children with autism
every day and they themselves are experienced in the application of the
pressure, they've been great sounding boards for us."



"And they're still using my first prototype at the school," added Rembrand.



Both Schiffmiller and Rembrand are confident that the BioHug represents a
huge leap in the field of controlled pressure devices for patients with
autism. Some devices are based on the principle of weight, where weighted
garments place pressure on the user's shoulders. But Schiffmiller claims
there are two drawbacks to that type of therapy.



"One is the issue of habituation - after a few minutes, you don't really
feel it. And two, in order to be effective, the total weight needs to about
10 percent of the wearer's body weight - that's heavy, especially if you're
talking about adults."



And then there's a device invented a decade ago by Temple Grandon - a very
high functioning person with autism in the US - who created a machine that's
based on restraining chute for cattle.



"As a child, she always craved pressure. Once when she was visiting her
uncle's farm, she saw him using a restraining chute for the cattle, and she
climbed in and found that the pressure helped calm her," explained
Schiffmiller.



"Her device is large and cumbersome - about 350 pounds and uses an
industrial air compressor. What Rafi has done - in essence - is to
miniaturize that process into the BioHug."



Depending on the population, the BioHug can function in a number of
different ways, says Schiffmiller. For ADHD students, it could be worn at
homework time enabling the user to concentrate and stay on task. And with
people with autism who sometimes suffer through periods of severe agitation,
it's a tool to help them calm down.



"With some some people with autism, the possibility exists that they may
hurt themselves, or hurt others, and the BioHug is an effective way to get
them to relax," he said.



Rembrand is confident that the BioHug will prove to be a useful device for
the families of children with autism. And he only has to look as far as his
own son, Jacob, now 23 years old.



"He's my primary beta tester. And if he says it's good, then we know it's
good."



By David Brinn

Fidgety Children Are On The Rise

Hyperkinetic disorders among children and adolescents are becoming increasingly common. In the current issue of Deutsches Arzteblatt International, Ingrid Schubert of the PMV Research Group at the University of Cologne and her colleagues address the question how this has affected the frequency of prescriptions for methylphenidate, a stimulant drug that is used to treat such disorders (Dtsch Arztebl Int 2010; 107[36]: 615?­21). The authors analyzed data concerning tens of thousands of persons insured by the AOK health insurance company in the German state of Hesse over the period 2000 to 2007.


In 2007, the overall prevalence of hyperkinetic disorders among persons aged 0 to 18 years was 2.2%. This figure was nearly 50% higher than the corresponding figure for 2000. The authors found the greatest rise in prevalence in the 15- to18-year-old age group. This secular trend was particularly noteworthy for girls: among persons aged 6 to 18 years, the prevalence of hyperkinetic disorders rose by 70% among girls, as compared to 53% among boys.


In 2007, 1.1% of 6- to 18-year-olds received at least one prescription for methylphenidate. This figure corresponded to a 252% increase in daily doses prescribed in comparison to the 2000 level. The authors found that the increase was due to rises not only in the number of persons for whom me

Study Finds Young Children Can Develop Full-blown OCD

A new study by researchers at the Bradley Hasbro Children's Research Center has found that children as young as four can develop full-blown obsessive compulsive disorder (OCD) and often exhibit many of the same OCD characteristics typically seen in older kids.



The study, published online by the Journal of Psychopathology and Behavioral Assessment, is the largest sample of young children with OCD published to date.



"There have been very few studies focusing on early childhood OCD, even though we know that OCD, if left untreated, can significantly disrupt a child's growth and development and can worsen as the child gets older," says lead author Abbe Garcia, PhD, director of the Bradley Hasbro Children's Research Center (BHCRC) Pediatric Anxiety Research Clinic. "That's why we need to understand more about OCD in very young children, since early diagnosis and intervention are critical to reducing the severity of symptoms and improving quality of life."



OCD is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. According to the American Academy of Child and Adolescent Psychiatry, as many as 1 in 200 children and adolescents struggle with OCD.



