University of Utah Study Links Rates of ADHD to Altitude

April 10, 2015 by  
Filed under Featured, Research

So we should have moved to the mountains?

Recent research has linked the thin air of higher elevations to increased rates of depression and suicide. But a new study shows there’s also good news from up in the aspens and pines: The prevalence of attention deficit hyperactivity disorder (ADHD) decreases substantially as altitude increases.

In Utah, for example, an analysis of information from two national health surveys correlated with the average state elevation of 6,100 feet showed that the rate of diagnosed ADHD cases is about 50 percent of states at sea level. In Salt Lake City, whose elevation is about 4,300 feet, diagnosed ADHD prevalence is approximately 38 percent less than at sea level.

One potential reason for the decreased rate of ADHD, University of Utah researchers believe, is higher levels of dopamine produced as a reaction to hypobaric hypoxia—a condition caused when people breathe air with less oxygen at higher elevations. Decreased dopamine levels are associated with ADHD so when levels of the hormone increase with elevation, the risk for getting the disorder diminishes. There are other potential reasons for the disparities in the rates of the disorder, such as regional inconsistencies in diagnosing ADHD.

The study findings, published in the Journal of Attention Disorders online, have important implications for potentially treating ADHD, according to Douglas G. Kondo, M.D., assistant professor of psychiatry and senior author on the study. “Our previous studies of mood disorders and suicide consistently suggest that hypobaric hypoxia associated with altitude may serve as a kind of environmental stressor,” Kondo says. “But these results raise the question of whether, in the case of ADHD, altitude may be a protective factor.

Rebekah Huber, a doctoral candidate in educational psychology at the University of Utah, is the first author. Huber works in the research group of Perry F. Renshaw, M.D., Ph.D., M.B.A., a University of Utah professor of psychiatry, USTAR investigator and a co-author on the study.

Huber, Kondo, Renshaw and their colleagues conducted the study with data from two national health surveys and information on average state elevations taken from NASA’s Shuttle Radar Topography Mission and the National Geospatial-Intelligence Agency.

The National Survey on Children’s Health contacted 91,642 households in 2007 and found that 73,123 children ages 4-17 had been diagnosed with mild, moderate or severe ADHD by a physician or other health care provider. The 2010 National Survey of Children with Special Healthcare Needs contacted 372,689 households and found that 40,242 children in that age range had been diagnosed with full ADHD.

The researchers correlated the number of cases of diagnosed ADHD with average elevations in the lower 48 states and the District of Columbia as reported by the federal agencies to determine rates of ADHD. From this, they derived data on ADHD rates at sea level and above and found that for every 1-foot increase in elevation, the likelihood of being diagnosed with ADHD by a healthcare provider decreases by .001 percent.

The data showed that North Carolina, whose average elevation is 869 feet above sea level, had the highest percentage of children diagnosed with ADHD – 15.6 percent. Delaware, Louisiana and Alabama—all states with an average elevation of less than 1,000 feet—followed closely behind North Carolina with high percentages of ADHD.

Nevada—with an average elevation of 5,517 feet above sea level—had the lowest percentage at 5.6. Utah had one of the lowest rates of ADHD, 6.7 percent. All of the Mountain West states rated well below average for the percentage of children diagnosed with ADHD. The study also took into account other factors—such as birth weight, ethnicity, and sex (males are more likely to have ADHD)— that could affect ADHD diagnoses and influence the rate of the disorder in each state.

This study follows research in which Renshaw and colleagues at the University of Utah and in South Korea showed correlations between increased rates of suicide and depression with higher altitudes.

The decrease in ADHD at elevation doesn’t mean people need to start moving to the mountains, according to Renshaw. But the research results do have potential implications for treating the disorder.

“To treat ADHD we very often give someone medication that increases dopamine,” he says. “Does this mean we should be increasing medications that target dopamine? Parents or patients might want to take this information to their health care providers to discuss it with them.”

