At the recent scientific meeting of the American Academy of Child and Adolescent Psychiatry, a study was released which documented that Strattera improved ADHD and Reading Disorder (dyslexia). I will summarize this study here, but if you want to read the full report, please visit here.

In this study, children aged 10-16 were treated with Strattera for their ADHD for 16 weeks. There were two main groups - children who had ADHD alone, compared to children who had ADHD plus a Reading Disorder (Dyslexia).

At the end of the study, there was approximately a 50% improvement in ADHD symptoms in both groups.

The interesting difference came when looking at improvement in reading scores. The ADHD and Reading Disorder group had a 2 year improvement in their reading scores, compared to a 17 month improvement in the ADHD group.

Although Strattera is not approved for the treatment of Reading Disorder/Dyslexia, these are encouraging results.

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Two footbal legends, and one reality TV show.

Hmmm…

What do these have to do with ADHD, you may wonder?

Two months ago, I wrote an article about parenting for ADHD, and I talked about how much my daughter and I loved the reality show, ‘So you think you can dance’.

As you may have guessed by now, we also love ‘Dancing with the Stars’ in my house. It is great fun to watch the dancing, and to guess what the judges will say.

What does ‘Dancing with the Stars’ have to do with Attention Deficit Hyperactivity Disorder?

When I watch a reality show like this, I can’t help but watch the behavior of the contestants. When someone is being forced out of their comfort zone - you may see their true colors. Sometimes they shine, and sometimes they don’t.

I have been very impressed by the two football greats that have taken part in ‘Dancing with the Stars’. Jerry Rice got into the ‘final four’ last season, and Emmitt Smith is in the ‘final four’ this season (and who knows, maybe he’ll win?)

I am most impressed by one thing about Jerry Rice and Emmitt Smith. I’ll tell you what it is in a second…

These men were outstanding football players. They worked hard, they knew the value of team, and they dedicated themselves completely to their work. But that is not the thing that impresses me most and leads to an important lesson for ADHD treatment.

Here it is:

These men are very coachable.

That’s right - they listen to instructions, and are willing to be coached. They trust that their dance instructor on the show knows more than they do, and if they can implement what their teacher shows them, they will improve and excel.

They take the advice of a coach.

In the world of ADHD, coaches can play a great role in helping the treatment of teens or adults with ADD/ADHD.

I first learned about coaching for ADHD in Dr. Hallowell’s books. He discussed how a well trained coach can help someone with ADHD to improve his or her functioning.

An ADHD coach can help you to:

1. Create structures and tools to stay on track
2. Improve organization - with tools and systems
3. Plan more effectively
4. Improve time management
5. Increase self-awareness
6. Set and reach your goals
7. Improve your lifestyle habits such as diet, sleep, and exercise
8. Improve relationship skills
9. Improve communication skills

ADHD coaching is different than counseling or psychotherapy. It is not about ‘healing’ as much as it is about functioning at your best.

ADHD coaches generally work with someone with ADHD on a very frequent basis for six months or longer.

ADHD coaches generally work with telephone appointments, and can provide great help and support to their clients.

Do you want to learn more about ADHD coaching?

If so, I recommend that you read more by clicking on the following links:

• 26 Benefits of ADD Coaching (on Pete Quily’s site)
• What is ADD/ ADHD Coaching: by Bonnie Mincu

I know Pete and Bonnie personally, and I suggest you visit their sites to learn more.

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As a Child Psychiatrist, I clearly see the impact that our society has on young woman.

I regularly see teenage girls, preteens, and young girls who have a terrible body image. They are the perfect body size or shape, but they think that they are fat, and ugly, because they don’t look like a super model.

Now, I am not just talking about girls who develop anorexia. I am talking about almost all girls.

I just saw a video online, which I suggest is mandatory watching for all girls.

It came from a place that I wouldn’t have guessed - a Dove soap website.

This short video demonstrates how a ‘regular’ woman, is created into a super model. It is done with make up, hair styling, and then photoshop (to digitally enhance the photo).

I suggest that if you are a parent of a teenage girl, or a girl of any age (or if there is a little girl still inside you…) take 60 seconds to watch this important video.

Frankly, we should show the boys too, so they can start to learn an important lesson about beauty.

