Mar 25, 2020 | Stephen Faraone, Ph.D.
Does ADHD Medication Improve the Parenting Skills of Adults with ADHD?
Raising children is not easy. I should know. As a clinical psychologist, I’ve helped parents learn the skills they need to be better parents. And my experience raising three children confirmed my clinical experience. Parenting is a tough job under the best of circumstances but it is even harder if the parent has ADHD. For example, an effective parent establishes rules and enforces them systematically. This requires attention to detail, self-control and good organizational skills. Given these requirements, it is easy to see how ADHD symptoms interfere with parenting. These observations have led some of my colleagues to test the theory that treating ADHD adults with medication would improve their parenting skills. I know about two studies that tested this idea. In 2008, Dr. Chronis-Toscano and colleagues published a study using a sustained release form of methylphenidate for mothers with ADHD. As expected, the medication decreased their symptoms of inattention and hyperactivity/impulsivity. The medication also reduced the mothers use of inconsistent discipline and corporal punishment and improved their monitoring and supervision of their children. In a 2014 study, Waxmonsky and colleagues observed ADHD adults and their children in a laboratory setting once when the adults were off medication and once when they were on medication. They used the same sustained release form of amphetamine for all the patients. As expected, the medications reduced ADHD symptoms in the parents. This laboratory study is especially informative because the researchers made objective ratings of parent-child interactions rather than relying on the parent’s report of those interactions. Twenty parents completed the study. The medication led to less negative talk and commands and more praise by parents. It also reduced negative and inappropriate behaviors in their children. Both studies suggest that treating ADHD adults with medication will improve their parenting skills. That is good news. But they also found that not all parenting behaviors improved. That makes sense. Parenting is a skill that must be learned. Because ADHD interferes with learning, parents with the disorder need time to learn these skills. Medication can eliminate some of the worst behaviors but doctors should also provide the adjunct behavioral or cognitive behavioral therapies that could help ADHD parents learn parenting skills and achieve their full potential as parents.
REFERENCES
Chronis-Tuscano, A., K. E. Seymour, et al. (2008). “Efficacy of osmotic-release oral system (OROS) methylphenidate for mothers with attention-deficit/hyperactivity disorder (ADHD): preliminary report of effects on ADHD symptoms and parenting.” J Clin Psychiatry 69(12): 1938-1947.
Waxmonsky, J. G., D. A. Waschbusch, et al. (2014). “Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial.” CNS Drugs 28(7): 665-677.
Mar 20, 2020 | Stephen Faraone, Ph.D.
A recent structural magnetic resonance imaging (MRI) study of pre-adolescent and adolescent youth reports findings relevant to clinicians who treat ADHD patients of any age. It suggests that stimulant medications normalize cerebellar volumes. See more at
A recent structural magnetic resonance imaging (MRI) study of pre-adolescent and adolescent youth reports findings relevant to clinicians who treat ADHD patients of any age (Ivanov, et al.. (2014). Neuropsychopharmacology 39, 718-26.). We know from much prior work that ADHD is associated with small volumes in several regions of the brain. In this new paper, Ivanov and colleagues replicate this finding for the cerebellum. Their work supports the idea that defects in the attentional and cognitive control mechanisms regulated by neural connections among striatum, cerebellum and the frontal lobes. Several decades of prior MRI studies suggest that these frontal-striatal-cerebellar networks contribute to the risk for ADHD. These networks have been implicated by multiple studies and confirmed by meta-analyses. Scientists who study ADHD point to these data as evidence that changes in the brain underlie the pathophysiology of ADHD. Yet some in the media and blogosphere have suggested that these brain defects are caused by the medications that treat the disorder. Ivanov et al.’s study addresses this issue. They did not conduct a prospective clinical trial, but there was sufficient variability of stimulant therapy in their sample to examine the effects of stimulants on cerebellar volumes. Here is what they found. The ADHD patients who had been treated with stimulant medications for longer durations showed larger cerebellar hemispheres. The implications are clear. Rather than being toxic to the brain, stimulant medication possibly normalizes cerebellar volumes. I use the term “possibly” because these studies are naturalistic, cross-sectional studies, not prospective randomized clinical trials (RCTs). Because long term RCTs are not feasible, none exist. Ivanov’s data raise the intriguing possibility that stimulants lead to increases in brain