SOURCE: University of Utah

Washington State Legislature Moves to Limit Schools Pinning Down and Isolating Kids

April 1, 2015 by  
Filed under Advocacy

by Annie Waldman ProPublica, March 10, 2015, 11:31 a.m.

A bill that would limit Washington public schools restraining or isolating students is working its way through the state Legislature, making it at least the fourth state to move to limit restraints in recent months.

Last year, an analysis of government data by ProPublica and NPR revealed that educators frequently pin down kids and isolate them. During the 2012 school year, these practices were used on students more than 267,000 times. Nearly three-quarters of the reported restraints involved children with disabilities. Hundreds of children are injured each year during restraints and at least 20 have died as a result.

Washington’s House of Representatives passed the restraints bill earlier this month and the state Senate is expected to vote on it in the coming weeks. It would prohibit pinning down kids or isolating them unless a student’s actions could lead to the harm of a person or property. Such interventions would also no longer be allowed in the pre-approved behavior plans of special needs students.

State Sen. Rosemary McAuliffe, who supports the bill, said she hopes it will decrease the dropout rate, in particular for students with special needs.

“Some districts use handcuffs and some use scream rooms,” McAuliffe told ProPublica. “Many of these children have a fear of isolation and restraint and I don’t think they’re going to want to go back to school.”

Several other states have also moved to decrease schools’ reliance on restraints and seclusion.

Virginia legislators passed a bill earlier this year requiring state leaders to set limits on the use of these practices in schools. In Massachusetts, new rules will be enacted by the end of 2016 requiring educators to get permission from principals before giving students “time-outs” that last more than 30 minutes. New York City, which in the past has faced criticism for its lack of transparency on restraining kids in schools, recently reformed its discipline code to mandate the tracking of such interventions.

According to federal data, Washington children were restrained or isolated more than 10,500 times during the 2012 school year. Although the reporting of restraints is required under state law, exactly how and when the techniques could be used was not clearly defined in the statute.

“Districts were using this as a form of punishment,” Arzu Forough, the founder of Washington Autism Alliance and Advocacy, said in an interview. “It was intended to be an emergency response.”

The new bill clarifies that restraints should only be used as a last resort.

Not all legislators support the proposed reforms.

“Let’s be honest, some of these children are very large and very strong,” State Rep. Brad Klippert told Tacoma’s News Tribune. “I do want to be able to give our teachers the latitude to protect everyone.”

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One in six college students misuse ADHD stimulant drugs

March 12, 2015 by  
Filed under Research

Getting into trouble with drugs is one way to derail a promising future, and a lot more than traffickers in hard narcotics are engaging in risky behavior on university campuses. A recent literature review published by researchers at the University of South Carolina shows that one in six college students misuse common stimulant medications prescribed for attention deficit hyperactivity disorder (ADHD). Given that Ritalin, Adderall and their ilk are Schedule II controlled substances — the same as cocaine and methamphetamine — a lot of young adults are flirting with potentially serious legal jeopardy.

Senior psychology major Kari Benson has seen that firsthand with fellow students. As a sophomore, she had started working with associate professor Kate Flory in the University of South Carolina’s Parenting and Family Research Center, studying social impairment in children with ADHD.

Friends would ask her what she was up to, and once word got around that she was doing ADHD research, a few acquaintances that didn’t know her very well started making requests.

“People would ask me if I could get them Adderall or Ritalin,” Benson says. “I realized that this was a pretty prevalent issue on campus, and I wanted to see what I could do about it.”

She set out to analyze collegiate misuse of stimulant ADHD drugs, earning a grant as a Magellan Scholar from the Office of Undergraduate Research to help put together a survey of Carolina students. To familiarize herself with previous work in the area, she prepared a literature review that Flory thought merited publication, particularly because it highlighted how much uncertainty there was in the field.

“If you looked at individual studies, the rates of college student misuse were all over the place,” says Flory. “They ranged from 2 percent to 43 percent. So when we submitted this for publication, the journal was really interested in us doing a meta-review of all the existing studies.”

