What happens to a child’s ADHD symptoms over time? Studies show that approximately 40-60% of children with ADHD will become adults with ADHD. However there is relief for parents wondering how they will keep up with their very active ADHD child through the years. The ADHD symptoms that do typically improve with age are the hyperactive and impulsive symptoms. It’s the fidgety, can’t-sit-still kids who will show the greatest decrease in symptoms with maturity. This is the reason the medical community previously believed that children would “grow out of” the disorder. It is now clear that is not the case.

Recent research confirms prior studies that it is the inattentive, daydreamy ADD types who are most likely to continue to struggle with symptoms into adulthood, particularly if they also suffer from depression or anxiety. These inattentive symptoms are the ones which often go unrecogized given the lack of outwardly physical or behavioral signs. As adults these individuals may continue to find it difficult to focus at work or follow through on everyday tasks.

Interestingly changes in symptoms with age do not seem to differ between groups of ADHD kids who took medications and those that did not. This is an important statistic since we know that over 60% of children in the U.S. are medicated at some point for their ADHD. The attached article describes additional research on tracking ADHD symptoms over time both in the U.S. and Finland.

http://www.latimes.com/features/health/la-he-adhd28jan28,1,5908673.story?ctrack=3&cset=true

On December 19th, 2007 the Drug Enforcement Administration changed the regulations on Schedule II controlled substances to allow up to a 90 day supply. Prior to this new regulation physicians could only prescribe up to a 30 day supply. Schedule II controlled substances include medications such as stimulants for ADHD, pain medications, and other potentially addictive drugs.

The regulatory change still does not allow for refills on such prescriptions. Instead, a physician may write 3 separate prescriptions totaling 90 days worth of medication during a single patient visit. This gives the physician more flexibility in treating patients with chronic medical conditions previously requiring monthly re-writes on these prescriptions.

Ask your doctor if this change will affect you. The shift in government regulations may not apply in your state since each state can still impose limits on the amount of a controlled substance that physicians prescribe. In order for your doctor to dispense a 90 day supply, your state laws must permit the issuance of multiple prescriptions.

For more information, the DEA regulation is posted at www.deadiversion.usdoj.gov/fed_regs/rules/2007/fr1119.htm

There was recently an article in New York Times magazine on brain fitness tools. Below is my response to the authors. Though there are many brain training programs with little to no research data, we at ADD Health and Wellness we have been successfully using the Cogmed program on training working memory skills and attention. The Cogmed program does have significant research support in addition to the positive feedback from thousands of clients. Feel free to give us a call with questions on Cogmed and the proven benefits of brain training.

Theresa Cerulli, M.D.
Neuropsychiatrist

Dear Editor,
I’d like to applaud Sandra Aamodt and Sam Wang for throwing some cold water on the current brain fitness craze in last week’s Opinion Editorial “Exercise on the Brain.” They are correct in labeling the host of “mental fitness” products that target aging baby boomers as “inspired by science — not to be confused with actually proven by science.”
For the last 30 years, terms like “brain plasticity” have been widely and casually used, creating hype that risks drowning out the real breakthroughs that brain researchers are making in this area. 
It is important to distinguish the “mental fitness” trend that Aamodt and Wang rightly criticize from actual researched-based cognitive training. Unlike “mental fitness” programs, cognitive training programs focus very narrowly on specific cognitive functions that research has shown to be plastic. This is in stark contrast to compiling a smattering of exercises or activities that are generally thought to be good for the brain, but lack true scientific research and are ultimately ineffective. Cognitive training does not claim to be for everyone—only those who experience deficits in specific cognitive functions that can be improved through persistent training. A qualified clinical professional can determine if and when cognitive training is the right form of intervention.
One type of cognitive training that has proven to be effective is the training of working memory—the ability to hold information in mind for a few seconds. As Aamodt and Wang point out, working memory is a critical component of executive function, a collection of cognitive skills that together allow us to organize, manage and prioritize activities. Training working memory offers more than just improvements in the trained task. Other brain functions such as attention, reading, and problem solving skills also improve with working memory training. (Important research on the effectiveness of working memory training to improve attention and executive functioning was published in Aamondt’s Nature Neuroscience).
In my clinical practice, I have had the pleasure of observing the often dramatic impact of working memory training on the daily lives of many of my patients who struggle with debilitating attention problems. Working memory training is a research-based breakthrough for children and adults with attention deficits, as well as victims of stroke and traumatic brain injury. For clients with executive functioning challenges, working memory training targets these very difficulties which medications so often fail to treat.
Baby boomers need to remain cautious when it comes to the fountain-of-youth promises of the brain fitness programs. The key lies in drawing a clear line between the “mental fitness” fad and proven cognitive training that has been validated repeatedly in the laboratory and in clinical practice.