I suggest that after watching this video - you take a few moments to discuss with your child what the video means, and how it is relevant to his or her life. Maybe it won’t sink in now, but plant the seed for the future.

To watch the video, just go over to: Campaign for real beauty

After you share this video with a child, please share his or her reaction with us by posting it in the comments. Or you can just share your own reaction, if you like. Do you see the spot for comments below this post?

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We know that ADHD is real.

We know that ADHD is a developmental disorder - which means that it starts in childhood.

We also know that the cause of ADHD is primarily genetics - in fact genetics accounts for over 80% of the cause. Of the 20% of causes which are not genetic - these are acquired cases. Most acquired cases occur before the age of 3 years old.

So, knowing all of these facts - can’t preschoolers have ADHD?

The answer is yes.

Some kids can be clearly diagnosed at the ages of 3, 4 or 5 years old with ADHD.

The issue with treating these children with medication has been a real concern because they are so young.

Their brains are still developing, and until now - there had been no reliable published research on using medication in such young children.

The November issue of the Journal of the American Academy of Child and Adolescent Psychiatry has several articles about a large study of preschoolers with ADHD.

The study was called “The Preschool ADHD Treatment Study”, or ‘PATS’. It was a large study, with 303 children aged 3-5 enrolled. It was funded by the National Institues of Mental Health
in the US, and there were 6 major centres in the US involved in the study, incluing Columbia, Duke, Johns Hopkins, UCLA, UC Irvine and NYU.

For the 303 children enrolled in the study, the children and their parents took part in a 10 week pre-trial behavioral therapy and training course.
To take medication in the study, the children had to meet three criteria:

1. The children had the most severe ADHD
2. They did not benefit from the behavioral treatment
3. Their parents agreed to a trial of medication

While all studies go through review boards for ethical reviews, this study went through extra steps and precautions to ensure that there was true informed consent, and that the study was designed completely ethically.

The medication arm of the study compared the use of methylphenidate (the generic medicine also found in Ritalin, Concerta, Metadate, Focalin and Biphentin) to a placebo.

The study found that preschool children responded well to doses from 3.75 mg per day to 22.5 mg per day. All doses were given three times daily in equal dosing. The average medication dose was 14 mg per day.

There was a side effect of note - showing that children of this age have some growth slowing related to the medication. This is a side effect in older children as well, though generally recognized to not occur in more than 3% of children on stimulants.

There were 11% of medication treated children who had to stop the medicine related to severe side effects. These included: decreased appetite and weight loss, insomnia, mood disturbances, feeling nervous or worried, and skin picking behaviors.

It was found that children in this age range were more sensitive to these side effects than children of older ages.

One of the main conclusions of the study is that the use of methylphenidate in preschool children can work, but children in this age range are more sensitive to side effects. Thus, the decision to treat with medicine should be considered very carefully. Certainly a good trial of behavioral treatment is a must before considering medicine.

To read the abstracts (summaries) of these studies, click here:

• Rationale, Design, and Methods of the Preschool ADHD Treatment Study (PATS)
• Stimulant-Related Reductions of Growth Rates in the PATS
• Efficacy and Safety of Immediate-Release Methylphenidate Treatment for Preschoolers With ADHD

What does this mean to you?

If you have a child who is 3-5 years old, and you suspect ADHD, please talk to your doctor. It is best to have a specialist involved - i.e. a Child Psychiatrist. If after a good trial of behavioral treatment, there is no improvement, it may be worth a trial of medication.

This study is very important, because it establishes practice guidelines for these very difficult to treat children, because prior to this, doctors would be working with very little research to back them up.

We all know that making a decision to medicate a child for ADHD can be difficult, but it is often even more difficult for a preschooler. This research sheds light on how and when to use medication in these kids.

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Concerta is a newer, long acting preparation of Methylphenidate - which is the medication name for Ritalin.

It has been out for several years in the USA and Canada, and many other countries in the world.

Despite the fact that it has been around for quite some time, I still see dosing mistakes in patients who are sent to my office.

Allow me to explain to you how Concerta should be dosed.

To start off, we need to go back to the original Ritalin.

