Tag Archives: ADHD

Cincinnati Children’s Hospital Medical Center study: Exposure to pesticide linked to ADHD in boys

17 Jun

Many parents will be presented with a diagnosis of ADHD regarding their child. Yahoo medical reported in the article, Top 10 Myths About ADHD:

Myth #1: Only kids have ADHD.
Although about 10% of kids 5 to 17 years old have been diagnosed with ADHD, at least 4% of adults have it, too — and probably many more, since adult ADHD is often undiagnosed or misdiagnosed. That’s partly because people think only kids get it.

Myth #2: All kids “outgrow” ADHD.
Not nearly always. Up to 70% of children with ADHD continue to have trouble with it in adulthood, which can create relationship problems, money troubles, work strife, and a rocky family life.

Myth #3: Medication is the only treatment for ADHD.
Medication can be useful in managing ADHD symptoms, but it’s not a cure. And it’s not the only treatment. Lifestyle changes, counseling, and behavior modification can significantly improve symptoms as well. Several studies suggest that a combination of ADHD treatments works best.

Myth #4: People who have ADHD are lazy and lack intelligence and willpower.
This is totally not true. In fact, ADHD has nothing to do with intelligence or determination. It’s a neurobehavioral disorder caused by changes in brain chemicals and the way the brain works. It presents unique challenges, but they can be overcome — which many successful people have done. Even Albert Einstein is said to have had symptoms of ADHD.

Myth #5: ADHD isn’t a real disorder.
Not so. Doctors and mental-health professionals agree that ADHD is a biological disorder that can significantly impair functioning. An imbalance in brain chemicals affects brain areas that regulate behavior and emotion. This is what produces ADHD symptoms.

Myth #6: Bad parenting causes ADHD.
Absolutely not! ADHD symptoms are caused by brain-chemical imbalances (see #4 and #5) that make it hard to pay attention and control impulses. Good parenting skills help children deal with their symptoms.

Myth #7: Kids with ADHD are always hyper.
Not always. ADHD comes in three “flavors”: predominantly inattentive; predominantly hyperactive-impulsive; and combined, which is a mix of inattentive and hyperactive-impulsive symptoms. Although kids with hyperactive-impulsive or combined ADHD may be fidgety and restless, kids with inattentive ADHD are not hyper.

Myth #8: Too much TV time causes ADHD.
Not really. But spending excessive amounts of time watching TV or playing video games could trigger the condition in susceptible individuals. And in kids and teens who already have ADHD, spending hours staring at electronic screens may make symptoms worse.

Myth #9: If you can focus on certain things, you don’t have ADHD.
It’s not that simple. Although it’s true that people with ADHD have trouble focusing on things that don’t interest them, there’s a flip side to the disorder. Some people with ADHD get overly absorbed in activities they enjoy. This symptom is called hyperfocus. It can help you be more productive in activities that you like, but you can become so focused that you ignore responsibilities you don’t like.

Myth #10: ADHD is overdiagnosed.
Nope. If anything, ADHD is underdiagnosed and undertreated. Many children with ADHD grow up to be adults with ADHD. The pressures and responsibilities of adulthood often exacerbate ADHD symptoms, leading adults to seek evaluation and help for the first time. Also, parents who have children with ADHD may seek treatment only after recognizing similar symptoms in themselves.
http://shine.yahoo.com/parenting/top-10-myths-about-adhd-2528710.html

 Whether drug or behavior therapy is chosen to treat ADHD depends upon the goals of the parents.

Science Daily reported in Study links exposure to common pesticide with ADHD in boys:

A new study links a commonly used household pesticide with attention deficit hyperactivity disorder (ADHD) in children and young teens.

The study found an association between pyrethroid pesticide exposure and ADHD, particularly in terms of hyperactivity and impulsivity, rather than inattentiveness. The association was stronger in boys than in girls.

The study, led by researchers at Cincinnati Children’s Hospital Medical Center, is published online in the journal Environmental Health.

“Given the growing use of pyrethroid pesticides and the perception that they may represent a safe alternative, our findings may be of considerable public health importance,” says Tanya Froehlich, MD, a developmental pediatrician at Cincinnati Children’s and the study’s corresponding author.

Due to concerns about adverse health consequences, the United States Environmental Protection Agency banned the two most commonly used organophosphate (organic compounds containing phosphorus) pesticides from residential use in 2000-2001. The ban led to the increased use of pyrethroid pesticides, which are now the most commonly used pesticides for residential pest control and public health purposes. They also are used increasingly in agriculture.

Pyrethroids have often been considered a safer choice because they are not as acutely toxic as the banned organophosphates. Animal studies, on the other hand, suggested a heightened vulnerability to the effects of pyrethroid exposure on hyperactivity, impulsivity and abnormalities in the dopamine system in male mice. Dopamine is a neurochemical in the brain thought to be involved in many activities, including those that govern ADHD.

The researchers studied data on 687 children between the ages of 8 and 15. The data came from the 2000-2001 National Health and Nutrition Examination Survey (NHANES), which is a nationally representative sample of the United States population designed to collect information about health.

The 2000-2001 cycle of NHANES was the only cycle of the study that included a diagnostic interview of children’s ADHD symptoms and pyrethroid pesticide biomarkers. Pesticide exposure measurements were collected in a random sample of the urine of half the 8-11 year olds and a third of the 12-15 year olds.

ADHD was determined by meeting criteria on the Diagnosic Interview Schedule for Children, a diagnostic instrument that assesses 34 common psychiatric diagnoses of children and adolescents, or by caregiver report of a prior diagnosis. The DISC is administered by an interviewer…

http://www.sciencedaily.com/releases/2015/06/150601122535.htm

Citation:

Study links exposure to common pesticide with ADHD in boys

Date:              June 1, 2015

Source:           Cincinnati Children’s Hospital Medical Center

Summary:

A new study links a commonly used household pesticide with attention deficit hyperactivity disorder in children and young teens. The study found an association between pyrethroid pesticide exposure and ADHD, particularly in terms of hyperactivity and impulsivity, rather than inattentiveness. The association was stronger in boys than in girls.

Journal Reference:

  1. Melissa Wagner-Schuman, Jason R Richardson, Peggy Auinger, Joseph M Braun, Bruce P Lanphear, Jeffery N Epstein, Kimberly Yolton, Tanya E Froehlich.Association of pyrethroid pesticide exposure with attention-deficit/hyperactivity disorder in a nationally representative sample of U.S. childrenEnvironmental Health, 2015; 14 (1) DOI: 1186/s12940-015-0030-y

Here is the press release from Cincinnati Children’s Hospital Medical Center:

Study Links Exposure to Common Pesticide With ADHD in Boys

Monday, June 01, 2015

A new study links a commonly used household pesticide with attention deficit hyperactivity disorder (ADHD) in children and young teens.

The study found an association between pyrethroid pesticide exposure and ADHD, particularly in terms of hyperactivity and impulsivity, rather than inattentiveness. The association was stronger in boys than in girls.

The study, led by researchers at Cincinnati Children’s Hospital Medical Center, is published online in the journal Environmental Health.

“Given the growing use of pyrethroid pesticides and the perception that they may represent a safe alternative, our findings may be of considerable public health importance,” says Tanya Froehlich, MD, a developmental pediatrician at Cincinnati Children’s and the study’s corresponding author.

Due to concerns about adverse health consequences, the United States Environmental Protection Agency banned the two most commonly used organophosphate (organic compounds containing phosphorus) pesticides from residential use in 2000-2001. The ban led to the increased use of pyrethroid pesticides, which are now the most commonly used pesticides for residential pest control and public health purposes. They also are used increasingly in agriculture.

Pyrethroids have often been considered a safer choice because they are not as acutely toxic as the banned organophosphates. Animal studies, on the other hand, suggested a heightened vulnerability to the effects of pyrethroid exposure on hyperactivity, impulsivity and abnormalities in the dopamine system in male mice. Dopamine is a neurochemical in the brain thought to be involved in many activities, including those that govern ADHD.

The researchers studied data on 687 children between the ages of 8 and 15. The data came from the 2000-2001 National Health and Nutrition Examination Survey (NHANES), which is a nationally representative sample of the United States population designed to collect information about health.

The 2000-2001 cycle of NHANES was the only cycle of the study that included a diagnostic interview of children’s ADHD symptoms and pyrethroid pesticide biomarkers. Pesticide exposure measurements were collected in a random sample of the urine of half the 8-11 year olds and a third of the 12-15 year olds.

