ADD / ADHD, ADD / ADHD Medication

The Bonkers Institute for Nearly Genuine Research takes a satirical look at the science and marketing of psychiatry and its medication. Like all good satire it mixes humour with laser sharp observations about the products and how doctors works. Mock scientific papers like Therapeutic Efficacy of Cash in the Treatment of Anxiety and Depressive Disorders and entirely factual reposts, such this list of all 1195 side-effects reported by users of Ritalin and Concerta in a two year period, sit side by side.

One particular page may interest Myomancy though, a gallery of adverts for medication aimed at children. Several adverts for medications aim at treating ‘problem children from the early 1960’s shows how little has changed apart from the terminology. Ritalin adverts feature several times and demonstrates how good drug companies are at inventing new problems, such as Tired Mother Syndrome. The advert below is from 1988.

Ritalin Advert

Thanks to Mind Hacks for the link.

ADD / ADHD, ADD / ADHD Diagnosis, ADD / ADHD Medication, ADD / ADHD Treatment, Digital Fitness, Dore Achievement Centres, Dyslexia, Dyslexia Testing & Diagnosis, Dyslexia Treatment, Dyspraxia, Medication, Memory, Music, Nintendo DS, Nintendo Wii, Rhythm Games, Wii Fit

One of the reasons I started this blog was because I was interested in creating a cerebellum training program that was quicker, more effective than Dore. Myomancy was my notebook of interesting technology and relevant science. Over the years I’ve examined many different approaches to the treatment of dyslexia and ADHD. Some were simply nonsense, others had promise but were lacking the scientific, technological or business resources to make them viable. Some lacked the ethical honesty necessary when selling products to parents desperately worried about their children.

Slowly overtime I refined my ideas about how cerebellum training should work and how a independent company without much in the way financial resources could develop and sell such a product in an ethical manner. One main stumbling block has been the cost and availability of the technology necessary to track a user’s limb movements and balance. So I’ve been watching the progress of the Wii and latterly the Wii Fit with interest. The technology needed for cerebellum training was finally cheaply and readily available. What’s more many people already own it.

Originally I intended to make an announcement after slowly develop a proof of concept over the next few months but with the collapse of Dore and the shadow that will cast over the cerebellum training field, I’ve decided to move my plans forward. So I’m pleased to announced the creation of WyyMi, a project to create a free, open-source, open-science cerebellum training program.

What is WyyMi?
WyyMi is a project to develop a cerebellum training program to help people with dyslexia, ADHD, dyspraxia and similar educational problems.

Project Goals
To develop a system that cost nothing (or as close to nothing as possible) to use; to do it using open-source software; and to make freely available as much scientific evidence on its effectiveness as possible.

How Will It Work?
The idea is to use cheap and easily available computer hardware that can monitor and assess gross motor movements and balance. At the moment the Wii Remote and Wii Fit Balance Board seem the best candidates but they need to be adapted to work on PCs and Macs because the Wii console itself is difficult to develop for.

Using this hardware and software on the website, users will be perform a series of exercises. The amount of time spent training and the accuracy of the user’s movement will be logged on the server so that the user can track their progress and so the server can inform the user which exercises to do next. This data will also be aggregated, made anonymous and published so that it can be analyzed by any interested 3rd party. Ideally, symptom specific measures (e.g. spelling tests) will also be included so that the training programs effectiveness in treating educational problems can be measured.

Other than a broad statement of goals and the planned route for achieving them, there is nothing else on site at the moment. Progress is likely to slow, not least because I am working on another project at the moment as well maintaining my existing portfolio of web sites. If you wish to help in anyway, please see the announcement for ways you can contribute, not matter what your skills are.

Myomancy will be continuing to report on anything and everything I think is relevant to dyslexia, ADHD and autism. Obviously as I am planning to create my own training program, that might create a conflict of interest when discussing other people’s approach. I will try and be as unbiased as possible and make my conflict of interest clear.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Medication

What is Intuniv?

Intuniv is the latest ADHD drug from Shire PLC, the makers of Adderall XR, for tackling ADHD and it marks a big change in potential treatment options. It is not a stimulant like Ritalin or Adderall but instead its a selective alpha-2A receptor agonist. More simply, the active part of the drug helps specific parts of the brain to function more effectively. The key to making it an effective ADD medication is that it targets the area of the brain relating to the central nervous system. This, in theory has a calming effect, suppresses the fight / flight response and allows the normal functioning of the brain.

Secret Ingredient

Intuniv is based on the drug Guanfacine (also known as Tenex) that is used for treating hypertension and blood pressure. In 2006 the makers applied to FDA to allow its approval as a treatment for ADHD and this was granted in June 2007. However Guanfacine is only effective for a few hours before the patient has to take more pills. In the ADHD market, parents want to be able to give their child a tablet in the morning before school and have it working all day. This makes life easier for the school who no longer have to give out medicines at lunch time.

Adderall XR has been very successful for Shire PLC because it proved to be an effective, time release version of the standard stimulant used in Ritalin. Intuniv is very much in the same mold. Taking the existing drug Guanfacine and repackaging it in a time delayed formula. It is not clear exactly how it works but most likely it will use the same system as Adderall XR. The pill effectively consists of two tablets, one of which dissolves quickly in the stomach providing an immediate dose, and the second tablet, protected by a special coating, dissolves a lot slower, delivering its medicine some hours later and at a slower rate. The effect is that the patient receives a continuous level of medication through-out the day.