Here are the dosing guidelines for Ritalin:

Recommended daily max = 60 mg
Timing: as each dose only lasts 3-4 hours, it is generally dosed 3 times daily - i.e. morning, noon and 4 pm
It is not dosed too late in the day, as it may lead to insomnia
Children would be started at 5 mg twice to three times daily, and the dose would be increased upwards as needed.

When Concerta was developed, they used a fascinating technology called OROS. OROS refers to: osmotic-controlled release oral delivery system. What OROS does, is use the water in the gut to cause the medicine to be absorbed gradually, through osmosis. Suffice it to say that this new pill takes a medicine that has to be taken 3 times daily, and makes it once per day. You can see a short video of how this works here.

Concerta comes in 4 doses:

18 mg
27 mg
36 mg
54 mg

The way to convert Concerta doses into the equivalent of Ritalin doses is this:
Take 22% of the Concerta dose, and that becomes the effective Ritalin dose, three times daily. In other words, the initial 22% is quickly released, and the whole rest of the pill supports that dose.

You need to remember that not all of the medicine is released from the Concerta pill - about 10% is not absorbed.

Why?

Just picture a ketchup bottle - can you ever get the last bit out?

So, here is a conversion:

18 mg Concerta = 4 mg Ritalin 3 times per day
27 mg Concerta = 6 mg Ritalin 3 times per day
36 mg Concerta = 8 mg Ritalin 3 times per day
54 mg Concerta = 12 mg Ritalin 3 times per day

Here is an example of how some people get into trouble:

Let’s say that a teen required 60 mg of Ritalin per day - i.e. 20 mg three times daily.

If the doctor converts the dose of 60 mg Ritalin to 54 mg of Concerta - because they seem close, this can have dire consequences.

54 mg of Concerta is like 12 mg of Ritalin 3 times per day, so there would be a significant dose drop from 20 mg 3 times per day to 12 mg 3 times per day (i.e. a 40 % dose reduction!). It would be no surprise if the people noticed a change and felt that Concerta wasn’t working.

In the recent past, there has been approval in the US for 72 mg of Concerta for teenagers if needed.

Recent ADHD practice guidelines published by CADDRA - the Canadian ADHD Resource Alliance, suggest that teens and adults with ADHD may require up to 108 mg of Concerta daily.

To put these doses into perspective:

72 mg Concerta = 16 mg 3 times per day
90 mg Concerta = 20 mg 3 times per day
108 mg Concerta = 24 mg 3 times per day

To achieve these doses, you can use:

72 mg Concerta = two 36 mg tablets, or 54 mg + 18 mg
90 mg Concerta = 54 mg tablet + 36 mg tablet
108 mg Concerta = two 54 mg tablets

What’s the bottom line ?

If you or your loved one was switched from another form of methylphenidate to Concerta, and it seemed that Concerta didn’t work, please consider the information above.

You may even want to print this article, so that you can take it with you to your next doctor’s appointment.

Concerta is a great preparation of methylphenidate, and can work very well.
Don’t give up on it unless you are sure you have had the right dose.

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When you are facing a major challenge in life - the trick is to turn your lemons into lemonade.

One of the goals that I have with this blog, is to help you to turn weaknesses into strengths - so that you or your loved ones can succeed with ADHD.

As many of my subscribers know, my family has been touched by breast cancer. It is a big challenge to say the least.

I am writing this article to point you to a friend of mine - Sylvie Fortin - who has taken massive action since her diagnosis of breast cancer. She has taken her diagnosis, and used it as an opportunity to do massive good in the world. She is publishing a blog at: Breast Cancer Victory. She is sharing very intimate and personal information about her feelings, her treatments, and her whole journey.

I just read Sylvie’s most recent post - Hair Today, Gone Tomorrow. In it, Sylvie describes how she is going to shave her hair prior to starting chemo. She is doing this for 2 reasons:

1. To donate her hair to Locks of Love, a charity which takes hair donations and creates wigs for children who have medical hair loss.
2. To raise money for the Avon Breast Cancer Crusade

Here is the amazingly creative part - Sylvie has created an outstanding approach to raising money. You may have heard of ‘pixel pages’. These hit the news about 6-12 months ago. Basically, someone could buy some ‘pixels’ on a page, and get a link back to their website.

Sylvie is going to ’sell’ square inches of her scalp!