ADHD was determined by meeting criteria on the Diagnosic Interview Schedule for Children, a diagnostic instrument that assesses 34 common psychiatric diagnoses of children and adolescents, or by caregiver report of a prior diagnosis. The DISC is administered by an interviewer.

Boys with detectable urinary 3-PBA, a biomarker of exposure to pyrethroids, were three times as likely to have ADHD compared with those without detectable 3-PBA. Hyperactivity and impulsivity increased by 50 percent for every 10-fold increase in 3-PBA levels in boys. Biomarkers were not associated with increased odds of ADHD diagnosis or symptoms in girls.

“Our study assessed pyrethroid exposure using 3-PBA concentrations in a single urine sample,” says Dr. Froehlich. “Given that pyrethroids are non-persistent and rapidly metabolized, measurements over time would provide a more accurate assessment of typical exposure and are recommended in future studies before we can say definitively whether our results have public health ramifications.”

This study was supported by National Institutes of Health grants R01ES015991, R01ES015991-04S1, P30ES005022, K23 MH083881, K24 MH064478, R00 ES020346, and R01ES015517-01A1.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News & World Report’s 2014 Best Children’s Hospitals. It is also ranked in the top 10 for all 10 pediatric specialties. Cincinnati Children’s, a non-profit organization, is one of the top three recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org. Connect on the Cincinnati Children’s blog, via Facebookand on Twitter.

Contact Information

Jim Feuer, 513-636-4656, Jim.Feuer@cchmc.org

http://www.cincinnatichildrens.org/news/release/2015/study-links-pesticide-ADHD-in-boys-06-01-2015/

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary

http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report

http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide

http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and Executive Functioning

http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes

http://www.helpforld.com/efacoutcomes.pdf

Related:

Louisiana study: Fit children score higher on standardized tests

https://drwilda.com/2012/05/08/louisiana-study-fit-children-score-higher-on-standardized-tests/

Studies: ADHD drugs don’t necessarily improve academic performance

https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome

https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

An ADHD related disorder: ‘Sluggish Cognitive Tempo’

https://drwilda.com/2014/04/12/an-adhd-related-disorder-sluggish-cognitive-tempo/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©

http://drwildareviews.wordpress.com/

Dr. Wilda ©

https://drwilda.com/

University of Central Florida study: Kids with ADHD must fidget to learn

19 Apr

Moi wrote in ADHD coaching to improve a child’s education outcome:
The American Academy of Child and Adolescent Psychiatry discusses the primary symptoms of ADHD in the article, What Is ADHD:

The primary symptoms of ADHD are hyperactivity, impulsivity, and inattention.
Hyperactive children always seem to be in motion. A child who is hyperactive may move around touching or playing with whatever is around, or talk continually. During story time or school lessons, the child might squirm around, fidget, or get up and move around the room. Some children wiggle their feet or tap their fingers. A teenager or adult who is hyperactive may feel restless and need to stay busy all the time.
Impulsive children often blurt out comments without thinking first. They may often display their emotions without restraint. They may also fail to consider the consequences of their actions. Such children may find it hard to wait in line or take turns. Impulsive teenagers and adults tend to make choices that have a small immediate payoff rather than working toward larger delayed rewards….

ADHD News has a synopsis of the ADHD news
http://www.medicalnewstoday.com/categories/adhd
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Science Daily reported in Kids with ADHD must squirm to learn, study says:

But new research conducted at UCF shows that if you want ADHD kids to learn, you have to let them squirm. The foot-tapping, leg-swinging and chair-scooting movements of children with attention-deficit/hyperactivity disorder are actually vital to how they remember information and work out complex cognitive tasks, according to a study published in an early online release of the Journal of Abnormal Child Psychology.

The findings show the longtime prevailing methods for helping children with ADHD may be misguided.

“The typical interventions target reducing hyperactivity. It’s exactly the opposite of what we should be doing for a majority of children with ADHD,” said one of the study’s authors, Mark Rapport, head of the Children’s Learning Clinic at the University of Central Florida. “The message isn’t ‘Let them run around the room,’ but you need to be able to facilitate their movement so they can maintain the level of alertness necessary for cognitive activities.”
The research has major implications for how parents and teachers should deal with ADHD kids, particularly with the increasing weight given to students’ performance on standardized testing. The study suggests that a majority of students with ADHD could perform better on classroom work, tests and homework if they’re sitting on activity balls or exercise bikes, for instance.

The study at the UCF clinic included 52 boys ages 8 to 12. Twenty-nine of the children had been diagnosed with ADHD and the other 23 had no clinical disorders and showed normal development….. http://www.sciencedaily.com/releases/2015/04/150417190003.htm

Citation:

Kids with ADHD must squirm to learn, study says
Date: April 17, 2015

Source: University of Central Florida

Summary:

Excessive movement common among children with attention-deficit/hyperactivity disorder is actually vital to how they remember information and work out complex cognitive tasks, a new study shows. The findings show the longtime prevailing methods for helping children with ADHD may be misguided.

Journal Reference:
1. Dustin E. Sarver, Mark D. Rapport, Michael J. Kofler, Joseph S. Raiker, Lauren M. Friedman. Hyperactivity in Attention-Deficit/Hyperactivity Disorder (ADHD): Impairing Deficit or Compensatory Behavior? Journal of Abnormal Child Psychology, 2015; DOI: 10.1007/s10802-015-0011-1

Here is the press release from the University of Central Florida:

Kids with ADHD Must Squirm to Learn, UCF Study Says

For decades, frustrated parents and teachers have barked at fidgety children with ADHD to “Sit still and concentrate!”

But new research conducted at UCF shows that if you want ADHD kids to learn, you have to let them squirm. The foot-tapping, leg-swinging and chair-scooting movements of children with attention-deficit/hyperactivity disorder are actually vital to how they remember information and work out complex cognitive tasks, according to a study published in an early online release of the Journal of Abnormal Child Psychology.

The findings show the longtime prevailing methods for helping children with ADHD may be misguided.

“The typical interventions target reducing hyperactivity. It’s exactly the opposite of what we should be doing for a majority of children with ADHD,” said one of the study’s authors, Mark Rapport, head of the Children’s Learning Clinic at the University of Central Florida. “The message isn’t ‘Let them run around the room,’ but you need to be able to facilitate their movement so they can maintain the level of alertness necessary for cognitive activities.”
The research has major implications for how parents and teachers should deal with ADHD kids, particularly with the increasing weight given to students’ performance on standardized testing. The study suggests that a majority of students with ADHD could perform better on classroom work, tests and homework if they’re sitting on activity balls or exercise bikes, for instance.

The study at the UCF clinic included 52 boys ages 8 to 12. Twenty-nine of the children had been diagnosed with ADHD and the other 23 had no clinical disorders and showed normal development.

Each child was asked to perform a series of standardized tasks designed to gauge “working memory,” the system for temporarily storing and managing information required to carry out complex cognitive tasks such as learning, reasoning and comprehension.

Children were shown a series of jumbled numbers and a letter that flashed onto a computer screen, then asked to put the numbers in order, followed by the letter. A high-speed camera recorded the kids, and observers recorded their every movement and gauged their attention to the task.

Rapport’s previous research had already shown that the excessive movement that’s a trademark of hyperactive children – previously thought to be ever-present – is actually apparent only when they need to use the brain’s executive brain functions, especially their working memory.

The new study goes an important step further, proving the movement serves a purpose.
“What we’ve found is that when they’re moving the most, the majority of them perform better,” Rapport said. “They have to move to maintain alertness.”

By contrast, the children in the study without ADHD also moved more during the cognitive tests, but it had the opposite effect: They performed worse.