Will my child outgrow ADHD? It is well known that 50% of children diagnosed with ADHD will no longer meet full criteria for the condition by the time they reach adolescence and adulthood. The reason why is becoming clearer. Studies show that children with attention deficit disorder do have normal patterns of brain maturation, but their brains may just mature a little bit later. Findings at the Montreal Neurological Institute reported an average delay of 3 - 5 years in some brain regions, most notably in the front part of the brain which helps with organization, planning, and attention.

Great news - as the ADHD mind continues to mature, symptoms will likely improve. People can literally “grow out of ” their ADHD. Interestingly there are some brain regions that mature faster in ADHD kids than those without ADHD. One such region is the “motor area” which is responsible for initiating movement. This may accountant for some of the restlessness and fidgeting that kids with ADHD experience.

The study appears in the latest issue of the Proceedings of the National Academy of Science. http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20071112/brain_adhd_071112/20071114?hub=Health

Teaching children from a young age to eat a low-fat diet can be effective — even as they reach their teens and begin eating more meals away from home, according to a new study. The study of children in Finland found that those who were taught to focus on healthy fats — those found in fish, nuts, seeds and oils from plants — had slightly lower cholesterol levels compared to those who ate an unrestricted diet. The researchers have been following the 1,062 children since the age of 7 months. About half of the children and their families were counseled to shift fat intake from animal-based saturated fats to healthier unsaturated fats. The rest did not get specific diet advice. The new study reported the results on the children at age 14. Dr. Harri Niinikoski, lead author of the study done at the University of Turku in Finland, said children begin forming their eating and lifestyle habits in childhood. “The earlier you intervene, the more likely you are going to be successful,” she said. 

A study published in the American Heart Association Journal recently compared 540 children assigned to a dietary counseling group to 522 who did not get special diet advice, starting from seven months of age and found that regular counseling of families and children about the benefits of avoiding saturated fats in their diet led to diets lower in fat and saturated fat, and reduced blood cholesterol levels in children up to the age of 14. There were no differences in stature between counseled children and those who were not, suggesting a low-fat diet can pay dividends from the start without affecting growth.  Among the findings, counseling seemed to have a bigger impact on the cholesterol level of boys than girls. The researchers were not sure why. The counseled children also ate more protein and carbohydrates than those who received no dietary advice. “At age 14, the dietary group had a small but statistically significant lower median cholesterol level,” the Heart Association said in a statement. Families in the counseling group received regular advice from a nutritionist and the children were counseled directly from the age of seven. 

Approximately 60% of children under the age of 11 experience some kind of sleep difficulty at least a few nights a week. A recent study conducted by published in the journal Sleep found that more than 80 percent of American children who visit a doctor because they have difficulty sleeping are given some form of prescription medication, even though no sleeping pills are currently approved for use in kids. The research was conducted at the Ohio State University College of Pharmacy in Columbus and complement a 2004 National Sleep Foundation poll that revealed that sleep difficulties are extremely widespread among the young. Specific medications included: about a third were prescribed antihistamines, a quarter alpha-2 agonists, 15% were offered benzodiazepines, and 6% antidepressants.
81% of these children and teens were prescribed medication for their sleep issues. Other recommendations included: 7% were recommended diet and nutritional counseling, 22 % were offered behavioral therapy, and 17% were offered mental health and stress management treatment. A combined regimen of medication plus behavioral therapy was prescribed in just under a fifth of cases. Patients who sought care from a psychiatrist were more than three times as likely to be prescribed a drug for their sleep trouble than those who visited a general practice physician.
Children having difficulty sleeping isn’t “normal”. Rather than simply treat the symptom it is important to figure out the cause – then we can more effectively correct the problem. Antidotally, my experiences as a psychologist have proven to me that therapy for sleep difficulties is very effective. It is critical to approach difficulties from a holistic perspective. In other words, assessing a child’s:
-          Diet: With particular focus on the level of caffeine intake as well as how close to bedtime he eating.
-          Exercise: How much physical exercise does the child engage in and when in the day is she most active.
-          Well-being: Areas to consider include what his school day like, anything new happening at home, is she being bullied or is he worried about upcoming tests, etc…? Often parents are surprised by the worries of a young person since to an adult they are not realistic. Without thoughtful discussion in a safe and relaxed environment, some kids never talk about their concerns and continue to have sleepless nights for long periods of time.
-          Home Life: How comfortable does the child feel in his room? Is the light and noise level appropriate for REM sleeping? Are parents fighting in the other room? How comfortable is the mattress?
-          Relaxation Techniques: Learning simple breathing techniques or body scanning strategies are a useful non-medication approach to falling asleep. 

A study published in this month’s American Journal of Clinical Nutrition reveals more evidence that Omega-3 fatty acids are critical in brain development. The study reports that children whose mothers get enough omega-3 fatty acid during pregnancy may have stronger cognitive skills in infancy. Specifically, researchers found that 9-month-olds whose mothers had eaten DHA-fortified bars during pregnancy performed better on a test of problem-solving abilities than infants whose mothers had not added DHA to their diets.