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.

Digital Fitness, Music, Nintendo DS, Nintendo Wii

Do you think that Guitar Hero is just about bad 80’s pop and heavy metal? Think again. Alex Wroten, a music student, has converted it into a genuine musical instatement for serious music.

One thing that struck me about [Guitar Hero] is that it has a stigma from those people who think it is ruining the potential musical literacy of children by giving them instant success versus practicing on a real instrument. This led me to want to turn the controller into a viable instrument.

I wrote Guitar Hero Instrument in MaxMSP on my Macbook to turn the XBOX Guitar Hero controller (only tested with GHII’s X-plorer controller!) into a playable instrument. This software has a lot of features, including harmonic tweaking, overdrive, delay, scale selection, and scale temperament (from 3 to 25-note equal temperament). It processes the controller input into pitches based on which button is pressed first and subsequent slurring; this gives the controller a range of 25 pitches (these pitches depend on base frequency, harmonic tweaking, and scale selection). The Guitar Hero controller’s tilt function is not mapped to any software feature at this time.

And here is a video of an original piece of music being performed with it.

More detail on Alex Wroten’s site.

Music, Rhythm Games, Sports

Apologies for another quick post but work-related project combined with the death a family member is leaving very little time for the in-depth examination I want to do.

Run to the Beat is an interesting example of music and its role in psychology. Its a half-marthon where music is part of the run. Taking the idea of running whilst listening to an iPod to its logical conclusion, Run To The Beat plan to have live music playing along the course but carefully chosen to fit the needs of the runners at that point.

1. During sub-maximal running, music can narrow attention and, as a consequence, divert your mind from sensations of fatigue. This lowers your perception of effort and is a technique known as dissociation. This phenomenon can promote more positive mood through encouraging you to avoid thoughts that relate to the physical symptoms of fatigue. Also, music increases positive aspects of mood such as vigour and happiness but reduces negative aspects such as tension and depression.

2. Music alters emotional and physiological arousal and can therefore be applied as a type of stimulant or sedative prior to competition to ease your nerves and curb your anxiety. In such instances, the music is used before running to help you achieve the right mindset. Some athletes use very upbeat music to psych-up while others use slow-tempo music to psych-down. Music is considered by some athletes as a “legal drug” with the added advantage of no unwanted side effects!

3. Numerous studies have shown that the synchronisation of music with repetitive exercise results in increased levels of work output. This applies to activities such as rowing, cycling and cross-country skiing as well as running. Musical tempo can regulate movement and reduce the energy expenditure or “oxygen uptake” required during running. Recent research shows that during moderate intensity exercise synchronous music can help to reduce energy expenditure by 6%.

4. The rhythmical qualities of music emulate the pattern of some physical skills. Therefore, music can enhance the acquisition of motor skills and create a better learning environment. Essentially, the performance of running drills can be improved by the presence of background music while, during a long run, music can enhance your technique and make you a more efficient athlete.

Science, Television

The campaign group Sense about Science have started to attack the spread of Brain Gym through the UKs primary schools.

Sense About Science has been receiving calls from parents and teachers who are concerned about the use of ‘Brain Gym’ – a programme of teacher-led physical exercises claimed to improve cognitive abilities – in primary schools.

These exercises are being taught with pseudoscientific explanations that undermine science teaching and mislead children about how their bodies work.

Whilst I’m favour of movement based programmes and want to see teachers being more aware of how movement and learning go hand-in-hand, some of the claims made by Brain Gym are bizarre. More importantly they are not back by proper peer-reviewed science.

The BBC’s Newsnight program did a segment on the Sense about Science’s campaign and Brain Gym. It wasn’t very flattering.

Part 2

Digital Fitness, Dyslexia, Music, Rhythm Games

An interesting example of how technology is changing music, except this one is aim at small children. Imprint Talk

Japanese magazine for the first graders, “Shougaku Ichinensei“, covers popular Mangas and some educational stuff. Every issue, there is a special supplement to the magazine, but the latest issue’s supplement was way too cool “Finger Piano”.

The original article has video of a child trying it but more impressive is this video of an adult using it to play When The Saints Go Marching In.

The quality of sound the device makes is poor but this is a toy given away on the cover of a magazine. For $10 or so it would be possible to manufacture a device with better sound and include an LCD display that teaches the user how to play a tune.

Such a device would help dyslexic children and other children with sound sensitivities who can be overwhelmed by typical classroom teaching. Even one-on-one teaching can be futile because of the demands it places in the child. To play a piano the child has to listen to what the teacher is saying, find the right notes on the keyboard, press them in time and in the right order, and listen to the sound of the notes they have just played. All this is needs to happen at the same time. A difficult task for someone with an underdeveloped cerebellum.

A device that allowed the child to learn one their own, at the own pace, and gives feedback or score as to how well they are doing would make learning music so much easier.

Autism, Brain & Body, Digital Fitness, Games

Remember the Emotiv Systems Brain Controller headset I posted about the other day? Well here is a video of a prototype in action. Its nothing amazing until about the 2 minute mark when they demonstrate how it can read emotions and replicate those emotions in simple animated face.

A major symptom of autism is the inability to read facial expressions and other people’s emotions. Teaching this and other social skills can be very time consuming, requiring intensive one-on-one training. There are books that aim to help but emotions are dynamic so any book based training system is problematic. With the Emotiv Systems headset, the possibility of an effective, responsive training system come ever closer. Combine the brain sensing headset with the work of Paul Ekman and there is the potential for a ground-breaking, world changing product.

Digital Fitness, Music, Nintendo DS

Linking education to the iPhone may seem like a huge leap but in two to three years it will be obvious.

Really I’m not talking about the iPhone, its about the iTouch (which is the iPhone without the phone bit) and what I’m really focusing on is the technology that drives it: the multi-touch screen; high quality graphics and sound; WiFi allowing it internet access anywhere. All this in a unit half the size of a DVD box. It may be expensive and only available from Apple but over the next few months, similar but cheaper products will be appearing. In two years time it will be bigger, better and everywhere.

This technology is not the only factor at play. Basic skills such as short-term memory and rhythm are showing themselves to have unexpected and significant impact on general levels of success. (See Intelligent Insights and Tick Tock Talk for more). Now couple this with the popularity of Dr Kawashima braining games on the Nintendo DS and the potential for a small, handheld education device is amazing. The One Laptop Per Child is setting the standard for creating robust, affordable devices that are suitable for children. Next may be the One iPhone Per Child or as it should be called, the iLearn.

This may seem unlikely and there are certainly a number of problems to overcome. Not least is that brain training hasn’t been conclusively be shown to work other than in limited areas. We need proof that learning how to playing a memory or rhythm game actually helps in the classroom. RoboMemo and Interactive Metronome have pointed the way with ADHD but more work is need. There also needs to be an open standard that has a long-life so schools can buy from multiple different suppliers knowing they will work together and that they are not going to be redundant in a couple of years.

The potential for an iPhone type device is amazing. The iGuitar and the iAno show just how much is possible on these devices. Being WiFi ready, an iLearn can download new content and enable group learning games. The teacher can easily have a master control unit that overrides or turns off the iLearn when required. All this could be done on a laptop now but laptops are fragile and, for a five to ten year-old, they are bulky. A small unit, the size of a paperback book would make it a usable size but manageable for small hands.

What the iPhone represents is a new class of handheld devices that allow real interaction with their users. Tiny keyboards and unreadable screens are a thing of the past. What we are finding out about the brain gives us unprecedented insight into how we learn and what intelligence really is. Some day soon, these two forces will combine in the iLearn.