In addition to Rapport, the study was co-authored by Dustin Sarver of the University of Mississippi Medical Center, Michael Kofler of Florida State University, Lauren Friedman of the University of Central Florida, and Joe Raiker of Florida International University. http://today.ucf.edu/kids-with-adhd-must-squirm-to-learn/

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report
http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide
http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and Executive Functioning
http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes
http://www.helpforld.com/efacoutcomes.pdf

Louisiana study: Fit children score higher on standardized tests
https://drwilda.com/2012/05/08/louisiana-study-fit-children-score-higher-on-standardized-tests/

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:

Studies: ADHD drugs don’t necessarily improve academic performance
https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

An ADHD related disorder: ‘Sluggish Cognitive Tempo’
https://drwilda.com/2014/04/12/an-adhd-related-disorder-sluggish-cognitive-tempo/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©                                                                                       http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

University of Illinois Urbana- Champaign study: ADHD kids may benefit with FITKids exercise intervention

21 Oct

Moi wrote in ADHD coaching to improve a child’s education outcome:
The American Academy of Child and Adolescent Psychiatry discusses the primary symptoms of ADHD in the article, What Is ADHD:

The primary symptoms of ADHD are hyperactivity, impulsivity, and inattention.
Hyperactive children always seem to be in motion. A child who is hyperactive may move around touching or playing with whatever is around, or talk continually. During story time or school lessons, the child might squirm around, fidget, or get up and move around the room. Some children wiggle their feet or tap their fingers. A teenager or adult who is hyperactive may feel restless and need to stay busy all the time.
Impulsive children often blurt out comments without thinking first. They may often display their emotions without restraint. They may also fail to consider the consequences of their actions. Such children may find it hard to wait in line or take turns. Impulsive teenagers and adults tend to make choices that have a small immediate payoff rather than working toward larger delayed rewards….

ADHD News has a synopsis of the ADHD news     http://www.medicalnewstoday.com/categories/adhd

https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Julia Lawrence of Education News reported about a Quebec study in the article, Study: ADHD Drugs Don’t Improve Academic Performance in Kids:

Shirley S. Wang of The Wall Street Journal writes about one such study published in June which looked at academic outcomes of Quebec students prescribed ADHD drugs like Ritalin and Adderall over a span of 11 years. Researchers concluded that boys who were taking drugs academically underperformed peers with the same symptoms who were not medicated. The working paper published by the National Bureau of Economic Research also reported that girls who took ADHD drugs had higher incidence of emotional problems than ones who did not.

“The possibility that [medication] won’t help them [in school] needs to be acknowledged and needs to be closely monitored,” says economics professor Janet Currie, an author on the paper and director of the Center for Health & Wellbeing, a health policy institute at Princeton University. Kids may not get the right dose to see sustained benefits, or they may stop taking the medication because side effects or other drawbacks outweigh the benefits, she says.

Why drugs that claim to improve concentration, focus and emotional control don’t lead to academic improvement is a question that has puzzled researchers for some time — and answering the question could be the key to effective ADHD treatment in children. Finding an effective treatment regime could help a lot of kids; according to Centers for Disease Control and Prevention, there are 2.7 million children currently on ADHD drugs of some kind in the United States alone.

http://www.educationnews.org/parenting/study-adhd-drugs-dont-improve-academic-performance-in-kids/#sthash.HkASci3N.dpuf

This study is in accord with research from Yale University.

Geneva Pittman of Reuters wrote in the article, Be cautious of mind-altering drugs for kids: doctors:

Focusing on stimulants typically used to treat attention deficit hyperactivity disorder, or ADHD, researchers said the number of diagnoses and prescriptions have risen dramatically over the past two decades.

Young people with the disorder clearly benefit from treatment, lead author Dr. William Graf emphasized, but the medicines are increasingly being used by healthy youth who believe they will enhance their concentration and performance in school.

According to the National Institute on Drug Abuse, 1.7 percent of eighth graders and 7.6 percent of 12th graders have used Adderall, a stimulant, for nonmedical reasons.
Some of those misused medicines are bought on the street or from peers with prescriptions; others may be obtained legally from doctors.

“What we’re saying is that because of the volume of drugs and the incredible increase… the possibility of overdiagnosis and overtreatment is clearly there,” said Graf, from Yale University in New Haven, Connecticut.

In their statement, published in the journal Neurology, he and his colleagues say doctors should not give prescriptions to teens who ask for medication to enhance concentration against their parents’ advice. http://www.reuters.com/article/2013/03/13/us-medications-kids-idUSBRE92C17H20130313

A University of Illinois study indicates that exercise might be an effective therapy.

James Hamlin wrote in the Atlantic article: Exercise Is ADHD Medication:

Physical movement improves mental focus, memory, and cognitive flexibility; new research shows just how critical it is to academic performance.

Mental exercises to build (or rebuild) attention span have shown promise recently as adjuncts or alternatives to amphetamines in addressing symptoms common to Attention Deficit Hyperactivity Disorder (ADHD). Building cognitive control, to be better able to focus on just one thing, or single-task, might involve regular practice with a specialized video game that reinforces “top-down” cognitive modulation, as was the case in a popular paper in Nature last year. Cool but still notional. More insipid but also more clearly critical to addressing what’s being called the ADHD epidemic is plain old physical activity.

This morning the medical journal Pediatrics published research that found kids who took part in a regular physical activity program showed important enhancement of cognitive performance and brain function. The findings, according to University of Illinois professor Charles Hillman and colleagues, “demonstrate a causal effect of a physical program on executive control, and provide support for physical activity for improving childhood cognition and brain health.” If it seems odd that this is something that still needs support, that’s because it is odd, yes. Physical activity is clearly a high, high-yield investment for all kids, but especially those attentive or hyperactive. This brand of research is still published and written about as though it were a novel finding, in part because exercise programs for kids remain underfunded and underprioritized in many school curricula, even though exercise is clearly integral to maximizing the utility of time spent in class…..                                                                                                                       http://www.theatlantic.com/health/archive/2014/09/exercise-seems-to-be-beneficial-to-children/380844/?single_page=true

Citation:

Effects of the FITKids Randomized Controlled Trial on Executive Control and Brain Function

  1. Charles H. Hillman, PhDa,
  2. Matthew B. Pontifex, PhDb,
  3. Darla M. Castelli, PhDc,
  4. Naiman A. Khan, PhD, RDa,
  5. Lauren B. Raine, BSa,
  6. Mark R. Scudder, BSa,
  7. Eric S. Drollette, BSa,
  8. Robert D. Moore, MSa,
  9. Chien-Ting Wu, PhDd, and
  10. Keita Kamijo, PhDe

+ Author Affiliations

1.     aDepartment of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois; 2.     bDepartment of Kinesiology, Michigan State University, East Lansing, Michigan; 3.     cDepartment of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas; 4.     dDepartment of Exercise Science, Schreiner College, Kerrville, Texas; and 5.     eSchool of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan

Abstract

OBJECTIVE: To assess the effect of a physical activity (PA) intervention on brain and behavioral indices of executive control in preadolescent children.

METHODS: Two hundred twenty-one children (7–9 years) were randomly assigned to a 9-month afterschool PA program or a wait-list control. In addition to changes in fitness (maximal oxygen consumption), electrical activity in the brain (P3-ERP) and behavioral measures (accuracy, reaction time) of executive control were collected by using tasks that modulated attentional inhibition and cognitive flexibility.

RESULTS: Fitness improved more among intervention participants from pretest to posttest compared with the wait-list control (1.3 mL/kg per minute, 95% confidence interval [CI]: 0.3 to 2.4; d = 0.34 for group difference in pre-to-post change score). Intervention participants exhibited greater improvements from pretest to posttest in inhibition (3.2%, 95% CI: 0.0 to 6.5; d = 0.27) and cognitive flexibility (4.8%, 95% CI: 1.1 to 8.4; d = 0.35 for group difference in pre-to-post change score) compared with control. Only the intervention group increased attentional resources from pretest to posttest during tasks requiring increased inhibition (1.4 µV, 95% CI: 0.3 to 2.6; d = 0.34) and cognitive flexibility (1.5 µV, 95% CI: 0.6 to 2.5; d = 0.43). Finally, improvements in brain function on the inhibition task (r = 0.22) and performance on the flexibility task correlated with intervention attendance (r = 0.24).

CONCLUSIONS: The intervention enhanced cognitive performance and brain function during tasks requiring greater executive control. These findings demonstrate a causal effect of a PA program on executive control, and provide support for PA for improving childhood cognition and brain health.

Key Words:

  • Accepted July 25, 2014.

After-school exercise program enhances cognition in 7-, 8- and 9-year-olds

Date:         September 29, 2014

Source:           University of Illinois at Urbana-Champaign

Summary:

A nine-month-long, randomized controlled trial involving 221 prepubescent children found that those who engaged in moderate-to-vigorous physical activity for at least 60 minutes a day after school saw substantial improvements in their ability to pay attention, avoid distraction and switch between cognitive tasks, researchers report.

