Functional Brain Pathways Disrupted in Children with ADHD

New research presented at a Radiological Society of North America conference is offering new and important insight into ADHD.

Using functional magnetic resonance imaging (fMRI), researchers have identified abnormalities in the brains of children with Attention Deficit Hyperactivity Disorder (ADHD) that may serve as a biomarker (indicator) for the disorder.

ADHD is one of the most common childhood disorders, affecting an estimated five to eight percent of school-aged children. Symptoms, which may continue into adulthood, include inattention, hyperactivity and impulsivity behaviors that are out of the normal range for a child’s age and development.

According to the National Institute of Mental Health, there is no single test capable of diagnosing a child with the disorder. As a result, difficult children are often incorrectly labeled with ADHD while other children with the disorder remain undiagnosed.

“Diagnosing ADHD is very difficult because of its wide variety of behavioral symptoms,” said lead researcher Xiaobo Li, Ph.D., assistant professor of radiology at the Albert Einstein College of Medicine in New York. “Establishing a reliable imaging biomarker of ADHD would be a major contribution to the field.”

For the study, Dr. Li and colleagues performed fMRI on 18 typically developing children and 18 children diagnosed with ADHD (age range 9 to 15 years). While undergoing fMRI, the children engaged in a test of sustained attention in which they were shown a set of three numbers and then asked whether subsequent groups of numbers matched the original set. For each participant, fMRI produced a brain activation map that revealed which regions of the brain became activated while the child performed the task. The researchers then compared the brain activation maps of the two groups.

Compared to the normal control group, the children with ADHD showed abnormal functional activity in several regions of the brain involved in the processing of visual attention information. The researchers also found that communication among the brain regions within this visual attention-processing pathway was disrupted in the children with ADHD.

“What this tells us is that children with ADHD are using partially different functional brain pathways to process this information, which may be caused by impaired white matter pathways involved in visual attention information processing,” Dr. Li said.

Dr. Li said much of the research conducted on ADHD has focused on the impulsivity component of the disorder.

“Inattention is an equally important component of this disorder,” she said, “and our findings contribute to understanding the pathology of inattentiveness in ADHD.”

Shugao Xia, Ariane Kimball and Craig Branch, Ph.D. co-authored the report.

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5-year-old with ADHD handcuffed, charged with battery on officer

All too often, I read something in the news that upsets me with all of my hats on – as a psychologist, a mother, and a disability rights advocate – like the item I posted earlier about using vinegar-soaked cotton balls in the mouths of autistic children or my coverage on this blog of the use of aversives and the  controversial Judge Rotenberg Center.  Other stories that are particularly upsetting to me are those involving the arrest of young children. I’ve posted some of those incidents in the past on this blog, and  in August, I read of another case where Toronto police handcuffed an autistic 9-year-old.  Then this week, I saw a news report from California by Dave Manoucheri of KCRA News involving a 5-year-old with ADHD that was very disturbing:

Earlier this year, a Stockton student was handcuffed with zip ties on his hands and feet, forced to go to the hospital for a psychiatric evaluation and was charged with battery on a police officer. That student was 5 years old.

Michael Davis is diagnosed with Attention Deficit Hyperactivity Disorder or ADHD. His mother says it has led to fights at school. But when the school district said it had a plan to change Michael’s behavior, his mother says things went wrong.

“Michael is energetic,” Thelma Gray said. “He is one big ball of energy.”

Gray calls Michael a comedian. She says his biggest problem is his ADHD stops him from thinking before he acts or speaks.

“He’s very loving,” Gray said. “He’s a good kid and he’s not the discipline problem that he was made out to be.”

Those discipline problems include fights with other students, even throwing a chair.

Gray says the school, Rio Calaveras Elementary of Stockton, wanted to change that behavior by having Michael meet with a school police officer.

“He could come out and talk to Michael and the kids are normally scared straight,” said Gray, describing how she says the school district proposed the meeting.

But the meeting didn’t go as planned.

You can read more of the news story on KCRA. In this case, the U.S. Department of Education reportedly did investigate and the news station obtained the report under Freedom of Information. I’m not sure why the department released the report and didn’t invoke FERPA like the district did, but the news station summarizes the report:

The report states that the Stockton Unified School District “delayed an evaluation of the student {Michael} which denied the student a fair and public education.”

They added that the school didn’t offer behavioral services to Michael or his mother, because “it would cost the district money.”

The report goes on to say that, whether or not funds are available through state or federal grants, the school district had an obligation to have Michael evaluated, which it failed to do.

The comments under the news story are also upsetting as the lack of understanding expressed by some people reminds me of how much ignorance still exists about ADHD.

But commenters aside, this case represents a total failure on the part of the school district, the building administration, and the state.

What the heck were the school personnel thinking if they thought a 5 year-old with ADHD could be “scared straight?” That they would even consider this approach demonstrates to me that they do not understand ADHD at all.

Would you want these people educating your child? I wouldn’t. This child might have (or may have?) been seriously psychologically harmed by their inappropriate handling.

I have often noted that schools fail to use research-validated or best practices in handling students with neurological challenges.  This is a case in point.  Have the school personnel received adequate training in how to educate students with ADHD (or other neurological disorders, for that matter)?  Are budgetary concerns an excuse for mishandling a student?

I am not a lawyer, but I hope that the family sues the district.  And I hope that as part of any settlement, the district is required to undergo training in best practices for educating students with neurological disorders – and is audited for compliance with I.D.E.A.

In various places around this country, parents have banded together to call for a halt to handcuffing young children. If you have not been involved in such advocacy efforts, you might want to look into what goes on in your area or state lest this happen to your child.

My kids are safe because they are out of school.  Are your children safe?