Garcia and colleagues studied 58 children with OCD between the ages of four and eight, including 23 boys and 35 girls. All children underwent a series of clinical psychological assessments. Approximately 19 percent had been previously treated with medication and 24 percent had received some form of previous psychotherapy for OCD. Twenty percent reported a first-degree family history of OCD. Nearly 22 percent of children had an additional diagnosis of attention deficit hyperactivity disorder (ADHD) and about 20 percent were also diagnosed with generalized anxiety disorder (GAD).



Common obsessions among children in the study included fear of contamination and aggressive/catastrophic fears (involving death or harm to themselves or loved ones), and three-quarters reported having multiple obsessions. Nearly all of the children suffered from multiple compulsive behaviors, with an average of four compulsions per child. Washing, checking and repeating were the most commonly reported compulsions.



A data analysis revealed a number of parallels between young children with OCD and reported samples of their older peers in terms of symptoms and severity. For example, both groups appear to have similar types of obsessions and compulsions, multiple psychiatric diagnoses, and high rates of OCD family history.
















"These similarities suggest this is a study sample involving full-blown OCD, as opposed to children who are either in the beginning phases of the illness or only have a partial OCD diagnosis," says Garcia, who is also an assistant professor of psychiatry (research) at The Warren Alpert Medical School of Brown University.



However, Garcia says they also discovered some important differences between younger and older children with OCD. Although anxiety disorders seem to be a common comorbid diagnosis in both groups, younger children were less likely to have depression, compared to older children. Also, while many experts believe boys are more likely to present with juvenile OCD, the findings from the current study actually indicate a lower boy to girl ratio.



"Our findings offer the first glimpse at the features and variables that emerge during early childhood onset OCD and will hopefully lead to further studies focusing on assessment and treatment of this age group," Garcia says.







The study was supported in part by a grant from the National Institutes of Mental Health. Co-authors were Jennifer Freeman and Henrietta Leonard from the BHCRC and Alpert Medical School; Noah Berman, Alexandra Ogata and Molly Choate-Summers from the BHCRC; Michael Himle from the University of North Dakota; and Janet Ng from the University of Oregon.



Founded in 1931, Bradley Hospital, located in East Providence, RI, was the nation's first psychiatric hospital devoted exclusively for children and adolescents. Today, it remains a nationally recognized center for children's mental health care, training and research. A teaching hospital for The Warren Alpert Medical School of Brown University, Bradley Hospital offers a wide range of services for psychological, developmental and behavioral conditions, including inpatient, outpatient, residential and home-based treatment options. More than 30 postdoctoral residents and fellows in child psychiatry, psychology and pediatrics receive training in Bradley Hospital's programs every year. Its research arm, the Bradley Hasbro Children's Research Center, brings together a multidisciplinary team of investigators working to advance our knowledge of children's mental health through federally funded research projects. Bradley Hospital also operates the Bradley School, a fully certified special education school. A private, not-for-profit hospital, Bradley Hospital is a member of the Lifespan health system. For more information, please visit bradleyhospital/



Source: Jessica Collins Grimes


Lifespan

CME LLC Offers Education To Help Medical Professionals Better Recognize Adult ADHD

CME LLC, a leading provider of fully accredited continuing medical education programs since 1978, today announced a new interactive educational program designed to increase recognition of the complexities and complications often encountered when diagnosing and treating patients with adult ADHD.


The presentation of adult ADHD is often complicated by the presence of comorbid conditions such as depression, anxiety, bipolar disorder and substance abuse. A patient's symptoms often mask either the comorbid condition or the adult ADHD, making a diagnosis more challenging.


"Of the estimated four-to-five percent of adults with ADHD, only 20 percent are ever diagnosed, and this presents us with a tremendous opportunity to raise awareness and make a positive impact for patients and physician learners alike," said Niki Oquist, M.D., FAAP and senior vice president of medical affairs for CME LLC. "ADHD is most commonly associated with children and adolescents, and it morphs to take on a completely different form in adults. Sixty percent of children and adolescents with ADHD continue to have impairment into adulthood."