structure to compensate for ADHD defects. Is this finding a fluke? Probably not, because other studies report similar results. In fact, Frodl and colleagues reviewed eleven structural MRI studies and used meta-analysis to show that ADHD associated brain volume reductions in the right globus pallidus and putamen were greatest for those patients that had not received pharmacotherapy (Frodl, T. & Skokauskas, N. (2012). Acta Psychiatr Scand 125, 114-26.). Possibly beneficial effects of ADHD medications have also been seen in reviews of functional MRI studies. These studies suggest that, in addition to normalizing brain structures, pharmacotherapy for ADHD may normalize neural functioning (Paloyelis, Y. et al. (2007). Expert Rev Neurother 7, 1337-56.). Importantly, administering clinically effective doses of stimulants boosts brain activations in ADHD patients in regions that are typically under-activated in ADHD (i.e., caudate, prefrontal cortex, cingulate and cerebellum). So, we can see from prior studies, that Ivanov’s finding is not isolated. Importantly, these results do not mean that stimulants create “super brains” or that they should be used for performance enhancement. But they offer some relief from the concern that ADHD medications are toxic to the brain. And instead suggest that these medications possibly normalize brain structure and functioning as measured by MRI.
Mar 16, 2020 | Stephen Faraone, Ph.D.
Can Physical Exercise Help People with ADHD?
By Stephen V. Faraone
Animal studies clearly show that physical exercise helps with brain development and improves behaviors known to be impaired in ADHD people. Some studies in humans are consistent with this, but the data are weaker. Studies using exercise to treat ADHD suggest that moderate to vigorous physical activity improve behavior and cognition in ADHD people. This work was recently summarized in a meta-analysis by Vysniauske and colleagues.
REFERENCES
Vysniauske, R., Verburgh, L., Oosterlaan, J. & Molendijk, M. L. (2016). The Effects of Physical Exercise on Functional Outcomes in the Treatment of ADHD: A Meta-Analysis. J Atten Disord.
Halperin, J. M., Berwid, O. G. & O’Neill, S. (2014). Healthy Body, Healthy Mind?: The Effectiveness of Physical Activity to Treat ADHD in Children. Child Adolesc Psychiatr Clin N Am 23, 899-936.
Mar 11, 2020 | Stephen Faraone, Ph.D.
Adult ADHD and Comorbid Somatic Disease
By Stephen V. Faraone, PhD
Although there has been much research documenting that ADHD adults are at risk for other psychiatric and substance use disorders, relatively little is known about whether ADHD puts adults at risk for somatic medical disorders. Given that ADHD people are disorganized and inattentive and that they tend to favor short-term over long term rewards, it seems logical that they should be at higher risk for adverse medical outcomes. But what do the data say? In a systematic review of the literature, Instanes and colleagues provide a thorough overview of this issue. Although they found 126 studies, most were small and were of “modest quality”. Thus, their results must be considered to be suggestive, not definitive for most of the somatic conditions they studied. Also, they excluded articles about traumatic injuries because the association between ADHD and such injuries is well established. Using qualitative review methods, they classified associations as being a) well-established; b) tentative or c) lacking sufficient data. Only three conditions met their criteria for being a well-established association: asthma, sleep disorders and obesity. They found tentative evidence implicating ADHD as a risk factor for three conditions: migraine headaches, celiac disease and diseases of the circulatory system. These data are intriguing but cannot tell us why ADHD people are at increased risk for somatic conditions. One possibility is that ADHD symptoms lead to an unhealthy lifestyle, which leads to increased medical risk. Another possibility is that the biological systems that are dysregulated in ADHD are also dysregulated in some medical disorders. For example, we know that there is some overlap between the genes that increase risk for ADHD and those that increase risk for obesity. We also know that the dopamine system has been implicated in both disorders. Instanes and colleagues also point out that some medical conditions might lead to symptoms that mimic ADHD. They give sleep disordered breathing as an example of a condition that can lead to symptom of inattention. But this seems to be the exception, not the rule. Other medical conditions co-occurring with ADHD seem to be true comorbidities rather than the case of one disorder causing the other. Thus primary care clinicians should be alert to the fact that many of their patients with obesity, asthma or sleep disorders might also have ADHD. By screening such patients for ADHD and treating that disorder, you may improve their medical outcomes indirectly via increased compliance with your treatment regime and an improvement in health behaviors. We don’t yet have data to confirm these latter ideas as the relevant studies have not yet been done.