Here is the press report from the University of Illinois Urbana- Champaign:

After-school exercise program enhances cognition in 7-, 8- and 9-year-olds

Email Share

9/29/2014 | Diana Yates, Life Sciences Editor | 217-333-5802; diya@illinois.edu

CHAMPAIGN, Ill. — A nine-month-long, randomized controlled trial involving 221 prepubescent children found that those who engaged in moderate-to-vigorous physical activity for at least 60 minutes a day after school saw substantial improvements in their ability to pay attention, avoid distraction and switch between cognitive tasks, researchers report in the journal Pediatrics.

Fitness, cognitive function and brain function improved in children in the FITKids exercise intervention group, researchers report. | Photo by L. Brian Stauffer

Half of the study subjects were randomly assigned to the after-school program and the rest were placed on a wait list. All participants underwent cognitive testing and brain imaging before and after the intervention.

“Those in the exercise group received a structured intervention that was designed for the way kids like to move,” said University of Illinois kinesiology and community health professor Charles Hillman, who led the study. “They performed short bouts of exercise interspersed with rest over a two-hour period.”

The intervention, called FITKids, was based on the CATCH exercise program, a research-based health promotion initiative that was initially funded by the National Institutes of Health and now is used by schools and health departments across the U.S.

The children in the FITKids exercise group wore heart-rate monitors and pedometers during the intervention.

“On average, kids’ heart rates corresponded with a moderate-to-vigorous level of exercise intensity, and they averaged about 4,500 steps during the two-hour intervention,” Hillman said. The children were active about 70 minutes per day.

As expected, fitness increased most in the intervention group over the course of the study.

“We saw about a six percent increase in fitness in children in the FITKids intervention group,” Hillman said. Fitness improved less than one percent in the wait-list control group, he said.

Children in the exercise group also demonstrated substantial increases in “attentional inhibition,” a measure of their ability to block out distractions and focus on the task at hand. And they improved in “cognitive flexibility,” which involves switching between intellectual tasks while maintaining speed and accuracy. Children in the wait-list control group saw minimal improvements in these measures, in line with what would be expected as a result of normal maturation over the nine months, Hillman said.

“Kids in the intervention group improved two-fold compared to the wait-list kids in terms of their accuracy on cognitive tasks,” he said. “And we found widespread changes in brain function, which relate to the allocation of attention during cognitive tasks and cognitive processing speed. These changes were significantly greater than those exhibited by the wait-list kids.

“Interestingly, the improvements observed in the FITKids intervention were correlated with their attendance rate, such that greater attendance was related to greater change in brain function and cognitive performance,” Hillman said.

The study did not distinguish improvements that were the result of increased fitness from those that might stem from the social interactions, stimulation and engagement the children in the intervention group experienced, Hillman said.

“Other research at Georgia Regents University led by Catherine Davis has actually used social and game-playing as their control group, and showed that the cognitive effects of their physical activity intervention are above-and-beyond those that are gained just through social interactions,” he said.

The FITKids program is designed to get children socially engaged in exercise, which is part of what makes it an effective intervention, Hillman said.

“The fact is that kids are social beings; they perform physical activity in a social environment,” he said. “A big reason why kids participate in a structured sports environment is because they find it fun and they make new friends. And this intervention was designed to meet those needs as well.”

The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health funded this research.

Editor’s note: To reach Charles Hillman, call 217-244-2663; email chhillma@illinois.edu.

The paper, “Effects of the FITKids Randomized Controlled Trial on Executive Control and Brain Function,” is available online or from the U. of I. News Bureau.

Physically fit children are not only healthier, but are better able to perform better in school. Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary

http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report

http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide

http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and ExecutiveFunctioning

http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes

http://www.helpforld.com/efacoutcomes.pdf

Louisiana study: Fit children score higher on standardized tests

https://drwilda.com/2012/05/08/louisiana-study-fit-children-score-higher-on-standardized-tests/

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:

Studies: ADHD drugs don’t necessarily improve academic performance

https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome

https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

An ADHD related disorder: ‘Sluggish Cognitive Tempo’

https://drwilda.com/2014/04/12/an-adhd-related-disorder-sluggish-cognitive-tempo/

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Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

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Dr. Wilda Reviews ©

http://drwildareviews.wordpress.com/

Dr. Wilda ©

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Yale, New York University and University of Wisconsin Madison study: More ADHD medication given during school term to lower status children

16 Oct

Carolyne Gregoire reported in the Huffington Post article, American Teens Are Even More Stressed Than Adults:

Last year, the American Psychological Association’s Stress in America survey found that Millennials, aged 18-33, were the country’s most-stressed generation. Now, the title belongs to an even younger demographic: American teenagers.
Even before the pressures of work and adulthood set in, for most young Americans, stress has already become a fact of daily life. And this sets the stage early for unhealthy behaviors and lifestyle choices that may increase the risk of developing stress-related health problems down the road.
American teenagers are now the most stressed-out age group in the U.S., according to APA’s 2013 Stress In America survey. While adults rate their stress at a 5.1 on a 10-point scale, teens rate their stress levels at 5.8…… http://www.huffingtonpost.com/2014/02/11/american-teens-are-even-m_n_4768204.html?utm_hp_ref=email_share

Quite often stress and depression in children is treated with medication.

Science Tech Daily reported in the article, Study Finds Stimulant Use Increases by 30% During the School Year:

New research from Yale, NYU and the University of Wisconsin-Madison shows that students are 30% more likely to take a stimulant medication during the school year than they are to take one during the summer.
The authors found that school-year increases in stimulant use are largest for children from socioeconomically advantaged families. Because many children use stimulants only during the school year and take a “drug holiday” in the summer, the authors conclude that these children are using stimulants to manage their schools’ academic demands.
Stimulant medications, which improve concentration and help manage other symptoms associated with attention-deficit hyperactivity disorder (ADHD), are the most widely used class of medications among adolescents. Childrens’ use of these medications in the United States has increased dramatically in the last two decades, from approximately 2.4% of children in 1996 to 6% of children at present…. http://scitechdaily.com/study-finds-stimulant-use-increases-30-school-year/

Citation:

Medical Adaptation to Academic Pressure
Schooling, Stimulant Use, and Socioeconomic Status
1. Marissa D. Kinga
2. Jennifer Jenningsb
3. Jason M. Fletcherc
1. aYale School of Management
2. bNew York University
3. cUniversity of Wisconsin-Madison
1. Marissa King, Yale School of Management, 165 Whitney Avenue, New Haven, CT 06511 E-mail: marissa.king@yale.edu
Abstract
Despite the rise of medical interventions to address behavioral issues in childhood, the social determinants of their use remain poorly understood. By analyzing a dataset that includes the majority of prescriptions written for stimulants in the United States, we find a substantial effect of schooling on stimulant use. In middle and high school, adolescents are roughly 30 percent more likely to have a stimulant prescription filled during the school year than during the summer. Socioeconomically advantaged children are more likely than their less advantaged peers to selectively use stimulants only during the academic year. These differences persist when we compare higher and lower socioeconomic status children seeing the same doctors. We link these responses to academic pressure by exploiting variation between states in educational accountability system stringency. We find the largest differences in school year versus summer stimulant use in states with more accountability pressure. School-based selective stimulant use is most common among economically advantaged children living in states with strict accountability policies. Our study uncovers a new pathway through which medical interventions may act as a resource for higher socioeconomic status families to transmit educational advantages to their children, either intentionally or unwittingly.