Children with ADHD have symptoms of hyperactivity and impulsiveness which progress to inattentiveness and restlessness in adults. This educational initiative is just the start of a year-long program to educate and assist physicians with diagnosing and treating patients with ADHD.


"It's easy to understand why there's so much confusion about classifying ADHD," said Oquist. "A shortage of physician training and variable symptoms may lead to the underdiagnosis of adult ADHD."


"Understanding the Complexities in the Differential Diagnosis of Adult ADHD" offers clinicians access to a Web site (adultadhd-ddx) with online anecdotal patient case studies, as well as live 4-hour meetings in Chicago; Dearborn, Mich.; Los Angeles; Washington, D.C.; and New York beginning March 1 and running through April 12. Each meeting includes two sessions: "Understanding the Challenges in the Differential Diagnosis of Adult ADHD," with Joel L. Young, M.D., medical director and founder at the Rochester Center for Behavioral Medicine and "Evaluating Treatment Strategies for Adult ADHD," with David Goodman, M.D., assistant professor for the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University, the director of Suburban Psychiatric Associates, LLS and the director for the Adult Attention Deficit Disorder Center of Maryland. All course materials are peer-developed and peer-reviewed. Information and other educational opportunities will be added to the Web site throughout 2008. Meeting pre-registration is requested at adultadhd-ddx.


About CME LLC


CME LLC, a division of CMPMedica, is a leading provider of fully accredited continuing medical education programs and offers a wide range of informational and educational resources for healthcare professionals. Based in Irvine, Calif., CME produces a variety of live events and conferences, print supplements, multimedia home study products, and Web sites and is the sponsor of the U.S. Psychiatric and Mental Health Congress and Regional Extensions and the Advances series of medical education sessions, which includes Advances in Primary Care Medicine, Neurology and Pediatric Medicine.

CMELLC

Many Factors To Consider In Getting Treatment Right For ADHD

The quality of a child's relationships and their diet are now known to be minor risk factors implicated in attention deficit hyperactivity disorder (ADHD). Biological factors, including genetics, remain the most significant factor, however, so they must all be considered before treatment can begin.


"ADHD is rarely encountered as a pure, discrete disorder," says Professor Alasdair Vance from the Royal Children's Hospital in Melbourne. "That's why it is so important that children are properly assessed, so they can get the right support such as speech therapy, educational remediation and occupational therapy".


The first line treatment for ADHD continues to be psychosocial interventions alone, however, there is evidence that some children will do better when medicines are given in conjunction with comprehensive behavioural interventions. "Side effects also need to be well considered and understood," he says.


About Australian Prescriber


Australian Prescriber is an independent review of therapeutics. It aims to provide short direct and didactic reviews on a range of topics which will assist the readers in their professional duties.


Australian Prescriber was first published in 1975. Australian health professionals had previously been sent the British Prescribers' Journal, but this had become less relevant to Australian practice. Australian Prescriber was published by the Australian Department of Health until the National Prescribing Service assumed responsibility for the journal in 2002. Past covers of the journal make a colourful display, marking the evolution of the journal since 1975.


Australian Prescriber is distributed 6 times each year to doctors, dentists, pharmacists and students of these disciplines. The majority of readers are in Australia, but there is a growing readership in the Asia-Pacific region.


Australian Prescriber

New River Pharmaceuticals Inc. Receives Approvable Letter For NRP104

Two years after becoming a public company, New River Pharmaceuticals Inc. (Nasdaq: NRPH) has received a positive determination from the U.S. Food and Drug
Administration on its first product candidate.