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UK study finds low rate of Bipolar Disorder in ADHD youth

One of the “hot” topics in recent years has been the comorbidity between ADHD and Bipolar Disorder – and how difficult some people find it to be clear about whether a child or adult has one, the other, or both.

When it comes to the rate of comorbidity (co-occurrence of the two disorders), results from studies have been all over the place, with one study suggesting that 94% of youth with Bipolar Disorder also have ADHD. Studies demonstrating high comorbidity rates of 80% or higher are not unusual, although there have been some studies – usually from non-U.S. samples – that find significantly lower rates. Hence, the range of estimates has been from 4% to 94%.

If you pose the question the other way, though, i.e., what percent of youth with ADHD also have Bipolar Disorder, studies report that 11-22% of ADHD youth also have Bipolar. In 2010, I visually summarized the results in a presentation this way:

If you have only been hearing about the high estimates, here’s more food for thought:

A study conducted in the U.K. of 200 youth with ADHD aged 6-18 years found that only one child, a 9-year-old boy, met diagnostic criteria for both ICD-10 hypomania and DSM-IV bipolar disorder not otherwise specified.

The study was published in the March 2011 issue of the British Journal of Psychiatry.

So… are we overdiagnosing Bipolar youth in the U.S. or is there some other explanation?

 

ADHD doubles the risk of injury in grade-school kids

Back in 1998 when I first wrote an article for parents about ADHD and safety, my blog was one of the only resources on the internet for information on what I saw as a serious but often overlooked aspect of parenting children with ADHD.

Since that time, there has been more research on this issue. The following is a news release by Kevin Storr from the University of Alabama that I encourage parents and educators to read:

Injury kills more 11-year-olds in the United States than all other causes combined, and a new study from University of Alabama at Birmingham reveals ADHD almost doubles the risk of serious injury among this age group.

“We found that children with more ADHD symptoms, those in the 90th percentile, are nearly twice as likely to get hurt as those with symptoms in the 10th percentile,” says David Schwebel, Ph.D., director of the UAB Youth Safety Laboratory and lead author. Boys, he said, are nearly twice as likely to be injured as girls.

The research, published in the September/October Academic Pediatrics, studied 4,745 fifth-graders from Houston, Los Angeles and Birmingham. Serious injury is defined as one that requires medical attention; more than half of the injuries included broken bones.

“These are children that no longer have adults or parents or teachers watching over them all the time, which means they have to make decisions on their own,” Schwebel said. “Children with ADHD are impulsive, inattentive; they may not notice things because their mind is wandering, and they’re hyperactive so they’re always moving and getting into things.”

The Center for Disease Control and Prevention says 9.4 percent, or 5.4 million, kids ages 4-17 in the United States have been diagnosed with ADHD. Schwebel, professor in the UAB Department of Psychology, says this study will improve injury-prevention strategies for millions of mental health practitioners, pediatricians, parents and children.

“Medication, seeing a psychologist and getting treatment for ADHD will reduce the risk and the symptoms,” Schwebel said. “In some cases you can make the child aware and get them to think about what they’re doing so they will slow down and be more careful. It won’t work for everyone, but it certainly can’t hurt to try.”

This study is part of UAB’s Healthy Passages research, a decade-long program funded by the CDC, designed to help families, health-care providers, schools and communities develop effective policies and programs to keep children and adolescents healthy. The participants’ gender was 52 percent male. The mean age was 11.12 years. The racial/ethnic breakdown for the youth was: 30 percent African-American, 42 percent Hispanic, 23 percent white non-Hispanic, 5 percent multiracial or of other ethnicities.

Schwebel also analyzed the affect of Conduct Disorder. CD is a disorder marked by chronic behavioral problems like breaking rules without reason, physically or psychologically abusing people or animals and destruction of property, symptoms that go beyond simple mischievousness. Researchers wanted to know if the combination of CD and ADHD had a multiplier effect on a child’s chances of injury.

“What we found in the past, with younger children, is that ADHD and oppositional behaviors mattered equally. But in this study with fifth-graders, we found that ADHD is more relevant,” says Schwebel. “When you put ADHD and CD together statistically, we did not see multiplication at all. ADHD is the primary issue.”

The study was originally published online in June, 2011.

If you have a school plan for your child, does it include added supervision on the playground? Does the physical education teacher know to be extra vigilant in gym? How about extra supervision in close proximity when your child is in a novel situation or on a field trip?

As parents, you probably are already aware of the need to keep your child close lest they get into trouble or risk injury. But don’t assume that educators know this. If you haven’t had a conversation with them about your child’s safety, why not arrange for one?

Join Me at an All-Day Workshop for Educators & Parents on December 5th

I’ll be conducting an all-day workshop for educators on Monday, December 5, 2011 at the Grappone Conference Center in Concord, New Hampshire. The event is sponsored by the University of New Hampshire Institute on Disability and is geared to regular and special education teachers, school psychologists and social workers, behavior specialists, occupational therapists, administrators, and parents.

Description:

Neurological disorders that emerge in childhood often have significant impact on students’ academic, behavioral, and social-emotional functioning. Participants will learn about the cardinal features of Tourette’s Syndrome, Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Executive Dysfunction, Mood Disorders such as Depression and Bipolar Disorder, and the memory deficits, sensory issues and “storms” that sometimes accompany them. Strategies and assistive technology to accommodate symptom interference in activities such as handwriting, homework, math calculation, and written expression and big projects will be described. Pitfalls in behavioral interventions, and simple social skills and problem-solving interventions will also be identified.

For more information on the workshop and registration information, download the brochure or register online at www.iod.unh.edu.

Hope to see you there!

 

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