Here is the synopsis from Yale Insights:

Medicate to Educate: Study Finds Stimulant Use Increases by 30% During the School Year
Marissa D. King — October 2014
Children are 30% more likely to take a stimulant medication during the school year than they are to take one during the summer, according to a new study published in the American Sociological Review. The authors found that school-year increases in stimulant use are largest for children from socioeconomically advantaged families. Because many children use stimulants only during the school year and take a “drug holiday” in the summer, the authors conclude that these children are using stimulants to manage their schools’ academic demands.
Stimulant medications, which improve concentration and help manage other symptoms associated with attention-deficit hyperactivity disorder (ADHD), are the most widely used class of medications among adolescents. Childrens’ use of these medications in the United States has increased dramatically in the last two decades, from approximately 2.4% of children in 1996 to 6% of children at present.
Larger school-year increases in stimulant use were found in states with higher levels of accountability pressure, suggesting that education policies impact stimulant use. Children from families who are not poor and live in states with more strict standardized-testing and school-accountability environments are much more likely to use stimulants only during the school year compared to their less economically advantaged peers in states with less stringent accountability environments.
“Many parents are faced with a tough decision: Do they medicate their kids to help them manage in an increasingly demanding school environment?” said Marissa King, assistant professor of organizational behavior at the Yale School of Management and lead author of the study. “Rather than trying to make kids conform to the school system by taking stimulants, we need to take a closer look at what is happening in schools.”
To examine the effect of schooling on stimulant use, King and her colleagues analyzed a data set including the majority of prescriptions written for stimulants in the United States during the 2007-2008 academic year. They linked the patterns of stimulant use during the school year to academic pressure by analyzing state rankings of school-accountability policies published by Education Week. Differences in school year and summer use could not be explained by avoidance of medication side effects, medication cost, or type of ADHD.
The researchers also examined the influence of doctors on school-based stimulant use to determine whether the socioeconomic differences they observe occur because more- and less-advantaged children see different doctors. Even when children from more- and less-advantaged backgrounds were treated by the same doctor, children from more-advantaged backgrounds were more likely to use stimulants only during the school year. This suggests that socioeconomic differences in school-based stimulant use are driven by parents, not doctors. “Socioeconomically advantaged families are more likely to trust their own judgment about medication decisions rather than defer to their doctors,” said King.
The researchers say that the study suggests that medical interventions like stimulant use may be a new pathway through which more advantaged parents translate their economic advantages into educational advantages for their children, either intentionally or unwittingly.
“Medical Adaptation to Academic Pressure: Schooling, Stimulant Use, and Socioeconomic Status,” by Marissa King (Yale School of Management), Jennifer Jennings (New York University), and Jason Fletcher (University of Wisconsin-Madison), is published in the American Sociological Review.
http://insights.som.yale.edu/insights/medicate-educate-study-finds-stimulant-use-increases-30-during-school-year

Paul Tough wrote a very thoughtful New York Times piece about the importance of failure in developing character, not characters.
In What If the Secret to Success Is Failure? Tough writes:
Dominic Randolph can seem a little out of place at Riverdale Country School — which is odd, because he’s the headmaster. Riverdale is one of New York City’s most prestigious private schools, with a 104-year-old campus that looks down grandly on Van Cortlandt Park from the top of a steep hill in the richest part of the Bronx. On the discussion boards of UrbanBaby.com, worked-up moms from the Upper East Side argue over whether Riverdale sends enough seniors to Harvard, Yale and Princeton to be considered truly “TT” (top-tier, in UrbanBabyese), or whether it is more accurately labeled “2T” (second-tier), but it is, certainly, part of the city’s private-school elite, a place members of the establishment send their kids to learn to be members of the establishment. Tuition starts at $38,500 a year, and that’s for prekindergarten.
Randolph, by contrast, comes across as an iconoclast, a disrupter, even a bit of an eccentric. He dresses for work every day in a black suit with a narrow tie, and the outfit, plus his cool demeanor and sweep of graying hair, makes you wonder, when you first meet him, if he might have played sax in a ska band in the ’80s. (The English accent helps.) He is a big thinker, always chasing new ideas, and a conversation with him can feel like a one-man TED conference, dotted with references to the latest work by behavioral psychologists and management gurus and design theorists. When he became headmaster in 2007, he swapped offices with his secretary, giving her the reclusive inner sanctum where previous headmasters sat and remodeling the small outer reception area into his own open-concept work space, its walls covered with whiteboard paint on which he sketches ideas and slogans. One day when I visited, one wall was bare except for a white sheet of paper. On it was printed a single black question mark.
For the headmaster of an intensely competitive school, Randolph, who is 49, is surprisingly skeptical about many of the basic elements of a contemporary high-stakes American education. He did away with Advanced Placement classes in the high school soon after he arrived at Riverdale; he encourages his teachers to limit the homework they assign; and he says that the standardized tests that Riverdale and other private schools require for admission to kindergarten and to middle school are “a patently unfair system” because they evaluate students almost entirely by I.Q. “This push on tests,” he told me, “is missing out on some serious parts of what it means to be a successful human.”
The most critical missing piece, Randolph explained as we sat in his office last fall, is character — those essential traits of mind and habit that were drilled into him at boarding school in England and that also have deep roots in American history. “Whether it’s the pioneer in the Conestoga wagon or someone coming here in the 1920s from southern Italy, there was this idea in America that if you worked hard and you showed real grit, that you could be successful,” he said. “Strangely, we’ve now forgotten that. People who have an easy time of things, who get 800s on their SAT’s, I worry that those people get feedback that everything they’re doing is great. And I think as a result, we are actually setting them up for long-term failure. When that person suddenly has to face up to a difficult moment, then I think they’re screwed, to be honest. I don’t think they’ve grown the capacities to be able to handle that….” http://www.nytimes.com/2011/09/18/magazine/what-if-the-secret-to-success-is-failure.html?emc=eta1&_r=0
Because of high stakes testing, it appears that poorer children are being given medication because of educational policy issues like having a school or district appear to succeed in a testing environment, rather than the particular need of the child.

Related:

Schools have to deal with depressed and troubled children https://drwilda.wordpress.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

School psychologists are needed to treat troubled children https://drwilda.wordpress.com/2012/02/27/school-psychologists-are-needed-to-treat-troubled-children/

Battling teen addiction: ‘Recovery high schools https://drwilda.wordpress.com/2012/07/08/battling-teen-addiction-recovery-high-schools/

Resources:
Psych Central’s Depression In Young Children http://psychcentral.com/news/2010/05/20/depression-in-young-children/13970.html

WebMD’s Depression In Children http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed? http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

Medicine.Net’s Depression In Children http://www.medicinenet.com/depression_in_children/article.htm

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An ADHD related disorder: ‘Sluggish Cognitive Tempo’

12 Apr

Tania Tirraoro posted the article, It’s not ADHD, it’s Sluggish Cognitive Tempo at Special Needs jungle:

Have you heard of “Sluggish Cognitive Tempo” (SCT)? It’s apparently regarded by psychiatric professionals as a subtype of attention-deficit/hyperactivity disorder (ADHD). Until now, that is.
Medscape has reported some research that concludes it is most likely to be a distinct attention disorder, although there is notable overlap with ADHD.
The researchers, Dr Catherine Saxbe and Dr Russell A. Barkley from the Medical University of South Carolina in the US, have based their findings on reviewing nearly three decades’ worth of research on SCT and their own clinical experience. They’re predicting that, given the evidence, SCT may “eventually be accepted as an identifiable attention disorder with its own diagnostic criteria that distinguish it from ADHD.”. Writing in the Journal of Psychiatric Practice they claim that SCT may represent an exciting new frontier in psychiatry.
Characteristics of Sluggish Cognitive Tempo
• Like ADHD, SCT typically presents in childhood.
• Being daydreamy, mentally foggy, and easily confused.
• Staring frequently.
• May have symptoms of hypoactivity, lethargy, slow movement, possibly sleepiness.
• Children with SCT also appear to have slow processing speed and reaction times.
There are no officially endorsed criteria for SCT but the researchers believe that may change in the “foreseeable future,” and that most doctors who see children with ADHD have probably come across someone who falls within the parameters of SCT.
First, there needs to be more research on the cognitive deficits, such as which areas of the brain are most active when the patient appears the most distracted ― in other words the researchers say, “where does the mind go?” http://www.specialneedsjungle.com/adhd-sluggish-cognitive-tempo/

See, Slow Cognitive Tempo (SCT): The Second Attention Disorder http://www.youtube.com/watch?v=1t7X6uhgB4E

Alan Schwartz reported in the New York Times article, Idea of New Attention Disorder Spurs Research, and Debate:

