ChiroACCESS Article

Attention Deficit Hyperactivity Disorder (ADHD) on the Rise!

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ChiroACCESS Editorial Staff



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April 12, 2012

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The latest research suggests an increase in the prevalence of attention deficit hyperactivity disorder (ADHD) in both children and adults.  This increase seems to be a global phenomenon not confined to one region or country.  The cause appears to be multifaceted and some literature attributes genetics, second hand smoke, lead, food coloring or additives among the causes or risk factors.  A systematic review by the Department of Chiropractic, Faculty of Science, Macquarie University noted that “Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications.” 
Currently only low level research exists, much of which is case reports that provide support for chiropractic management of ADHD.  Anecdotal reports suggest a potentially significant role for chiropractic management of the disorder.  With the rising rate of ADHD this is a fertile area for future chiropractic research and yet another reason to increase support of the profession’s research efforts.
A free detailed booklet that includes information on the causes, diagnosis, and treatment of ADHD and published by the National Institutes of Mental Health and can be found here.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009.  [Link]

NCHS Data Brief. 2011 Aug;(70):1-8.

Akinbami LJ, Liu X, Pastor PN, Reuben CA.
Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders of childhood. The symptoms of ADHD (inattention, impulsive behavior, and hyperactivity) begin in childhood and often persist into adulthood. These symptoms frequently lead to functional impairment in academic, family, and social settings. The causes and risk factors for ADHD are unknown, but genetic factors likely play a role. Diagnosis of ADHD involves several steps, including a medical exam; a checklist for rating ADHD symptoms based on reports from parents, teachers, and sometimes the child; and an evaluation for coexisting conditions. Recent national surveys have documented an increase in the prevalence of ADHD during the past decade. This report presents recent trends in prevalence and differences between population subgroups of children aged 5-17 years.

Adult ADHD: prevalence of diagnosis in a US population with employer health insurance.  [Link]

Curr Med Res Opin. 2011;27 Suppl 2:5-11.

Montejano L, Sasané R, Hodgkins P, Russo L, Huse D.
Outcomes Research, Thomson Reuters, Cambridge, MA 02140, USA.

OBJECTIVE: The burden of attention-deficit/hyperactivity disorder (ADHD) in adults is increasingly recognized. This retrospective analysis was designed to estimate the prevalence of diagnosed ADHD in a population of insured, employed individuals and their dependents in the United States.

METHODS: Health care claims data obtained from the MarketScan Commercial Claims and Encounters Database were analyzed. Patients with ADHD were identified by at least two diagnostic claims per calendar year. Once identified, patient records were examined for evidence of continuing ADHD.

RESULTS: Between 2002 and 2007, the MarketScan database identified 342,284 patients with more than one claim for ADHD. Of these, 79,368 patients met the eligibility for the prevalence estimates. During the study period, the prevalence of diagnosed ADHD among adults increased more than three-fold: 1.24 to 4.02 cases per 1000 covered members. The largest proportion of cases was in the 18-24 years age group (42.8%-45.8% per year). Most cases were males; however, the ratio of females-to-males diagnosed increased over time. ADHD with hyperactivity was prevalent across all age groups analyzed, although more common in the 18-24 years group. Pharmacy claims showed patients receiving medical treatment for ADHD increased from 78% to 88.5%. A limitation of this study is that it is restricted to employed persons and their dependents. Thus, the results from this database may underestimate the true prevalence of diagnosed ADHD in the US population.

CONCLUSIONS: While the claims database used included employed insured persons and dependents only, study results highlight the rising prevalence of diagnosed ADHD in a US adult population. The prevalence increased more than three-fold from 2002 to 2007 with the largest increase in the 18-24 years age group. These findings on ADHD prevalence highlight the need for greater attention to the medical treatment of this disorder in different age groups, particularly in young adults.

Prevalence and impact of ADHD in college students.  [Link]

J Clin Psychiatry. 2011 Sep;72(9):e30.

Culpepper L.
Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.

The prevalence of ADHD on college campuses has increased dramatically during the last several decades. The brain abnormalities caused by ADHD result in impairments in executive function, which in turn make ordinary college challenges, such as managing long-term class assignments and prioritizing academic and social life, especially difficult for those with ADHD. However, college students with ADHD who receive proper treatment and take advantage of on-campus and community disability services can have a successful college career.

[The influence of different diagnostic criteria and the culture on the prevalence of attention deficit hyperactivity disorder] [Article in Spanish].  [Link]

Rev Neurol. 2011 Mar 1;52 Suppl 1:S109-17.

Cardo E, Servera M, Vidal C, de Azua B, Redondo M, Riutort L.
Laboratorio de Neurociencias/IUNICS, Hospital Son Llàtzer, Ctra. Manacor km 4, Palma de Mallorca, Spain.