REFERENCE
Instanes, J. T., Klungsoyr, K., Halmoy, A., Fasmer, O. B. & Haavik, J. (2016). Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review. J Atten Disord.
Mar 9, 2020 | Annual Conference, APSARD Members in the News, Conference Blog, Editorial
Vallon Pharmaceuticals Presents Positive Data from Pilot Intranasal Human Abuse Study of Its Investigational Abuse Deterrent Stimulant, ADAIR, at the American Professional Society of ADHD and Related Disorders (APSARD) Annual Meeting
– According to reports from the US Department of Health and Human Services, more than 5 million Americans misuse or abuse prescription stimulants annually
– ADAIR is a novel, patented formulation of dextroamphetamine under development for the treatment of ADHD and narcolepsy that is designed to deter attempts to crush and snort it or take it by other non-oral routes that can produce a greater “high”
PHILADELPHIA–(BUSINESS WIRE)–Vallon Pharmaceuticals Inc., a specialty pharmaceutical company focused on the development of novel drugs for CNS disorders, today announced the presentation of positive data from a pilot study assessing human abuse liability for its investigational Abuse Deterrent Amphetamine Immediate Release (ADAIR). The data were presented this weekend at the 2020 American Professional Society of ADHD and Related Disorders (APSARD) Annual Meeting in Washington, D.C. ADAIR, the Company’s lead investigational new drug, is in development for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy.
The poster, titled, “A Pilot Human Abuse Potential Study in Recreational Stimulant Drug Users Assessing Safety, Pharmacokinetics and Abuse Liability of Intranasally Administered Manipulated ADAIR and Dextroamphetamine Sulfate Tablets,” reported data from an intranasal (snorting) clinical trial of ADAIR, Vallon’s novel formulation of immediate release dextroamphetamine. The results of this 16-subject trial (VAL-103) demonstrated that intranasal administration of manipulated ADAIR was generally well tolerated, with all adverse events considered mild or moderate, and no new safety or tolerability signals identified. In this crossover comparative study, as compared to crushed and snorted dextroamphetamine sulfate, ADAIR demonstrated a blunted pharmacokinetic profile (lower Cmax, delayed Tmax, and lower AUC, especially during the early hours after administration). In addition, as compared to dextroamphetamine sulfate, even after extensive manipulation, ADAIR, when snorted, was less desirable to recreational drug abusers on key measures of abuse liability, in particular the Emax drug-liking scale (primary pharmacodynamic endpoint).
“Results from this pilot study suggest that Vallon’s investigational immediate release stimulant, ADAIR, may demonstrate less abuse potential than standard dextroamphetamine when manipulated and misused intranasally,” said Dr. Timothy Whitaker, a board-certified psychiatrist and Vallon’s Chief Medical Officer. “We appreciate the opportunity to present these findings to the attendees at APSARD, many of whom are at the forefront of ADHD research and patient care.”
According to reports from the US Department of Health and Human Services, more than 5 million Americans misuse or abuse prescription stimulants annually, most commonly teenagers and young adults. Separate studies report that approximately 40% of people who misuse prescription stimulants do so by snorting them.
“While we plan to consult with the FDA and conduct additional clinical trials, the data presented at APSARD, combined with market research feedback from physicians who treat ADHD and parents of teenagers and young adults who are prescribed ADHD stimulants, suggest that ADAIR, if approved, could be an important addition to available treatments for ADHD,” said David Baker, President & Chief Executive Officer of Vallon.
(more…)