The company announced that it has received an approvable letter from
the FDA for 30mg, 50mg and 70mg capsules of NRP104 (lisdexamfetamine
dimesylate), for the treatment of Attention-Deficit/Hyperactivity Disorder
(ADHD) in children aged 6 - 12. Developed by New River as a once-a-day
medication to provide efficacy throughout the day up to 6 p.m., NRP104 is a
new chemical entity in which d-amphetamine is covalently linked to
l-lysine, a naturally occurring amino acid. NRP104 remains inactive until
converted in the body and the active, d-amphetamine, is gradually released.



In January 2005, New River and Shire plc (LSE: SHP), (Nasdaq: SHPGY),
(TSX: SHQ) signed a collaboration agreement to develop and commercialize
NRP104.



According to the FDA's letter, marketing approval of NRP104 is
contingent upon final scheduling by the U.S. Drug Enforcement
Administration (DEA). No additional studies have been requested by the FDA
as a condition for approval of NRP104. New River and Shire will continue
dialog with FDA officials to agree upon a final trade name.



The Controlled Substance Staff of the FDA has initially proposed that
NRP104 be placed in Schedule II of the Controlled Substance Act. The
initial proposal will be submitted to the DEA, which is responsible for
making a final scheduling assignment. New River anticipates timely
resolution of this process.



R. J. Kirk, New River Chief Executive Officer, said, "This is a
landmark day for New River. We are pleased to have received an approvable
letter on our first drug candidate, and we view this as a significant step
toward bringing NRP104 to market. Pending final labeling discussions and a
scheduling assignment from the DEA, we are preparing for a product launch
in the second quarter of 2007."



"This approvable letter for NRP104 is positive news for Shire and its
partner New River," said Shire Chief Executive Officer Matthew Emmens. "We
look forward to working with New River to bring NRP104 to market. We
believe NRP104 will offer patients, their families, and healthcare
providers the next generation of ADHD treatment."



Kirk also noted, "As we work toward final approval of NRP104, we
continue progress on the development of our other pipeline drug candidates,
including NRP290 to treat acute pain, and NRP409, which, if approved,
should mark the first significant improvement in thyroid hormone
replacement therapy in half a century."



The Collaboration Agreement



Under the terms of the agreement, the parties will collaborate on
NRP104 development, manufacturing, marketing and sales in the U.S. Shire
will book the product sales and New River may supply up to 25 percent of
the sales effort under a co-promotion right. New River will be financially
and operationally responsible for clinical and manufacturing development.
















New River plans to file a Current Report on Form 8-K with the U.S.
Securities and Exchange Commission providing additional details on the
company's U.S. collaboration agreement with Shire.



Upon receiving marketing approval in the U.S., the agreement requires
Shire to launch and commercialize NRP104 carrying out its obligations and
tasks consistent with the reasonable best practices of the pharmaceutical
industry for the development or commercialization of a pharmaceutical
product having similar market potential, profit potential or strategic
value, based on conditions then prevailing. The agreement also obligates
Shire to give NRP104 marketing and promotional priority over its other oral
ADHD stimulants should NRP104's label contain a claim relating to a
decreased potential for abuse or overdose protection.



Under the agreement, in the event that NRP104 is approved with a
Schedule III, IV or V classification or be unscheduled ("favorable
scheduling"), the parties will divide operating profit as follows: New
River will receive 25 percent of profits for the first two years following
launch, and the parties will share the profits equally thereafter. However,
in the event that NRP104 receives a final Schedule II classification, the
collaboration agreement allows for an alternative profit-sharing scheme.
Under this scenario, New River's share of U.S. product profits for the
first two years will be at least 25%, though it may increase to a value
determined by a preset formula. After the first two years, it will be at
least 50%, though it may increase to a value determined by a preset
formula. These formulas, which include yearly threshold sales, will be
included in the Current Report on Form 8-K New River intends to file.