When you make a donation to the Avon Breast Cancer Crusade, through Sylvie’s blog, then you can have recognition of your donation and even a link back to your website (if you have one), on Sylvie’s ‘virtual scalp’.

I wanted to share this with you, because this is an outstanding demonstration of courage and resolve to help others. Sylvie is definitely making lemons out of lemonade.

The sad reality is that breast cancer is too common, and if it hasn’t already touched your life or your family’s life, then it likely will.

Here’s what I suggest:

1. Visit this post on Sylvie’s blog: Hair Today, Gone Tomorrow
2. Read it, and consider donating to this great cause.
3. Email your friends and family about it - send it to anyone you know who has been touched by breast cancer (just copy the link into an email and send it to those who will want to know about this)
4. If you have any media contacts - please let them know about this great fund raising campaign. This will help to raise more funds, raise more awareness, and help in the process of beating breast cancer.

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For people who have ADHD (or ADD) and Epilepsy, there has been concern over the years as to whether taking ADHD medication, such as Ritalin, may worsen seizures.
Researchers from Harvard have just presented their data from a study which reviewed the impact of Concerta on seizures. The results are reassuring for ADHD and epilepsy sufferers.

This study included 27 children, with a mean age of 10, with ADHD and epilepsy. This was a randomised, double blind, placebo controlled, cross over study. In other words, it was very well designed.

In the end the researchers were able to conclude that Concerta does not induce seizures.

This should help to reassure parents of children with ADHD and seizures that Concerta is safe in this combination of disorders.

Of course it is important to review your particular situation with your doctor.

Also, as is always the case in science - replication of studies is important to verify and truly establish facts.

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Recently, a study came out in the prestigious journal of Pediatrics, which addressed whether a tonsillectomy could eliminate ADHD.

A recent news cast on NBC summarizes the research and can be watched here.

The issue here is that some children develop ’sleep disordered breathing’.

In adults, we know that sleep apnea exists - i.e. sometimes snoring can be so bad that someone actually stops breathing during their sleep. This can have serious consequences, and can be treated.

In kids, a similar condition can happen - related to enlarged tonsils. The tonsils get so big, that the children have trouble getting enough oxygen during their sleep. This can lead to behavioral consequences, such as inattention and hyperactivity.

In the study published on this issue, the researchers found that in their group of kids with ADHD (total 22) who required tonsillectomy (as assessed by an Ear Nose and Throat specialist), 50% of them (total 11) had improved to the point of not having the diagnosis of ADHD 1 year after their surgery.

Does this mean that all kids with ADHD should have their tonsils out?

Absolutely not.

What it means is: if you child has ADHD, and has trouble with his or her tonsils - get them assessed. Your child may be in the group that will improve if the tonsils are taken out.

Best to talk to your pediatrician, family doctor, or child psychiatrist about how this new research may relate to your child.

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In February 2006, an FDA committee suggested very strong safety warnings on ADHD medication.

After extensive review, the warnings were increased, but not to the level of a ‘black box’, which is the strongest warning possible.

The decision was made to study the ADHD medications further, to clearly establish the risks for side effects like heart attacks and strokes from the stimulant medicines.

It was reported today that the FDA does not have sufficient funding to study the ADHD medications. They may have to stop this study midstream.

It is reported that the FDA has a budget of $1.6 million to fund safety research of medications already on the market. It is estimated by outside experts that the budget that is needed is in the range of $20 million to $100 million annually.

This budget compares to the National Institutes of Health (NIH) in the US of $28.6 Billion. The NIH funds critically important research to further our understanding of major illnesses.

That’s right: 28.6 Billion to 1.6 Million. Couldn’t the budgets be adjusted to allow for proper safety monitoring of medications? Isn’t that a critically important health issue?

As the number of medications available increases, and as the ‘baby boom’ ages (and may take more medication), shouldn’t this be a priority?

As an advocate for ADHD, I feel that it is crucial to have the proper studies done to establish the safety of these medicines. As a Canadian Doctor, I do not pay taxes into the American system which funds this research. However, when I buy or prescribed medicines manufactured in the US, I do support the overall ’system’.

If you are an American, please consider contacting your member of congress to encourage the proper research funding be in place to ensure the safety of everyone who takes ADHD medication (or any medication for any medical condition the requires safety monitoring!).

You can find your member of congress quickly and easily here.

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