Is ADHD really a sleep problem?

Around 75 percent of children and adults with attention deficit hyperactivity disorder (ADHD) also have sleep problems, but until now these have been thought to be separate issues | ScienceDaily

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  • In 75% of ADHD patients, the physiological sleep phase — where people show the physiological signs associated with sleep, such as changes in the level of the sleep hormone melatonin, and changes in sleep-related movement — is delayed by 1.5 hours.
  • Core body temperature changes associated with sleep are also delayed (reflecting melatonin changes)
  • Many sleep-related disorders are associated with ADHD, including restless-leg syndrome, sleep apnea, and the circadian rhythm disturbance, the delayed sleep phase syndrome
  • ADHD people often show greater alertness in the evening, which is the opposite of what is found in the general population
  • Many sufferers benefit from taking melatonin in the evening or bright light therapy in the morning, which can help reset the circadian rhythm
  • Recent work has shown that around 70% of adult ADHD sufferers show an oversensitivity of the eyes to light, leading many to wear sunglasses for long periods during the day — which may reinforce the problems associated with a ‘circadian shift’.
  • Chronic late sleep leads to a chronic sleep debt, associated with obesity, diabetes, cardiovascular disease and cancer. This cascade of negative health consequences may in part be preventable by resetting the sleep rhythm.

Read the overview via ScienceDaily here

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Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder

A Process Map and Proposed Model to Overcoming Barriers to Care | Journal of Pediatric Psychology

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Objective: To provide a topical review of the personal vulnerabilities and systemic barriers facing transitional age young adults with attention-deficit hyperactivity disorder (ADHD), followed by a proposed model for overcoming those barriers.

Methods: Drawing from a growing, but limited, literature on the topic, we outline a process map for identifying and troubleshooting barriers to care in this at-risk population.

Results: Young adults with ADHD frequently lack the organizational skills, time management, prioritization, and persistence to manage their health care at an expected level of adult independence. These difficulties are compounded by a health-care system that has less time or fewer resources for supporting young adult patients.

Conclusions: Recommendations for easing the transition from pediatric to adult care for late adolescents with ADHD include heavily leveraging the doctor–patient relationship, and capturing the young adult’s attention through technologies that already absorb them.

Full reference: Fogler, J.M. et al. (2017) Topical Review: Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder: A Process Map and Proposed Model to Overcoming Barriers to Care. Journal of Pediatric Psychology. Published online: 01 August 2017

Digital technology and adolescent conduct problems

Adolescents spend an unprecedented amount of time using digital technology to access the Internet and engage with social media. There is concern that this continuous connectivity could increase their mental health symptoms, especially for at-risk adolescents. | Journal of Pediatric Nursing

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A new US study has reported that on days that at-risk adolescents used technology more, they experienced more conduct problems and higher attention-deficit hyperactivity disorder (ADHD) symptoms compared to days when they used digital technologies less.

However, the study also found that on days when adolescents spent more time using digital technologies they were less likely to report symptoms of depression and anxiety.

Key findings:

•Daily digital technology use by at-risk adolescents is associated with worse mental health symptoms.
•Higher levels of digital technology use were associated with increases in next-day conduct problems.
•Attention-deficit hyperactivity disorder symptoms increased with increased digital technology use.
•When adolescents spent more time using digital technologies they reported fewer symptoms of depression and anxiety.

Full reference: McBride, Deborah L. Daily Digital Technology Use Linked to Mental Health Symptoms for High-risk Adolescents. Journal of Pediatric Nursing: Nursing Care of Children and Families. Published online 7th June 2017

Antidepressant use in early pregnancy does not increase autism & ADHD risk in kids

Large-scale analysis suggests fewer risks than previously thought from exposure to antidepressant medications in early pregnancy | ScienceDaily

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A study led by Indiana University suggests that mothers’ use of antidepressants during early pregnancy does not increase the risk of their children developing autism or attention deficit hyperactivity disorder, conditions previously associated with these medications.

The research, reported today in the Journal of the American Medical Association, found significant evidence for only a slight increase in risk for premature birth in the infants of mothers who used antidepressants during the first trimester of pregnancy.

After controlling for multiple other risk factors, the researchers did not find any increased risk of autism, ADHD or reduced fetal growth among exposed offspring. The risk for premature birth was about 1.3 times higher for exposed offspring compared to unexposed offspring.

Read the full commentary here

The original research abstract is available here

Practical guide to the management of ADHD

Fischer, B. & Herberholz, N. Paediatrics and Child Health. Published online: 5 August 2016

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Image source: Ian Barbour – Flickr // CC BY-SA 2.0

Attention Deficit Hyperactivity Disorder (ADHD) manifests in persistent and pervasive inattention, hyperactivity and impulsivity, which interferes with functioning. It usually presents in childhood and can persist into adulthood. Severity, psychiatric co-morbidity, and parental psychopathology predict persistence. UK prevalence (ages 5–15 years) is 3.62% (boys) and 0.85% (girls) and the reported prevalence of children and young people on medication has increased over time. However, pharmacological treatment is not a solution in itself.

Read the abstract here

Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence

Beau-Lejdstrom, R. et al. BMJ Open. 2016. 6:e010508

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Image source: Practical Cures // CC BY 2.0

Objectives To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013.

Methods All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated.

Results The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years.

Conclusions There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries.

Read the full article here

Diagnosis and treatment of ADHD in Primary Care

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents.

PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics and children/adolescents, abstracts addressing diagnosis and/or treatment with 105 citations identified including supplementary treatment guidelines/books.

Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations.

The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence as substance use disorders.

Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.

Full reference: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review. Journal of Adolescent Health. Published Online:May 18, 2016