Shire paid an initial sum of $50 million on signing the collaboration
agreement and $50 million upon acceptance of the filing of the New Drug
Application by the FDA. Should NRP104 receive favorable scheduling by its
first commercial sale, the agreement entitles New River to a $300 million
milestone payment. Should NRP104 launch under a Schedule II classification
but receive favorable scheduling within 3 years of the first commercial
sale, the agreement provides for an alternative milestone payment on a
sliding scale as follows: if the favorable scheduling occurs within one
year of the first commercial sale, the milestone payment will be $200
million; if it occurs by the third anniversary, the milestone payment will
be $100 million.



In addition, New River will be entitled to a $100 million milestone
payment at the end of the first calendar year in which cumulative worldwide
net sales of all collaboration products during that calendar year exceed $1
billion.



Shire is entitled to terminate the agreement until 30 days following
approval of NRP104. If Shire terminates before regulatory approval, no
payment would be due Shire. If Shire terminates after approval and NRP104
has received a favorable scheduling assignment, no payment would be due
Shire. If the approved NRP104 has received a Schedule II classification,
Shire would be entitled to a $50 million termination payment, payable in
cash, New River common stock, or an unsecured, 5-year promissory note, as
will be agreed upon by Shire and New River.



About ADHD



ADHD affects approximately 7.8 percent of all school-age children, or
about 4.4 million children in the U.S.(i) ADHD is considered the most
commonly diagnosed psychiatric disorder in children and adolescents.(ii)
ADHD is a neurobiological disorder that manifests as a persistent pattern
of inattention and/or hyperactivity-impulsivity more frequent and severe
than typically observed in individuals at a comparable level of
development.(iii) To be properly diagnosed with ADHD, a child needs to
demonstrate at least six of nine symptoms of inattention; at least six of
nine symptoms of hyperactivity/impulsivity; the onset of such symptoms
before age 7 years; that some impairment from the symptoms is present in
two or more settings (e.g., at school and home); and that the symptoms
continue for at least six months.(iv) If untreated, ADHD can acutely affect
a child's life, leading to problems with family members, friends, sports,
after-school activities and academics.(v)



Although there is no "cure" for ADHD, there are accepted treatments
that specifically target its symptoms. The most common standard treatments
include educational approaches, psychological or behavioral modification,
and medication.(vi)



About New River



New River Pharmaceuticals Inc. is a specialty pharmaceutical company
developing novel pharmaceuticals that are generational improvements of
widely prescribed drugs in large and growing markets.



For further information on New River, please visit the company's
website at nrpharma.



"SAFE HARBOR" STATEMENT UNDER THE PRIVATE SECURITIES LITIGATION REFORM
ACT OF 1995



This press release contains certain forward-looking information that is
intended to be covered by the safe harbor for "forward-looking statements"
provided by the Private Securities Litigation Reform Act of 1995. Forward-
looking statements are statements that are not historical facts. Words such
as "expect(s)," "feel(s)," "believe(s)," "will," "may," "anticipate(s)" and
similar expressions are intended to identify forward-looking statements.
These statements include, but are not limited to, financial projections and
estimates and their underlying assumptions; statements regarding plans,
objectives and expectations with respect to future operations, products and
services; and statements regarding future performance. Such statements are
subject to certain risks and uncertainties, many of which are difficult to
predict and generally beyond the control of New River Pharmaceuticals, that
could cause actual results to differ materially from those expressed in, or
implied or projected by, the forward-looking information and statements.
These risks and uncertainties include: those discussed and identified in
the New River Pharmaceuticals Inc. annual report on Form 10-K, filed with
the SEC on March 15, 2006; the timing, progress and likelihood of success
of our product research and development programs; the timing and status of
our preclinical and clinical development of potential drugs; the likelihood
of success of our drug products in clinical trials and the regulatory
approval process; our drug products' efficacy, abuse and tamper resistance,
resistance to intravenous abuse, onset and duration of drug action, ability
to provide protection from overdose, ability to improve patients' symptoms,
incidence of adverse events, ability to reduce opioid tolerance, ability to
reduce therapeutic variability, and ability to reduce the risks associated
with certain therapies; the ability to develop, manufacture, launch and
market our drug products; our projections for future revenues,
profitability and ability to achieve certain threshold sales targets; our
estimates regarding our capital requirements and our needs for additional
financing; the likelihood of obtaining favorable scheduling and labeling of
our drug products; the likelihood of regulatory approval under the Federal
Food, Drug, and Cosmetic Act without having to conduct long and costly
trials to generate all of the data which are often required in connection
with a traditional new chemical entity; our ability to develop safer and
improved versions of widely prescribed drugs using our Carrierwave (TM)
technology; our success in developing our own sales and marketing
capabilities for our lead product candidate, NRP104; and our ability to
obtain favorable patent claims. Readers are cautioned not to place undue
reliance on these forward-looking statements that speak only as of the date
hereof. New River Pharmaceuticals does not undertake any obligation to
republish revised forward-looking statements to reflect events or
circumstances after the date hereof or to reflect the occurrence of
unanticipated events. Readers are also urged to carefully review and
consider the various disclosures in New River Pharmaceuticals' annual
report on Form 10-K, filed with the SEC on March 15, 2006, as well as other
public filings with the SEC.


