Stories about: attention deficit hyperactivity disorder

Brain ‘connectome’ on EEG could help diagnose attentional disorders

EEG connectome could diagnose attentional disorders ADHD
EEGs shouldn’t just be for epilepsy, say these researchers.

Attention deficit disorder (ADD), with or without hyperactivity, affects up to 5 percent of the population, according to the DSM-5. It can be difficult to diagnose behaviorally, and coexisting conditions like autism spectrum disorder or mood disorders can mask it.

While recent MRI studies have indicated differences in the brains of people with ADD, the differences are too subtle and MRI too expensive to be a practical diagnostic measure. But new research suggests a role for an everyday, relatively cheap alternative: electroencephalography (EEG).

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Sobering ADHD findings suggest: Stay in treatment

(leesean-Flickr)
(leesean-Flickr)

There’s a widespread view that attention-deficit hyperactivity disorder (ADHD) is grossly over-treated in kids, especially boys, and will eventually be outgrown. But the results of the first large, long-term population-based study, published recently in Pediatrics, suggest that couldn’t be further from the truth.

While other studies have indicated dire outcomes when children with ADHD grow up, most of these have been small and have focused on the severe end of the spectrum—for instance, boys referred to psychiatric treatment facilities. This new study, started at the Mayo Clinic and led by William Barbaresi, MD, looked at the general population of kids with ADHD and found a greater likelihood of their having other psychiatric disorders as adults, doing jail time or committing suicide.

“Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes,” says Barbaresi, now at Boston Children’s Hospital. “That’s a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults.”

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Web platform tracks ADHD patients in real time

It was a chance encounter. Eugenia Chan, MD, MPH, and Eric Fleegler, MD, MPH, both worked at Boston Children’s Hospital, and had met one another once or twice, but only in passing.

Running into each other at a conference, they fell to chatting. Chan, a pediatrician in Developmental Medicine, was looking for a way to measure how well patients with attention deficit hyperactivity disorder were responding to their medications. Fleegler, an emergency physician and health services researcher, described an online software program he developed to screen patients for health-related social problems and connect them with relevant services.

Two years later, Chan and Fleegler launched ICISS, the Integrated Clinical Information Sharing System, which monitors patients with ADHD and their changing medication responses.

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Is it really ADHD? Brain activity may provide an objective measure

The right inferior frontal gyrus, part of the prefrontal cortex, lights up on fMRI when children play a game requiring them to resist a natural impulse. This brain area is naturally in flux between ages 5 and 7, Sheridan has found.

Last month, the American Academy of Pediatrics released new guidelines on attention-deficit hyperactivity disorder (ADHD), lowering the minimum age at which physicians should consider drug treatment from 6 years to 4 years.

But here’s the problem. “Current behavioral criteria for ADHD are most effective only after age 8 or 9,” says Margaret Sheridan of the Laboratories of Cognitive Neuroscience at Children’s Hospital Boston. “If you use them at age 3 to 6, then you’re wrong about half the time, and the child will stop meeting the criteria by age 8.”

Little kids, especially boys, are naturally distractible, impulsive and fidgety. Some mature more slowly; some are just the youngest in their class. Many will grow out of their wild but largely age-appropriate behaviors.

But letting true ADHD fester, explaining symptoms away as “kids just being kids,” deprives children of the benefits of behavioral or pharmacologic treatment at a time when their young brains are highly responsive.

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Disease management meets intelligent design

At a conference in Texas a couple of years ago, I found myself – as at all good national conferences — talking to a colleague from my own institution. As we browsed the poster session, we talked about our respective work.

Eugenia Chan works in the Developmental Medicine Center at Children’s Hospital Boston, where I’m an emergency physician and health services researcher. I told Eugenia about The Online Advocate, a Web-based system I’d been developing for the past eight years. It screens patients and families for health-related social problems, provides feedback and helps them find services in their area that can assist them.

Eugenia was excited about bringing The Online Advocate to her patients.“This is really great, and I want to use it,” she said. “But I have another idea that I would like to explore with you.”

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Shadowing ADHD with web-based tools

This is how  it used to be when I saw a child with attention-deficit hyperactivity disorder: “You know, Dr. Chan, I really don’t think the medicine’s working,” the parent would tell me. “I just don’t see any difference in his behavior.”

“Well, the medicine has probably worn off by the time you see him at home,” I’d say. “What does his teacher think?”

“She hasn’t called me, so I assume there hasn’t been any trouble.” Then: “Oh—I was supposed to give her that questionnaire to fill out, wasn’t I?  I’m so sorry, I totally forgot.”

As a developmental-behavioral pediatrician specializing in ADHD, I used to have this conversation with parents at almost every single follow-up visit, leaving me frustrated.

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