Smart Kids With LD

Researchers at the Oregon Health & Science University have concluded that ADHD is not a single disorder, but rather an “entire family of disorders.” Their findings could impact the way patients are diagnosed and treated as well as the way future research is conducted.

Led by OHSU scientists Damien Fair, Ph.D., assistant professor of behavioral neuroscience, psychiatry, and the Advanced Imaging Research Center; and Joel Nigg, Ph.D., professor of psychiatry, behavioral neuroscience and pediatrics, the recently completed study suggests that ADHD is similar to cancer in that there are many different subtypes.

To reach their conclusions, the research team measured a number of cognitive skills (e.g. memory, inhibition, attention, comprehension, etc.) in a large sample of ADHD patients and a control group. The results, which are published in Proceedings of the National Academy of Sciences, were reported in Medical News Today (MNT).

Key Findings

In essence the researchers found a wide variation in both the ADHD and control groups; neither group consistently was found to have the same strengths and weaknesses. In addition, according to MNT, the findings showed “that ADHD patients can be subcategorized depending on their deficits and relative strengths, showing unique subgroups among all children with ADHD.” Dr. Fear explained the implications:

Traditionally, physicians and psychologists have diagnosed patients through the use of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM.

The problem with this approach is that it often relies on secondary observations of parents or teachers, where even if the descriptions are accurate, any given child may be behaving similarly, but for different reasons. Just as if there might be many reasons why someone might have chest pain, there might be many reasons why a child presents with ADHD. However, unlike diagnosing countless other well-understood diseases, there is no one test that can differentiate individuals when it comes to psychiatric and developmental conditions like ADHD. The data here highlights ways to recognize such individual variability and shows promise that we might be able to identify why any given child presents with ADHD, thus allowing for future examinations of more personalized treatments.

Based on this and future research, those who evaluate patients for ADHD may soon be able to replace observation with a battery of cognitive tests, which will allow them to determine strengths and weaknesses of their patients, categorize them accordingly, and tailor treatments for various subcategories.  

As we recently reported in this blog, the number of ADHD diagnoses among children and young teens have rapidly increased in the past decade–a stunning 66% between 2000 and 2010. While some suggest the increase is the result of better educated parents and doctors spotting ADHD, others believe that at least some of the increase can be attributed to misdiagnoses.

Writing in The New York Times, Kate Murphy notes:

Many children are given a diagnosis of ADHD researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of ADHD cases in children, and the drugs used to treat them may only be exacerbating the problem.

Citing a new study published recently in the journal Pediatrics, researchers found that children who had sleep issues due to apnea or common breathing problems such as snoring and mouth breathing were “40% to 100% more likely than normal breathers to develop behavioral problems resembling ADHD.”

A Little Deprivation Can Be Problematic

According to sleep experts, it doesn’t take much sleep loss for children to manifest behaviors associated with ADHD. Just one half hour less per night can have a detrimental effect on behavior—regardless of whether the loss is due to a sleep disorder or simply staying up too late watching TV or playing video games.

Having a correct diagnosis is fundamental to proper treatment. Children with sleep problems who are mistakenly treated with stimulant medication because they have been misdiagnosed with ADHD are at risk for even greater sleeplessness. When used improperly, ADHD medications can cause insomnia, thus exacerbating the problem.

Sleep Smarts

With so much at stake, both parents and doctors must learn more about the signs and symptoms of sleep problems and how to differentiate them from behavioral issues such as ADHD. In her article, Attention Problems May Be Sleep-Related Murphy points out that, “Of the 10,000 members of the American Academy of Sleep Medicine, only 500 have specialty training in pediatric sleep issues.” That leaves doctors to rely on parent reports of sleep concerns, which also may not be forthcoming. Adds Murphy:

Parents themselves often are uninformed about healthy sleep habits. A study conducted last year by researchers at Penn State University-Harrisburg and published in The Journal of Sleep Research showed that of 170 participating parents, fewer than 10 percent could correctly answer basic questions like the number of hours of sleep a child needs.

Sleep Recommendations

The National Sleep Foundation offers the following guidelines:

AGE                                                SLEEP NEEDS

Newborns (0-2 mos.)                    12-18 hrs.
Infants (3-11 mos.)                        14-15 hrs.
Toddlers (1-3 yrs.)                         12-14 hrs.
Preschoolers (3-5 yrs.)                  11-13 hrs.
School-Age (5-10 yrs.)                  10-11 hrs.
Teens (10-17 yrs.)                          8.5-9.5 hrs.
Adults                                              7-9 hrs.

The number of children and teens in the U.S. diagnosed with ADHD rose 66% from 2000 to 2010. According to a study published in the journal Academic Pediatrics, during that period the number of physician-diagnosed cases went from 6.2 million to 10.4 million, making ADHD one of the most commonly diagnosed conditions among people under 18 years old.

More Cases or Greater Awareness?