Intuniv Trial Success

Intuniv has not yet been given full approval by the FDA. In a recent press release, Shire stated that a 25% reduction in ADHD symptoms were seen in children compared with a placebo. This sounds good but remember this against children receiving no treatment. How effective it is versus Adderall XR or non-medical interventions has not been measured. It is also worth remembering that Shire PLC are selling Intuniv and will therefore be putting the best possible spin on their results. Independent researchers often find that real-world results do not match up to the drug company’s trial results.

Side Effects and Other Health Worries

Unlike most other ADHD medications, Intuniv is not stimulant based and is not a controlled substance. This means it has no potential for abuse in the way that Ritalin etc have. This should mean the drug is safer to take for long-periods of time but there has been no research in this area.

Unfortunately the story with side effects is not so good. Over 80% of children using it ireported adverse events (medical problems) during the 20 day trial. Most are unconnected to the drug and represent the normal childhood health problems but only 71% of users on the placebo had adverse effects. This is a significant difference and clearly shows that Intuniv has health risks. Adverse events reported include somnolence (32 percent), headache (26 percent), fatigue (18 percent), upper abdominal pain (14 percent) and sedation (13 percent) plus constipation, dizziness, dry mouth, hypertension and sedation. Shire PLC describe these as non-serious problems and highlight that fractionally less children on the drug developed serious problems compared to the placebo.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

We have looked at Caffeine as a treatment for ADHD before and the science indicated that it could have some benefits. As a footnote to this Wired has a report that regular small doses of caffeine are more effective than one single large dose.

Throughout the day, your noodle fills up with adenosine, a chemical thought to cause mental fatigue. Caffeine blocks the brain’s adenosine receptors, countering the chemical’s dulling effects. To maximize alertness and minimize jitters, keep those receptors covered with frequent small doses — like a mug of low-caf tea or half a cup of joe — rather than a onetime blast. Test subjects reported that periodic small shots made them feel clearheaded and calm, both of which enhance mental performance. Even better, add a lump of sugar or have a carbohydrate-rich snack at the same time for an extra cognitive kick. It seems that glucose and caffeine together do more to enhance cognition than either does alone.

Source: Caffeinate With Care: Small Shots Do a Brain Better Than Big Blasts. Note no reference to the research is given so please take this data with a large pinch of salt.

ADD / ADHD, ADD / ADHD Medication

I’ve not had time to check into this further but it suggests that children on medication like Ritalin, Adderall and other stimulants are at risk of sudden cardiac failure if they have a rare heart condition. The American Heart Association is therefore advising that children are given a ECG prior to being prescribed stimulents.

Children diagnosed with attention deficit and hyperactivity disorder should have a thorough heart work-up, including an electrocardiogram, before taking stimulants such as Ritalin to treat the condition, according to a new recommendation by the American Heart Association.

The advice marks the first time a medical-guidelines body in the U.S. has urged wide use of an electrocardiogram, which charts electrical activity in the heart, to screen a presumed healthy population for abnormalities.

From: New Guidelines Urge Heart Tests Before Kids Take ADHD Drugs

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment, Autism, Autism and Mercury, Autism Treatment, Dore Achievement Centres, Dyslexia

Are we too quick to medicate children?, a good round-up of the issue from the Las Angeles Times. Whilst The Guardian has a piece on the rise of students using brain boosting drugs such as Ritalin

The Spoof! has a short piece on PHADD (Pseudo Hyperactivity Attention Deficit Disorder)

Questionable Study Claims ADHD is Under-Diagnosed

Good Vibrations, a new, drug-free treatment for ADHD?

Understanding Chelation therapy, a brief round-up of this dubious autism therapy.

National Institutes of Health will intensify its efforts to find the causes of autism.

No explanation for ‘scary’ rise in autism in New Zealand

A Dore Program presentation at the Hallowell Center in Sudbury, MA.

Experts Demand End to Child Drugging in the US.

Shire reveals the effect size for it ADHD medication, Vyvanse.

Study on Concerta shows significant effect on ADHD sufferers.

ADD / ADHD, ADD / ADHD Medication, ADD / ADHD Treatment

In a ground breaking study for the National Institute of Mental Health, researchers have found no difference between the effectiveness of ADHD medication when compared to behavioral therapy or combined drug and behavioral therapy. In earlier stages of the study, ADHD medication had a clear advantage but over time the advantages of medication were lost.

The study started with around six hundred children who were randomly split between four groups: Medication, Behavioral Therapy, Medication & Behavioral Therapy, or no treatment. For the next 14 months the children followed the treatment plan supplied by the researchers. Then, for the next two years parents were able to chose how to treat their children.

“It’s quite clear that each of these treatments is better than no treatment at all,” said lead study author Peter Jensen, director of Columbia University’s Center for the Advancement of Children’s Mental Health.

Its not clear why medication started so strongly as the best treatment but faded over time. Its possibly due to an age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or a number of other factors.

Study abstract: 3-Year Follow-up of the NIMH MTA Study
Coverage in the Washington Post

ADD / ADHD, ADD / ADHD Medication, Autism

From Myomancy’s blogroll .

ADHD

ADHD Medication

ADD / ADHD Medication, Medication

Long time reader Mary sent me details of a study on how legal and illegal drugs effect the developing brain. The results suggest that Delta FosB, a brain chemical that is linked to addiction, greatly increases. However this only happens in adolescent brains, not in young or older brains. This highlights both how adolescent brains far more plastic and subject to change than adult or child brains.

See Jefferson Scientists Find Evidence Of Greater Sensitivity To Addictive Drugs In Adolescence for a write up of the study or Periadolescent Mice Show Enhanced Delta FosB Upregulation in Response to Cocaine and Amphetamine for the original study.