That involved standardizing and pooling data from 30 articles, which Benson and Flory did in collaboration with Kathryn Humphreys of the Tulane University School of Medicine and Steve Lee of UCLA. They recently published their results in the journal Clinical Child and Family Psychology Review.

Because the meta-analysis comprises a much larger sample size than any individual study, it provides greater statistical certainty in conclusions. One result is the finding that 17 percent of college students misuse stimulant medications prescribed for ADHD. Misuse includes taking more than prescribed or taking the medication without a prescription.

College students misuse the drugs primarily because they think they bolster academic performance, although there is no study showing stimulant medication does so, Flory says. In fact, the meta-analysis suggested the opposite may be true, correlating poor academic performance with stimulant misuse.

Recreational use of the drugs, such as taking them with alcohol to prolong the amount of time a student can party, is less prevalent but extremely dangerous. “It makes it possible to drink beyond the normal limit,” Benson says. “So instead of passing out drunk, you might end up in the hospital having to get your stomach pumped.”

The review also concluded that the most common source of stimulant drugs was among friends, meaning there’s an informal network of students sharing Schedule II controlled substances on most college campuses. Each individual in the network carries legal risks not just for possession and trafficking, but also potentially for the consequences of someone else’s highly hazardous — and possibly fatal — recreational abuse of the drugs.

Benson and Flory are using the meta-analysis and the results of their student survey, which involves more than a thousand Carolina students, to examine specific characteristics that are associated with misuse of the drugs. They hope that will help identify students for intervention programs on college campuses.

“That’s something we’re hoping to do here,” says Flory. “We have a substance abuse prevention and education office, and they have a group that’s focused on prescription medications. We’ve pulled together an interdisciplinary group of researchers here at USC to apply for a grant from the National Institute of Drug Abuse, which would enable us to actually do an intervention on campus.”

SOURCE: University of South Carolina via EurekAlert

Boredom and frustration trigger skin-picking and other compulsive behaviors

March 12, 2015 by  
Filed under Research

An interesting news release from the University of Montreal:

Individuals who get easily bored, frustrated or impatient are more inclined to develop skin-picking and other body-focused repetitive behaviors, say researchers at the Institut universitaire en santé mentale de Montréal and the University of Montreal. “Chronic hair-pulling, skin-picking disorder and nail-biting and various other habits are known as body-focused repetitive behaviors. Although these behaviours can induce important distress, they also seem to satisfy an urge and deliver some form of reward”, says principal investigator Kieron O’Connor. Chronic hair-pulling is also known as trichotillomania. “We believe that individuals with these repetitive behaviours maybe perfectionistic, meaning that they are unable to relax and to perform task at a ‘normal’ pace.  They are therefore prone to frustration, impatience, and dissatisfaction when they do not reach their goals. They also experience greater levels of boredom.”

O’Connor and his colleagues came to these conclusions by working with 48 study participants, half of whom suffered these repetitive behaviours and half of whom didn’t (acting therefore as the controls.) The participants were referred to a clinical evaluator for a telephone screening interview and completed questionnaires at home. The questionnaires included a scale that evaluates emotions, including boredom, anger, guilt, irritability, anxiety. The participants were then individually exposed to four experimental situations at the research centre, each one designed to provoke a different feeling: stress, relaxation, frustration and boredom. The first two involved the screening of videos (a plane crash and the waves on a beach.) Frustration was elicited by asking the participants to complete a task that was supposedly easy and quick (it wasn’t) and boredom was caused by… leaving the participant alone in a room for six minutes!

Individuals with a history of body-focussed repetitive behaviours reported a greater urge to engage in these behaviours than controls during the boredom and frustration phases of the experiment, but not in the relaxation situation. “These results partially support our hypothesis in that participants were more likely to engage in body-focussed repetitive behaviours when they felt bored, frustrated, and dissatisfied than when they felt relaxed. Moreover, they do engage in these behaviours when they are under stress. This means that condition is not simply due to “nervous” habits,” added Sarah Roberts, first author of the study. “The findings suggest that individuals suffering from body-focussed repetitive behaviours could benefit from treatments designed to reduce frustration and boredom and to modify perfectionist beliefs.”