Does the dramatic increase in ADHD diagnoses mean that the condition is more prevalent than it used to be? Probably not, says Dr. Craig Garfield, Assistant Professor of Pediatrics and Medical Social Sciences at Northwestern University and the lead author of the study. “The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD, which may have caused more physicians to recognize symptoms and diagnose the disorder.” The authors suggest that public awareness campaigns coupled with media coverage and advertisements for ADHD medications played a role in making both parents and physicians more aware of the problem.

Other Findings

The study also found that the number of children being treated for ADHD by child psychiatrists was growing at the expense of treatment by pediatricians. At the onset of the study about 25% of children were seen by psychiatrists; by the end of the study the number rose to 33%.

Finally, results of the study showed that stimulant medications remain the most common treatment for ADHD, although their use has declined from 96% of patients in 2000 to 87% by the end of the study period.

To learn more see Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000–2010.

Related Smart Kids Links

Signs & Symptoms of ADHD

Evaluating Your Child for ADHD

Medications for ADHD

The only driver more dangerous than a drunk driver is a teen driver with ADHD. According to an article in The New York Times, “Young drivers with A.D.H.D. are two to four times as likely as those without the condition to have an accident—meaning that they are at a higher risk of wrecking the car than an adult who is legally drunk.” These were the findings from a 2007 study by Russell A. Barkley of the Medical University of South Carolina and Daniel J. Cox of the University of Virginia Health System.

For parents of teens with ADHD—and those who share the highways and byways with them—that’s a worrisome statistic.

The mix of inexperience, inattention, and impulsiveness is a potent cocktail for those who get behind the wheel.

“It’s a bad combination,” explained Dr. Barkley, who also noted that many drivers with ADHD overestimate their driving skills. “They’re more prone to crashes because of inattention; the reason their crashes are so much worse is because they’re so often speeding.”

Preventing Problems

Experts agree that teens with ADHD can become safe drivers, but the process of getting there is likely to be slower and more challenging than it is for their peers without attention issues.

Some suggest teens with ADHD may be better off postponing driving. “If I were a parent of an ADHD or other special-needs kid, my goal would be to delay licensing,” said Dr. Bruce Simons-Morton, senior investigator at the National Institute for Child Health and Human Development.

“They mature, they accommodate to their deficits, and they’re more likely to take medication.”

Medication seems to play an important role. A number of studies have found that ADHD medications that focus attention can reduce the risk of accidents. In fact, Dr. Barkley maintains that medication should not be optional and he further encourages the use of extended-release formulations that work into the night hours when most accidents occur.

Other experts focus on maturity as an important indicator. As stated in the article, “If a teenager with ADHD is showing consistent poor judgment or has earned only limited independence, he may not be ready. Behavioral problems can be a red flag, regardless of whether they have to do with driving.” Adds pediatrician Dr. Patty Huang, “If your kid is that oppositional and defiant, she shouldn’t be driving.”

Other helpful strategies include hiring a professional driving instructor, allowing for an extended learning period, close parental monitoring after the license has been obtained, and forbidding the use of cellphones.

To learn more, read the full article Learning to Drive with ADHD.

Related Smart Kids Link

Driving Under the Influence of ADHD

Trying to discern if a young child’s inattentive behaviors are due to immaturity or ADHD is a challenge for parents and teachers alike. Now the results of a study recently published in the Canadian Medical Journal promises to add fuel to the fire.

Researchers studying a large group of children in British Columbia over an 11-year period found that younger children were 39% more likely to be diagnosed with ADHD and 48% more likely to be prescribed ADHD medication than their same-grade peers who were up to one year older.

As reported in Medical News Today the lead author, Richard Morrow of the University of British Columbia stated:

“The relative age of children is influencing whether they are diagnosed and treated for ADHD. Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications.”

No Gender Gap

Although boys receive a diagnosis of ADHD more frequently than girls, there were no gender differences in this study. In fact, younger girls were 70% more likely to receive an ADHD diagnosis than the older girls in the same grade.

According to co-author Jane Garland of the University of British Columbia and BC Children’s Hospital, these findings provoke questions for everyone involved including clinicians, teachers, and parents. “We need to ask ourselves what needs to change. For example, attention to relative age of children for their grade and more emphasis on behavior outside the school setting might be needed in the process of assessment.”

Melissa Rey, a former Smart Kids Youth Achievement Award winner, is among this year’s Top 4 Buick Achievers, earning a four-year scholarship worth $25,000 per year. Last year Buick awarded 1,100 students from around the country a total of $4.2 million in scholarship funds. The awards are given to students who are making a difference in the classroom and the community and who show extraordinary leadership and passion.

Rey, who was diagnosed with dyslexia in first grade, is no stranger to such recognition. As a 14-year-old, the Missouri native was named the nation’s Top Young Scientist by the Discovery Channel 3M Young Scientist Challenge, following a final grueling two-day competition at NASA’s Goddard Space Center.

As a top finisher in this year’s Buick competition, Rey becomes one of the four “faces” of the scholarship, and is highlighted on the Buick Achievers Scholarship Program page.

We invite you to watch the video that Melissa made for the Buick Achievers press release here: http://www.videoatgm.com/videos/us/en/gm

Related links:

Melissa Rey: 2010 Youth Achievement Award Winner (link to 6.2.4)

Smart Kids with LD Youth Achievement Award Winner Calls Dyslexia Her “Secret Weapon”

Learning Disabilities: Do They Impact ACT Scores?

