November 07, 2011

ADHD Medicine Doesn’t Increase Kids’ Heart Risk

Andrew Adesman, MD

Stimulant medications are generally viewed as the safest and most effective medications for the treatment of attention deficit hyperactivity disorder (ADHD). Several years ago, concerns were raised about the possibility of a small but increased risk of sudden cardiac death among children and adolescents treated with stimulant medication for ADHD. Although subsequent analyses suggested that there is no increased risk, patients and clinicians have remained cautious about these medications from a cardiac standpoint.

In this week’s New England Journal of Medicine, a team of researchers present findings from their analysis of an extraordinarily large sample (1.2 million children and young adults) with respect to ADHD drugs and serious cardiovascular events. This new study once again fails to find an association between treatment with stimulant medication and sudden cardiac death, myocardial infarction or stroke. Although the authors acknowledge that they cannot rule out a modest increase in risk, the data are overall quite reassuring, especially considering that they did not exclude children with congenital heart disease--a group presumed to be at increased cardiovascular risk--from the analyses.

In short, this study provides additional reassurance to families and clinical practitioners that stimulant medications like Concerta, Full Post - to Detail View

August 01, 2011

ADHD a Risk Factor in Kids' Pedestrian Accidents

Andrew Adesman, MD

Children with attention deficit hyperactivity disorder-combined type (ADHD-C) choose riskier pedestrian environments to cross within, according to a new study published in Pediatrics. Unintentional injury is the leading cause of pediatric mortality, and a leading cause of unintentional injury is pedestrian injury.

Kids with developmental disabilities, particularly those with ADHD-C, seem to have increased pedestrian injury risk. While kids with ADHD-C seem to display appropriate curbside pedestrian behavior, they don’t adequately process information to permit crossing safely, according to the journal.

This study reinforces the notion that kids with ADHD are more at risk in certain situations. In fact, this study may underestimate the extent of the problem: If kids are in a distraction-free setting and they still show more risk-related behavior, it may be an underestimate.

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March 04, 2011

ADHD and Diet: Is There a Connection?

Andrew Adesman, MD

Effect of a Restricted Elimination Diet on the Behavior of Children with ADHD (INCA Study): A Randomized Controlled Trial, recently published in The Lancet, is an interesting study that examines the issue of whether dietary treatment is an effective for attention deficit hyperactivity disorder (ADHD). Specifically, the authors looked at a restricted elimination diet and found some short-term benefits; however, the many limitations of this study threaten the legitimacy and generalizability of the findings.

The strengths of the study were that it was a prospective study of young children with ADHD who were randomly assigned to either a diet treatment or control group. The study did not limit subject enrollment to children with allergies or suspected food sensitivities. Unfortunately, the study's design was severely flawed: The investigators failed to use any objective, blinded or independent measure of attention, impulsivity, or behavior. Also, with respect to outcome measures and reported benefit, the magnitude of improvement noted by teachers was approximately half that noted by parents.

Since the study focused on young children with ADHD, only 12 percent of the sample were girls and only 6 percent of children had the non-hyperactive form of ADHD (i.e., ADHD, predominantly inattentive type, formerly known as "ADD"). Thus, the generalizability of the results is also suspect. And since none of the children stayed on the diet beyond 5 weeks, it is hard to know if this dietary intervention offers sustained benefit. Finally, since it is more difficult to enforce restricted diets in older children, this approach may not be suitable for the majority of older children with ADHD.

The investigators attribute the relapse of behavior to the food challenges, and yet this could easily also be explained by loss of a placebo effect. This alternative explanation may explain why they failed to find a difference between high- and low-IgG food challenges.

In short, dietary interventions may indeed merit further study, especially with young children. Full Post - to Detail View