About the study

Source : Roberts S, O’Connor K, Aardema F, Bélanger C. The impact of emotions on body-Focused repetitive behaviors: evidence from a non-treatment-seeking sample.  J Behav Ther Exp Psychiatry. 2015 Mar;46:189-97. PubMed PMID: 25460266.

Kieron O’Connor is researcher and director of the Obsessive-Compulsive Disorder and Tic Disorder Studies Centre at the Institut universitaire en santé mentale de Montréal and a full Professor at the Department of Psychiatry at the University of Montreal.

Sarah Roberts is a psychologist in private practice at the MindSpace Clinic in Montreal.

Frederick Aardema is researcher at the Institut universitaire en santé mentale de Montréal and assistant professor at the Department of Psychiatry at the University of Montreal.

Claude Bélanger is full professor at the Université du Québec à Montréal

This research was partially funded by a Quebec Health Research Fund (Fonds de Recherche en Santé du Québec) grant no. 20573 awarded to Dr. Kieron O’Connor.

The University of Montreal is officially known as Université de Montréal.

Elimination diets for ADHD: beyond the media hype

March 5, 2015 by  
Filed under Commentary, Tips

I am often asked by parents about whether their child’s diet could be causing their ADHD or worsening it. My answer is that yes, there is some controlled research demonstrating that foods or additives can produce the symptoms of ADHD or exacerbate them, but let’s not jump to an elimination diet.

One of the most well-known studies on diet and ADHD was conducted by Dr. Lidy Pelsser and her colleagues, and was published in Lancet in 2011. That study – and an earlier study by Feingold – are the ones that seem to have attracted a lot of parental interest in the topic.

Dr. Pelsser and her colleagues randomly assigned 100 children aged 4-8 years who were diagnosed with ADHD to either a 5 -weeks restricted elimination diet or to a control group who were simply given instructions for a healthy diet. In the ADHD restricted diet group, 41 of 50 children finished the first phase. In that group of 41 children, 32, or 78%, responded favorably by having fewer symptoms. Overall, 32 of 50, or 64%, had decreased ADHD symptoms while on the diet. Associated symptoms such as oppositional behavior and tantrums also decreased. Most parents hear that over 60% improved on the diet and think, “Wow, that sounds great!” But not so fast, because the methodology was seriously confounded by relying on the reports of parents who were not blind to the child’s experimental condition, which can introduce a bias or placebo effect into their reports of improvement.
Children who showed a significant improvement in their ADHD symptoms while on the restricted elimination diet were then assigned to one of two food-challenge groups based on their individual immunoglobulins (IgG) blood tests. Significantly, two-thirds of the children displayed a relapse in their symptoms when challenge foods were re-introduced to their diet.

More recently, Joel T. Nigg, PhD and  Kathleen Holton, PhD, MPH reviewed the literature on research on foods and additives. Their full article is well worth attempting to read if you are considering undertaking an elimination diet for your child, as they point out that adequately controlled experiments generally do not provide evidence of dramatic effects in symptom reduction for the majority of children with ADHD:

The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children.

Of course, every parent hopes their child will be in that subset who do respond to diet changes, but if you are not sure whether foods or additives are causing or exacerbating your child’s ADHD-like symptoms, speak with your pediatrician about whether an elimination diet might be in order as a 5-week trial or test. Maintaining a restricted diet is difficult, time-consuming, costly, and unlikely to work if you do not have pretty much total control over what your child eats both outside of the home and in your home. It is also important to ensure that the elimination diet does not deprive the child of important nutrients, so don’t just start removing everything from your child’s diet. Reading Drs. Nigg and Holton’s detailed review of studies may help you understand what to consider and what to ask your child’s physician.

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