(i) Mental health in the United States: prevalence of diagnosis and
medication treatment for attention-deficit/hyperactivity disorder, United
States, 2003," CDC MMWR, September 2, 2005; 54(34); 842-847. Available at:
cdc.gov/mmwr/preview/mmwrhtml/mm5434a2.htm. Accessed on
September 8, 2005.


(ii) American Academy of Child and Adolescent Psychiatry. Practice
parameters for the assessment and treatment of children, adolescents, and
adults with attention-deficit/hyperactivity disorder. J Am Acad Child
Adolesc Psychiatry. 1997; 36(10 Suppl):855-1215. Introduction. Available at
aacap/clinical/Adhdsum.htm. Accessed on September 16, 2005.


(iii) WebMD Health. The Facts About Adult ADHD page. Available at:
http://my.webmd/content/article/66/79706.htm?lastselectedguid={5FE84E90 . Accessed on March 8, 2004.


(iv) Diagnostic and Statistical Manual of Mental Disorders: Fourth
Edition, Text Revision. DSM-TR-IV(R). Washington, DC: American Psychiatric
Association; 2000: 85.


(v) "Introduction," Diagnosis and Treatment of Attention Deficit
Hyperactivity Disorder. NIH Consensus Statement 1998 Nov 16-18; 16(2):
1-37. Available at:
http://consensus.nih.gov/cons/110/110_statement.htm#0_Abstract. Accessed on
June 8, 2005.


(vi) Baumgartel A, et al. Practice guideline for the diagnosis and
management of attention deficit hyperactivity disorder. Ambulatory Child
Health. 1998;4:51.


New River Pharmaceuticals Inc

nrpharma

Children With ADHD At Increased Risk For Depression And Suicidal Thoughts As Adolescents

Children diagnosed with attention deficit/hyperactivity disorder (ADHD) at ages 4 to 6 are more likely to suffer from depression as adolescents than those who did not have ADHD at that age, according to a long-term study published in the October issue of the Archives of General Psychiatry. Although it was an uncommon occurrence, the children with ADHD also were somewhat more likely to think about or attempt suicide as adolescents.


"This study is important in demonstrating that, even during early childhood, ADHD in is seldom transient or unimportant" said study director Benjamin Lahey, Ph.D., a professor of health studies and psychiatry at the University of Chicago. "It reinforces our belief that parents of young children with ADHD should pay close attention to their child's behavior and its consequences and seek treatment to prevent possible long-term problems."


Children with ADHD have trouble paying attention and controlling impulsive behaviors and are often overly active. This can cause poor performance in school, difficulties in social situations, and a loss of confidence and self esteem. The Centers for Disease Control and Prevention estimate that about 4.4 million children, including about four percent of those aged 4 to 6, have ADHD.