With more than six million American children having received a diagnosis of attention deficit hyperactivity disorder, concern has been rising that the condition is being significantly misdiagnosed and overtreated with prescription medications.
Yet now some powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children.
Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship A.D.H.D. drug might treat it.
The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming that the question of its existence “seems to be laid to rest as of this issue.” The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”
In an interview, Keith McBurnett, a professor of psychiatry at the University of California, San Francisco, and co-author of several papers on sluggish cognitive tempo, said: “When you start talking about things like daydreaming, mind-wandering, those types of behaviors, someone who has a son or daughter who does this excessively says, ‘I know about this from my own experience.’ They know what you’re talking about.”
Yet some experts, including Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications — problems that A.D.H.D. already faces.
“We’re seeing a fad in evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances, an emeritus professor of psychiatry at Duke University. “This is a public health experiment on millions of kids.”
Though the concept of sluggish cognitive tempo, or S.C.T., has been researched sporadically since the 1980s, it has never been recognized in the Diagnostic and Statistical Manual of Mental Disorders, which codifies conditions recognized by the American Psychiatric Association. The editor in chief of The Journal of Abnormal Child Psychology, Charlotte Johnston, said in an email that recent renewed interest in the condition is what led the journal to devote most of one issue to “highlight areas in which further study is needed…” http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html?ref=education&_r=0

Citation:

Journal of Abnormal Child Psychology
January 2014, Volume 42, Issue 1, pp 1-6
Sluggish Cognitive Tempo in Abnormal Child Psychology: An Historical Overview and Introduction to the Special Section
• Stephen P. Becker,
• Stephen A. Marshall,
• Keith McBurnett
• …show all 3hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Abstract
There has recently been a resurgence of interest in Sluggish Cognitive Tempo (SCT) as an important construct in the field of abnormal child psychology. Characterized by drowsiness, daydreaming, lethargy, mental confusion, and slowed thinking/behavior, SCT has primarily been studied as a feature of Attention-Deficit/Hyperactivity Disorder (ADHD), and namely the predominately inattentive subtype/presentation. Although SCT is strongly associated with ADHD inattention, research increasingly supports the possibility that SCT is distinct from ADHD or perhaps a different mental health condition altogether, with unique relations to child and adolescent psychosocial adjustment. This introductory article to the Special Section on SCT provides an historical overview of the SCT construct and briefly describes the contributions of the eight empirical papers included in the Special Section. Given the emerging importance of SCT for abnormal psychology and clinical science, there is a clear need for additional studies that examine (1) the measurement, structure, and multidimensional nature of SCT, (2) SCT as statistically distinct from not only ADHD-inattention but also other psychopathologies (particularly depression and anxiety), (3) genetic and environmental contributions to the development of SCT symptoms, and (4) functional impairments associated with SCT. This Special Section brings together papers to advance the current knowledge related to these issues as well as to spur research in this exciting and expanding area of abnormal psychology.
Look
Inside
Citations
Within this Article
1. An Historical Overview of SCT
2. Special Section Studies
3. Conclusion
4. References
5. References
References (46)
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41. Stewart, M. A. (1970). Hyperactive children. Scientific American, 222, 94–98.CrossRef
42. Still, G. F. (1902). Some abnormal psychical conditions in children. Lancet, 1, 1008-1012, 1077-1082, 1163-1168.
43. *Watabe, Y., Owens, J. S., Evans, S. W., & Brandt, N. E. (2014). The relationship between sluggish cognitive tempo and impairment in children with and without ADHD. Journal of Abnormal Child Psychology. doi: 10.1007/s10802-013-9767-3.
44. Weinberg, W. A., & Brumback, R. A. (1990). Primary disorder of vigilance: a novel explanation of inattentiveness, daydreaming, boredom, restlessness, and sleepiness. Journal of Pediatrics, 116, 720–725.CrossRef
45. Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto, M. V., Rohde, L. A., & Tannock, R. (2012). Validity of DSM-IV attention-deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121, 991–1010.
46. *Willcutt, E. G., Chhabildas, N., Kinnear, M., DeFries, J. C., Olson, R. K., & Leopold, D. R. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM-IV ADHD. Journal of Abnormal Child Psychology. doi: 10.1007/s10802-013-9800-6.
About this Article
Title
Sluggish Cognitive Tempo in Abnormal Child Psychology: An Historical Overview and Introduction to the Special Section
Journal
Journal of Abnormal Child Psychology
Volume 42, Issue 1 , pp 1-6
Cover Date
2014-01-01
DOI
10.1007/s10802-013-9825-x
Print ISSN
0091-0627
Online ISSN
1573-2835
Publisher
Springer US

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and ExecutiveFunctioning http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes http://www.helpforld.com/efacoutcomes.pdf

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:

Studies: ADHD drugs don’t necessarily improve academic performance https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

Children’s Hospital of Philadelphia study: Parent’s attitudes determine ADHD treatment

6 Sep

Many parents will be presented with a diagnosis of ADHD regarding their child. Yahoo medical reported in the article, Top 10 Myths About ADHD:

Myth #1: Only kids have ADHD.
Although about 10% of kids 5 to 17 years old have been diagnosed with ADHD, at least 4% of adults have it, too — and probably many more, since adult ADHD is often undiagnosed or misdiagnosed. That’s partly because people think only kids get it.

Myth #2: All kids “outgrow” ADHD.
Not nearly always. Up to 70% of children with ADHD continue to have trouble with it in adulthood, which can create relationship problems, money troubles, work strife, and a rocky family life.

Myth #3: Medication is the only treatment for ADHD.
Medication can be useful in managing ADHD symptoms, but it’s not a cure. And it’s not the only treatment. Lifestyle changes, counseling, and behavior modification can significantly improve symptoms as well. Several studies suggest that a combination of ADHD treatments works best.

Myth #4: People who have ADHD are lazy and lack intelligence and willpower.
This is totally not true. In fact, ADHD has nothing to do with intelligence or determination. It’s a neurobehavioral disorder caused by changes in brain chemicals and the way the brain works. It presents unique challenges, but they can be overcome — which many successful people have done. Even Albert Einstein is said to have had symptoms of ADHD.

Myth #5: ADHD isn’t a real disorder.
Not so. Doctors and mental-health professionals agree that ADHD is a biological disorder that can significantly impair functioning. An imbalance in brain chemicals affects brain areas that regulate behavior and emotion. This is what produces ADHD symptoms.

Myth #6: Bad parenting causes ADHD.
Absolutely not! ADHD symptoms are caused by brain-chemical imbalances (see #4 and #5) that make it hard to pay attention and control impulses. Good parenting skills help children deal with their symptoms.

Myth #7: Kids with ADHD are always hyper.
Not always. ADHD comes in three “flavors”: predominantly inattentive; predominantly hyperactive-impulsive; and combined, which is a mix of inattentive and hyperactive-impulsive symptoms. Although kids with hyperactive-impulsive or combined ADHD may be fidgety and restless, kids with inattentive ADHD are not hyper.

Myth #8: Too much TV time causes ADHD.
Not really. But spending excessive amounts of time watching TV or playing video games could trigger the condition in susceptible individuals. And in kids and teens who already have ADHD, spending hours staring at electronic screens may make symptoms worse.

Myth #9: If you can focus on certain things, you don’t have ADHD.
It’s not that simple. Although it’s true that people with ADHD have trouble focusing on things that don’t interest them, there’s a flip side to the disorder. Some people with ADHD get overly absorbed in activities they enjoy. This symptom is called hyperfocus. It can help you be more productive in activities that you like, but you can become so focused that you ignore responsibilities you don’t like.

Myth #10: ADHD is overdiagnosed.
Nope. If anything, ADHD is underdiagnosed and undertreated. Many children with ADHD grow up to be adults with ADHD. The pressures and responsibilities of adulthood often exacerbate ADHD symptoms, leading adults to seek evaluation and help for the first time. Also, parents who have children with ADHD may seek treatment only after recognizing similar symptoms in themselves.
http://shine.yahoo.com/parenting/top-10-myths-about-adhd-2528710.html

Whether drug or behavior therapy is chosen to treat ADHD depends upon the goals of the parents.