Given how challenging parenting can be, it’s a relief to find that sometimes a simple solution is all that’s needed to help your child deal with difficulties. In a recent study, researchers found that simply acknowledging that learning is hard lessened fear of failure in the classroom and increased the academic performance of children.

According to the study, published in the American Psychological Association’s online Journal of Experimental Psychology, students are often afraid to take on challenging material lest they fail at it. “By being obsessed with success, students are afraid to fail, so they are reluctant to take difficult steps to master new material,” explains Frederique Autin, Ph.D., a member of the research team. “Acknowledging that difficulty is a crucial part of learning could stop a vicious cycle in which difficulty creates feelings of incompetence that in turn disrupt learning.”

In three different experiments with sixth-grade students given challenging tasks, those that were told learning was difficult, failure was common, but practice would help, performed significantly better on key measures, including working memory capacity (a predictor of academic achievement), reading comprehension, and feelings of incompetence.

The implications for these findings could impact the way adults approach learning. Says Autin, “Teachers and parents should emphasize children’s progress rather than focusing solely on grades and test scores. Learning takes time and each step in the process should be rewarded, especially at early stages when students most likely will experience failure.”

This month the Department of Education (DOE) announced a new effort to help students with disabilities attain higher levels of educational outcomes—this after years of focusing mainly on ensuring that children with disabilities had access to a free appropriate public education as mandated by federal law. With that goal largely achieved, the DOE is turning its attention now to improving the educational results for students with disabilities.

According to U.S. Secretary of Education Arne Duncan, “For too long we’ve been a compliance-driven bureaucracy when it comes to educating students with disabilities. We have to expect the very best from our students—and tell them the truth about student performance—so that we can give all students the supports and services they need. The best way to do that is by focusing on results.”

The details of the DOE’s strategy to move from the one-size-fits-all compliance focused approach to a system that focuses equally on how well students are educated remain a work in progress. According to a statement released by the agency, the plan includes the following:

Throughout the coming year, the Department will work closely with stakeholders to develop and implement a new review system that takes a more balanced, results-driven approach to assessing how states are educating students with disabilities and better targets monitoring to where it’s needed most.

Look for further details as they become available in future Smart Kids blog posts.

A link between another environmental risk and learning disabilities has been uncovered by researchers studying the effect on children of cadmium, a naturally occurring element found in some soils. The metal is also in tobacco smoke, and some children’s toys and jewelry.

In a recent article published in Environmental Health Perspectives, children with the highest levels of cadmium in their urine were more likely to have learning disabilities and be in special education than children with lower levels of the element. “Importantly,” explained the researchers, “we observed these associations at exposure levels that were previously considered to be without adverse effects and these levels are common among U.S. Children.”

The study involved analyzing data from a group of participants who took part in The National Health and Nutrition Examination Survey (NHANES) from 1999-2004. (Under the auspices of the Centers for Disease Control and Prevention, NHANES has been collecting data since the early 1960s. It’s unique in that it combines interviews with physical examinations.) The findings for this particular study were based on input from nearly 2,200 children, ages 6 to 15.

Putting It In Perspective

Despite the results of this study, experts are quick to clarify that because your child is exposed to cadmium does not mean he will develop learning disabilities; this study suggests association, not causation. As Harvard Medical School professor of pediatrics Robert Wright, MD explains, “It doesn’t mean that if they get exposed to cadmium, something terrible will happen, but there were more learning disabilities and special education seen in kids who were exposed to cadmium than those who weren’t.”

Speaking to Denise Mann, a reporter for WebMD Health News, Dr. Wright acknowledged the challenge concerned parents face: “It’s a little hard to figure out cadmium in food because it comes from soil, so it is based on where it is grown. There is no added value to having cadmium in children’s products, and this is evidence that is a dangerous practice. We need tighter regulations.”

Most agree that more research is necessary to understand exactly where the exposure is originating. Also further study should use methods that do not rely on parent reports of their children’s situations, which are not always accurate.

It’s been well documented that maternal nutrition is fundamental to healthy fetal development. A new study, undertaken by researchers in Australia, adds yet another wrinkle to the literature with findings that suggest vitamin D levels of pregnant women may impact language development in their offspring.

According to Andrew Whitehouse, the lead researcher of the study published in a recent issue of Pediatrics Online, “The effects of lower maternal vitamin D levels on the developing offspring is not fully understood. The current study found that women with vitamin D insufficiency during pregnancy have an increased risk of having a child with developmental language difficulties.”

The research team studied the vitamin D levels of 743 Australian women during pregnancy, and then measured various components of their offsprings’ behavior at 2, 5, 8, 10, 14, and 17 years of age. While no significant associations were found between prenatal vitamin D levels and behavioral or emotional problems at any age, there was a 2-fold increase in language learning problems among children whose mothers’ vitamin D was insufficient during pregnancy.

If the study can be replicated and the findings are valid, preventing some language impairments may be as easy as making sure women take vitamin D supplements during pregnancy.