Earlier studies of the long-term connections between ADHD, depression and suicidal thoughts produced mixed results. This study benefited from a more comprehensive assessment of depression over a decade, a focus on specific child and family factors that predict which children are most at risk, and consideration of other factors associated with suicidal ideas.


The study, performed by researchers at the University of Chicago and the University of Pittsburgh, followed 123 children diagnosed with ADHD at age 4 to 6 for up to 14 years, until they reached ages 18 to 20. It compared them with 119 children from similar neighborhoods and schools, matched for age, sex, and ethnicity. The children were assessed annually in study years 1 through 4, 6 through 9, and 12 through 14.


The researchers found that 18 percent of children diagnosed early with ADHD suffered from depression as adolescents, about 10 times the rate among those without ADHD. Children with early ADHD were five times as likely to have considered suicide at least once, and twice as likely to have made an attempt.


"Suicide attempts were relatively rare, even in the study group," cautioned Lahey. "Parents should keep in mind that more than 80 percent of the children with ADHD did not attempt suicide and no one in this study committed suicide."


Although the subtypes of ADHD--based on whether they had attention deficit or hyperactivity or both--predict subsequent depression and suicidal thoughts, distinct forms of the disease at age 4 to 6 were moderately predictive for specific problems later on. Children with inattention or combined subtype were at greater risk for depression. Those with combined type or hyperactivity were at greater risk for suicidal thoughts.


Far more boys that girls suffer from ADHD, but being female increased the risk of depression. Children whose mothers suffered from depression were also at increased risk.


Children with more complicated ADHD were most at risk, the authors conclude. "Greater numbers of depression, anxiety, oppositional defiant disorder, and conduct disorder symptoms at ages 4 to 6 among children with ADHD robustly predicted risk for depression during adolescence. Children with uncomplicated ADHD with few concurrent symptoms of other disorders were at low risk for depression, but children with many concurrent symptoms were at very high risk."


The National Institutes of Health funded this study Additional authors include Andrea Chronis-Tuscano, PhD, of the University of Maryland; Brooke Molina, PhD, of the University of Pittsburgh; William Pelham, PhD, of Florida International University; Brooks Applegate, PhD, of Western Michigan University; and Allison Dahlke and Meghan Overmyer of the University of Chicago.


Source: University of Chicago Medical Center

Mixed Amphetamine Salts Extended Release Improves Information Processing In Adults With ADHD

Toronto, Canada - Mixed amphetamine salts extended release (MAS XR) substantially improved the speed and accuracy in information processing of adults with attention-deficit/hyperactivity disorder (ADHD), according to a study presented today at the annual American Psychiatric Association Meeting in Toronto, Canada.


"ADHD affects cognitive functioning - how people process information - and can interfere with the efficiency of completing tasks primarily due to the deficits in attention and executive functions," said investigator Gary Kay, Ph.D., president of the Washington Neuropsychological Institute. "Our analyses demonstrate that mixed amphetamine salts help people with ADHD to respond to a number of demanding cognitive tasks with more speed and accuracy."
In this study, participants started taking mixed amphetamine salts extended release or placebo for three weeks and were then switched to the other treatment while being evaluated by the same battery of tests. In a study of 14, participants who took MAS XR performed significantly better than those taking placebo on four variables, demonstrating improvements in divided attention, visuospatial working memory, visual scanning and tracking, and mental flexibility.


Assessment of cognitive functioning was conducted with the computer-administered CogScreen - Aeromedical Edition test, a test battery originally developed under contract to the Federal Aviation Administration for evaluating pilots. This validated test battery assesses visual and auditory attention and includes measures of working memory, information processing speed, mental flexibility, and divided attention. CogScreen is used by airlines as a predictor of flight performance and by biomedical researchers investigating the beneficial or adverse effects of medications on neurocognitive functioning.


"One unexpected finding was that patients who received mixed amphetamine salts extended release in the first treatment period and who were then switched to placebo for the second treatment period either maintained or improved their accuracy and response speed despite no longer receiving the medication," said Dr. Kay. "This finding suggests some lasting effects of psychostimulant treatment on certain aspects of neurocognitive processing in young adults with ADHD, underscoring the importance of treating ADHD early and appropriately," continued Kay.