Genevra Pittman reported in the article, ADHD Treatment: Parents’ Goals Tied To Choice Of Behavior Therapy Or Medication (STUDY):

(Reuters Health) – Parents’ goals and concerns for their children with attention-deficit/hyperactivity disorder may influence their decision to start behavior therapy or medication, according to a new study that researchers say supports a shared decision-making approach to ADHD treatment.
Researchers found parents who were focused on their child’s academic achievement were twice as likely to have the child started on medications, which include Adderall and Ritalin, as other parents.
Parents who expressed goals of improved behavior and interpersonal relationships were 60 percent more likely to start behavior therapy – which involves parents meeting with a counselor to learn how to manage a child’s behavior.
“Studies like this really suggest that taking a shared decision-making approach may be one way to match the kids for whom (treatment) is warranted to the best treatment,” Dr. Alexander Fiks, from The Children’s Hospital of Pennsylvania in Philadelphia, said.
“For parents, the real thing is to ask pediatricians to really explain the pluses and minuses of all of the different options, and to make sure they can articulate what they’re really most hoping to achieve,” Fiks, the study’s lead author, told Reuters Health.
http://www.huffingtonpost.com/2013/09/02/adhd-treatment-parents-goals_n_3857116.html?utm_hp_ref=email_share

The medical Xpress article, Engaging parents leads to better treatments for children with adhd reported about the ADHD study:

Pediatricians and researchers at The Children’s Hospital of Philadelphia’s(CHOP) have developed a first-of-its kind tool to help parents and health care providers better treat ADHD (attention deficit-hyperactivity disorder). The new, three-part survey helps steer families and doctors toward “shared decision-making”, an approach proven to improve healthcare results in adults, but not widely used in pediatric settings. The results of the CHOP study are published in the journal Academic Pediatrics.
“Shared decision-making in health care means that doctors and families make decisions together. Doctors contribute their professional knowledge, and families weigh their values and personal experience,” explained lead author Alexander Fiks, M.D., M.S.C.E, an urban primary care pediatrician at CHOP and a faculty member at CHOP’s PolicyLab. “We chose to focus on ADHD for this study, because it is a relatively common diagnosis with two recommended treatment options – prescription medication and behavioral therapy – that require the family to make decisions about what will work best for them. Choosing a treatment that doesn’t ‘fit’ can lead to unsuccessful results. We wanted to see if we could create a tool to help guide families and physicians through this process.”
According to a study published earlier this year, the number of physician outpatient visits in which ADHD was diagnosed in children under age 18 was 10.4 million. Psychostimulants were used in 87 percent of treatments prescribed during those visits.
The CHOP study involved 237 parents of children aged 6-12 who were diagnosed with ADHD within the past 18 months. Using a combination of parent interviews, current research, and input from parent advocates and professional experts, researchers developed a standardized three-part questionnaire to help parents define and prioritize their goals for treatment; attitudes toward medication; and comfort with behavioral therapies. The completed survey serves as a guide to support families and health care providers to reach the most effective and workable treatment for a child’s ADHD.
“It’s important to know whether a parent’s primary goal is to keep a child from getting in trouble at school, improve academic performance, or maintain more peace with family members or peers,” said Fiks. “We also need to learn about the family’s lifestyle and attitudes toward behavioral therapy and medication. All of these factor into making the best treatment decision for each individual child and family.” http://medicalxpress.com/news/2012-10-engaging-parents-treatments-children-adhd.html

Citation:

Contrasting parents’ and pediatricians’ perspectives on shared decision-making in ADHD.
Fiks AG, Hughes CC, Gafen A, Guevara JP, Barg FK.
Source
Pediatric Research Consortium, Children’s Hospital of Philadelphia, 3535 Market St, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
Abstract
OBJECTIVE:
The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.
METHODS:
We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.
RESULTS:
Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians’ preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.
CONCLUSIONS:
Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.
PMID:
21172996
[PubMed – indexed for MEDLINE]
PMCID:
PMC3010085
Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010085/

The Centers for Disease Control provides great information in the article, Attention-Deficit / Hyperactivity Disorder (ADHD):
Treatment

On This Page
• Medications
• Behavioral intervention strategies
• Parent Education and Support
• Behavior Treatment for Preschoolers
• ADHD and School
• Related Pages
My Child Has Been Diagnosed with ADHD – Now What?
It is understandable for parents to have concerns when their child is diagnosed with ADHD, especially about treatments. It is important for parents to remember that while ADHD can’t be cured, it can be successfully managed. There are many treatment options, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help you guide your child towards success. Remember, you are your child’s strongest advocate!
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
Following are treatment options for ADHD:
Behavior Treatment for Preschoolers
Click here to learn more »
• Medications
• Behavioral intervention strategies
• Parent training
• ADHD and school

To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.
Medications
Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is one option that may help better control some of the behavior problems that have led to trouble in the past with family, friends and at school.
Several different types of medications may be used to treat ADHD:
• Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
• Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.
Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.
For more information on treatments, please click one of the following links:
National Resource Center on ADHD
National Institute of Mental Health
Behavioral Therapy
Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is another treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made.
Following are examples that might help with your child’s behavioral therapy:
• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized . Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
Parent Education and Support
Parent education and support are other important parts of treatment for a child with ADHD. Children with ADHD might not respond as well as other children to the usual parenting practices, so experts recommend additional parent education. This approach has been successful in teaching parents how to help their children become better organized, develop problem-solving skills, and cope with their ADHD symptoms.
Parent education can be conducted in groups or with individual families and is offered by therapists or in special classes. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers a unique educational program to help parents and individuals with ADHD navigate the challenges of ADHD across the lifespan. Find more information about CHADD’s “Parent to Parent” program by visiting CHADD’s website .
Behavior Treatment for Preschoolers
The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Parents or teachers can provide this treatment.
The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.
The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:
• Triple P (Positive Parenting of Preschoolers program),
• Incredible Years Parenting Program
• Parent-Child Interaction Therapy
• New Forest Parenting Program—Developed specifically for parents of children with ADHD [Abstract ] [Authors ]
Read the full AHRQ report here .
ADHD and the Classroom
Just like with parent training, it is important for teachers to have the needed skills to help children manage their ADHD. However, since the majority of children with ADHD are not enrolled in special education classes, their teachers will most likely be regular education teachers who might know very little about ADHD and could benefit from assistance and guidance.
Here are some tips to share with teachers for classroom success:
• Use a homework folder for parent-teacher communications
• Make assignments clear
• Give positive reinforcement
• Be sensitive to self-esteem issues
• Involve the school counselor or psychologist
What Every Parent Should Know…
As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights. Kids with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. To learn more about Section 504, click here .
Related Pages
• Child Development
• Positive Parenting Tips
• Injury, Violence, and Safety
• Safe and Healthy Kids and Teens
• CDC’s National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/adhd/treatment.html

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:
Studies: ADHD drugs don’t necessarily improve academic performance
https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Studies: ADHD drugs don’t necessarily improve academic performance

14 Jul

Moi wrote in ADHD coaching to improve a child’s education outcome:
The American Academy of Child and Adolescent Psychiatry discusses the primary symptoms of ADHD in the article, What Is ADHD:

The primary symptoms of ADHD are hyperactivity, impulsivity, and inattention.
Hyperactive children always seem to be in motion. A child who is hyperactive may move around touching or playing with whatever is around, or talk continually. During story time or school lessons, the child might squirm around, fidget, or get up and move around the room. Some children wiggle their feet or tap their fingers. A teenager or adult who is hyperactive may feel restless and need to stay busy all the time.
Impulsive children often blurt out comments without thinking first. They may often display their emotions without restraint. They may also fail to consider the consequences of their actions. Such children may find it hard to wait in line or take turns. Impulsive teenagers and adults tend to make choices that have a small immediate payoff rather than working toward larger delayed rewards.
Inattentive children may quickly get bored with an activity if it’s not something they really enjoy. Organizing and completing a task or learning something new is difficult for them. As students, they often forget to write down a school assignment or bring a book home. Completing homework can be huge challenge. At any age, an inattentive person may often be easily distracted, make careless mistakes, forget things, have trouble following instructions, or skip from one activity to another without finishing anything.
Some children with ADHD are mainly inattentive. They seldom act hyperactive or impulsive. An inattentive child with ADHD may sit quietly in class and appear to be working but is not really focusing on the assignment. Teachers and parents may easily overlook the problem.
Children with ADHD need support to help them pay attention, control their behavior, slow down, and feel better about themselves.
What Is Not ADHD?
Many children and adults are easily distracted at times or have trouble finishing tasks. To be ADHD, however, the behaviors must appear before age 7 and continue for at least six months. The symptoms must also create a real handicap in at least two areas of the child’s life—in the classroom, on the playground, at home, in the community, or in social settings.
If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors.
Even if a child’s behavior seems like ADHD, it might not actually be ADHD. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing
A death or divorce in the family, a parent’s job loss, or other sudden change.
Undetected seizures.
An ear infection that causes temporary hearing problems.
Problems with schoolwork caused by a learning disability.
Anxiety or depression. 