AIM: To compare the prevalence of attention deficit disorder and hyperactivity disorder (ADHD) using different diagnostic criteria (DSM-IV-TR versus ICD-10) and two specific scales based on DSM IV (ADHD-IV Rating Scales and SNAP-IV p90) in school-age children (6-12 years).

PATIENTS AND METHOD: A population-based study applying stratified multistage sample design (by courses), proportional to the type of school (public, private and enterd) and demographic areas (rural, city). From a target population of approximately 30 000 subjects a sample of 1509 children.

RESULTS: The prevalence rates of ADHD were within the expected range: 3.6% (95% CI = 2.6-4.6%) using DSM-IV criteria, 1.2% (95% CI = 0.6-1.8%) using the ICD-10, 4.6% (95% CI = 3.5-5.7%) using ADHD Rating Scales-IV with a cut-off of 90 percentile 4.11% (95% CI = 3.2-5.1%) using the scale SNAP-IV. However, we found some differences in reference to gender and subtype according to the criteria and instrument used.

CONCLUSIONS: We propose to use standard scales, scale by age, sex and evaluator that includes maturation and sociocultural factors help us draw conclusions about the true prevalence of ADHD.

Secondhand smoke exposure and neurobehavioral disorders among children in the United States.  [Link]

Pediatrics. 2011 Aug;128(2):263-70. Epub 2011 Jul 11.

Kabir Z, Connolly GN, Alpert HR.
Tobacco Free Research Institute, Dublin, Ireland.

OBJECTIVES: The association between parent-reported postnatal secondhand tobacco smoke exposure in the home and neurobehavioral disorders (attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders) among children younger than 12 years in the United States was examined using the 2007 National Survey on Children's Health. Excess neurobehavioral disorders attributable to secondhand smoke (SHS) exposure in the home in 2007 were further investigated.

METHODS: The methods used in this study were multivariable logistic regression models that accounted for potential confounders and complex survey designs to evaluate associations.

RESULTS: A total of 6% of 55 358 children (aged < 12 years), corresponding to a weighted total of 4.8 million children across the United States, were exposed to SHS in the home. The weighted prevalence and 95% confidence intervals of each of the children's neurobehavioral outcomes were 8.2% (7.5-8.8) with learning disabilities, 5.9% (5.5-6.4) with attention-deficit/hyperactivity disorder, and 3.6% (3.1-4.0) with behavioral and conduct disorders. Children exposed to SHS at home had a 50% increased odds of having =2 childhood neurobehavioral disorders compared with children who were not exposed to SHS. Boys had a significantly higher risk. Older children, especially those aged 9 to 11 years, and those living in households with the highest poverty levels were at greater risk. In absolute terms, 274 100 excess cases in total of these 3 disorders could have been prevented if children had not been exposed to SHS in their homes.

CONCLUSIONS: The findings of the study, which are associational and not necessarily causal, underscore the health burden of childhood neurobehavioral disorders that may be attributable to SHS exposure in homes in the United States.

Artificial food dyes and attention deficit hyperactivity disorder.  [Link]

Nutr Rev. 2011 Jul;69(7):385-91.

Kanarek RB.
Department of Psychology, Tufts University, Medford, Massachusetts, USA.

Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in children. Symptoms of ADHD include hyperactivity, low frustration tolerance, impulsivity, and inattention. While the biological pathways leading to ADHD are not clearly delineated, a number of genetic and environmental risk factors for the disorder are recognized. In the early 1970s, research conducted by Dr. Benjamin Feingold found that when hyperactive children were given a diet free of artificial food additives and dyes, symptoms of hyperactivity were reduced. While some clinical studies supported these findings, more rigorous empirical studies conducted over the next 20 years were less positive. As a result, research on the role of food additives in contributing to ADHD waned. In recent years, however, interest in this area has revived. In response to more recent research and public petitions, in December 2009 the British government requested that food manufacturers remove most artificial food dyes from their products. While these strictures could have positive effects on behavior, the removal of food dyes is not a panacea for ADHD, which is a multifaceted disorder with both biological and environmental underpinnings.

Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review.  [Link]

Chiropr Osteopat. 2010 Jun 2;18:13.

Karpouzis F, Bonello R, Pollard H.
Department of Chiropractic, Faculty of Science, Macquarie University, Sydney, NSW 2109, Australia.

BACKGROUND: Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors.

OBJECTIVE: The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD.

METHODS: Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines.

RESULTS: The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria.

CONCLUSIONS: To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.
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Attention Deficit Hyperactivity Disorder (ADHD) on the Rise!

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Re:Attention Deficit Hyperactivity Disorder (ADHD) on the Rise!

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