Example: CogScreen Matching to Sample Test


Participants given a placebo before switching to mixed amphetamine salts extended release improved the accuracy of their responses (mean scores improved from 92.64 percent correct to 97.16 percent correct) on the Matching to Sample Test. This is a visual-spatial working memory test that requires participants to remember a checkerboard pattern and then identify that pattern after a brief delay. Patients given MAS XR in the first treatment period performed better than those receiving placebo (95.16 percent correct) and appeared to largely maintain this accuracy when taking placebo (94.32 percent correct).















This improvement in accuracy with MAS XR was paralleled by improvements in response speed. Patients receiving placebo in the first treatment phase had a mean response speed of 1.17 seconds. Their response speed improved to 1.04 seconds when taking MAS XR. Patients who received MAS XR in the first treatment phase demonstrated good response speed (1.07 seconds) and maintained their rapid response times when switched to placebo (1.06 seconds).


Additional Study Information


Investigators evaluated 17 adult participants, aged 19 to 25, in this six-week, double-blind, placebo-controlled, randomized two-way cross-over study. Neurocognitive results are based on 14 completers. Subjects were administered the CogScreen test battery twice during screening to become familiar with the cognitive tasks. At the completion of each 3-week treatment phase they were administered the CogScreen test battery four times; at 0 hours, 2 hours, 7 hours and 12 hours post-dose. When treated with MAS XR, participants received 20 milligrams (mg) daily during week one, followed by 40 mg/day during week two and 50 mg/day during week three.


MAS XR was well tolerated in the study. Thirty days after the final dose of MAS XR, participants received a follow-up phone call inquiring about any new-onset and serious adverse events.


About Washington Neuropsychological Institute


The Washington Neuropsychological Institute is a private, independent research organization that conducts clinical research trials and provides consulting services to government agencies and to the pharmaceutical industry. At their Northwest Washington, DC facility WNI has conducted studies on antihistamines, anticholinergics, memory enhancement drugs, jet lag remedies, head trauma, epilepsy, diabetes, Parkinson's Disease, Alzheimer's Disease, and ADHD. WNI is fully equipped to support Phase III and Phase IV clinical trials. The institute specializes in computer-based neurocognitive testing and driving simulation. In addition, professional staff members are frequent lecturers at national and international medical and scientific meetings.


About ADHD


ADHD is a neurological brain disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable age and maturity level. Because everyone shows signs of these behaviors at times, the behaviors must appear early in life (before age 7 years) and continue for at least six months, according to the ADHD diagnosis criteria as defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR?). Up to 65 percent of children with ADHD may still exhibit symptoms into adulthood. In fact, approximately eight million American adults currently struggle with the inattention, impulsivity and hyperactivity symptoms of ADHD.


Without an effective treatment program, the symptoms of ADHD may lead to potentially serious consequences. A survey has shown that when compared to adults without ADHD symptoms, adults with untreated ADHD were more than twice as likely to have been arrested, 47 percent more likely to have received more than one speeding ticket in the last year, twice as likely to have been divorced and twice as likely to have held six or more jobs in the past decade. Further, evidence suggests that many adults with untreated ADHD may be at risk for other problems, including poor performance in the workplace and poor self-image.


Although there is no cure for ADHD, physicians and advocates are finding ways to help people with the condition learn to adapt to their school, home, social and work settings. ADHD usually can be successfully managed with behavioral therapy, structured coping techniques and medication. Psychostimulant medications are thought to stimulate areas of the brain that control attention, impulses, and self-regulation of behavior, remain among the most successful treatments for people with ADHD. Up to 70 percent of children with ADHD respond positively to psychostimulants. Medication should be considered part of an overall multi-modal treatment plan for ADHD.


Priya Namjoshi

Porter Novelli

porternovelli/