ADHD News has a synopsis of the ADHD diagnosis in the article by Mark Domoto, M.Ed. In the section, Diagnosing ADHD
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Julia Lawrence of Education News reports about a Quebec study in the article, Study: ADHD Drugs Don’t Improve Academic Performance in Kids:

Shirley S. Wang of The Wall Street Journal writes about one such study published in June which looked at academic outcomes of Quebec students prescribed ADHD drugs like Ritalin and Adderall over a span of 11 years. Researchers concluded that boys who were taking drugs academically underperformed peers with the same symptoms who were not medicated. The working paper published by the National Bureau of Economic Research also reported that girls who took ADHD drugs had higher incidence of emotional problems than ones who did not.
“The possibility that [medication] won’t help them [in school] needs to be acknowledged and needs to be closely monitored,” says economics professor Janet Currie, an author on the paper and director of the Center for Health & Wellbeing, a health policy institute at Princeton University. Kids may not get the right dose to see sustained benefits, or they may stop taking the medication because side effects or other drawbacks outweigh the benefits, she says.
Why drugs that claim to improve concentration, focus and emotional control don’t lead to academic improvement is a question that has puzzled researchers for some time — and answering the question could be the key to effective ADHD treatment in children. Finding an effective treatment regime could help a lot of kids; according to Centers for Disease Control and Prevention, there are 2.7 million children currently on ADHD drugs of some kind in the United States alone.
http://www.educationnews.org/parenting/study-adhd-drugs-dont-improve-academic-performance-in-kids/#sthash.HkASci3N.dpuf

This study is in accord with research from Yale University.

Geneva Pittman of Reuters writes in the article, Be cautious of mind-altering drugs for kids: doctors:

Focusing on stimulants typically used to treat attention deficit hyperactivity disorder, or ADHD, researchers said the number of diagnoses and prescriptions have risen dramatically over the past two decades.
Young people with the disorder clearly benefit from treatment, lead author Dr. William Graf emphasized, but the medicines are increasingly being used by healthy youth who believe they will enhance their concentration and performance in school.
According to the National Institute on Drug Abuse, 1.7 percent of eighth graders and 7.6 percent of 12th graders have used Adderall, a stimulant, for nonmedical reasons.
Some of those misused medicines are bought on the street or from peers with prescriptions; others may be obtained legally from doctors.
“What we’re saying is that because of the volume of drugs and the incredible increase… the possibility of overdiagnosis and overtreatment is clearly there,” said Graf, from Yale University in New Haven, Connecticut.
In their statement, published in the journal Neurology, he and his colleagues say doctors should not give prescriptions to teens who ask for medication to enhance concentration against their parents’ advice. http://www.reuters.com/article/2013/03/13/us-medications-kids-idUSBRE92C17H20130313

Here is the press release from Yale:

No attention-boosting drugs for healthy kids, doctors urge
Back to news list
Wednesday, March 13, 2013

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Karen N. Peart / 203-432-1326
Read this article on YaleNews
 
Doctors at Yale School of Medicine and the American Academy of Neurology (AAN) have called upon their fellow physicians to limit or end the practice of prescribing memory-enhancing drugs to healthy children whose brains are still developing. Their position statement is published in the March 13 online issue of the journal Neurology, the medical journal of the AAN.
The statement was written to address the growing trend in which teens use “study drugs” before tests and parents request attention deficit hyperactivity disorder (ADHD) drugs for children who don’t meet the criteria for the disorder. The AAN spent several years analyzing all of the available research and ethical issues to develop this official position statement on the topic.
“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and to prevent the misuse of medication,” said first author of the statement, Dr. William Graf, professor of pediatrics and neurology at Yale School of Medicine. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”
Graf and a group of child neurologists provide evidence that points to dozens of ethical, legal, social, and developmental reasons why prescribing mind-enhancing drugs, such as those used to treat ADHD, for healthy people is viewed differently in children and adolescents than it would be in functional, independent adults with full decision-making capacities.
Some of the reasons not to prescribe neuroenhancements include: the child’s best interest; the long-term health and safety of neuroenhancements, which has not been studied in children; kids and teens may lack complete decision-making capacities while their judgments and cognitive abilities are still developing; maintaining doctor-patient trust; and the risks of over-medication and dependency.
“A physician should talk to the child about the request, as it may reflect other medical, social, or psychological motivations such as anxiety, depression, or insomnia,” said Graf, who notes that there are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits, and exercise regimens.
Other authors on the position statement include Saskia K. Nagel, Dr. Leon G. Epstein, Dr. Geoffrey Miller, Dr. Ruth Nass, and Dr. Dan Larriviere.
Citation: Neurology 80 (March 13, 2013)

Citation:
Pediatric neuroenhancement Ethical, legal, social, and neurodevelopmental implications
1.William D. Graf, MD,
2.Saskia K. Nagel, PhD,
3.Leon G. Epstein, MD,
4.Geoffrey Miller, MD,
5.Ruth Nass, MD and
6.Dan Larriviere, MD, JD
+Show Affiliations
| + Show Full Disclosures
1.Correspondence to Dr. Graf: william.graf@yale.edu
1.Published online before print March 13, 2013, doi: 10.1212/WNL.0b013e318289703b Neurology March 26, 2013 vol. 80 no. 13 1251-1260
2.
Abstract
Full Text
Full Text (PDF)
1.Also available:
2.CME Course
3.Data Supplement
Abstract
The use of prescription medication to augment cognitive or affective function in healthy persons—or neuroenhancement—is increasing in adult and pediatric populations. In children and adolescents, neuroenhancement appears to be increasing in parallel to the rising rates of attention-deficit disorder diagnoses and stimulant medication prescriptions, and the opportunities for medication diversion. Pediatric neuroenhancement remains a particularly unsettled and value-laden practice, often without appropriate goals or justification. Pediatric neuroenhancement presents its own ethical, social, legal, and developmental issues, including the fiduciary responsibility of physicians caring for children, the special integrity of the doctor–child–parent relationship, the vulnerability of children to various forms of coercion, distributive justice in school settings, and the moral obligation of physicians to prevent misuse of medication. Neurodevelopmental issues include the importance of evolving personal authenticity during childhood and adolescence, the emergence of individual decision-making capacities, and the process of developing autonomy. This Ethics, Law, and Humanities Committee position paper, endorsed by the American Academy of Neurology, Child Neurology Society, and American Neurological Association, focuses on various implications of pediatric neuroenhancement and outlines discussion points in responding to neuroenhancement requests from parents or adolescents. Based on currently available data and the balance of ethics issues reviewed in this position paper, neuroenhancement in legally and developmentally nonautonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable. In nearly autonomous adolescents, the fiduciary obligation of the physician may be weaker, but the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues

Increasingly, some families find that an education coach improves their child’s chance of success at school.
Jean Enersen’s King5 News story,  ADHD coaches help students tackle academic goals tells the about the success one family has had with an ADHD coach:

Middle school is all about keeping track of schedules, and getting assignments in on time. It can be complicated.
“I have eight teachers,” said 7th grade student Marcus Wesley.
When his mother asked, “Have you started writing your story?” Marcus could only tell her, “No, but I have all my outline and stuff.” The story was pivotal to his grade.
Keeping a handle on all his upcoming assignments is hard for Marcus. He was recently diagnosed with ADHD.
“I’m a little more hyper than other kids. So they give me the medicine to calm me down,” he explained.
But medicine is only part of the answer said his mother. Alone, it won’t assure his success in school.
“I personally think every student deserves a coach,” said ADHD coach Naomi Zemont.
Since last September, Zemont has been Marcus Wesley’s ADHD coach.
“Last time around, you really wanted to make up this work in humanities,” she reminded Marcus.
Zemont helps the 7th grader develop a plan to achieve his goals. He sets the goals himself, and decides the actions it will take to complete them. In doing so, Marcus is learning to break tasks into parts he can manage. http://www.king5.com/health/childrens-healthlink/ADHD-coaches-help-students-tackle-academic-goals–144024376.html

Before deciding what is the most appropriate therapy, the diagnosis of ADHD must be made by a competent health care provider.

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Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART©                         http://drwildaoldfart.wordpress.com/
Dr. Wilda Reviews ©                                       http://drwildareviews.wordpress.com/
Dr. Wilda ©                                               https://drwilda.com/