New Research in ADHD

Attention Deficit/Hyperactivity Disorder (ADD/ADHD) is a condition that often evokes strong feelings and controversy. There are debates about the frequency of diagnosis and virtually every aspect of its treatment.

We know that between three and five per cent of all children have abnormal difficulties with attention, impulse control and hyperactivity and that the majority of these individuals continue to struggle in these areas into adulthood.

These individuals tend to suffer in school, participate in more high risk behaviour and have difficulties in social and work situations as a result of their condition.

There is also a higher prevalence of substance abuse and other psychiatric illnesses such as depression, bipolar disorder or antisocial personality disorder among individuals with ADD/ADHD. Clearly, this is something that needs to be better understood and dealt with so that affected individuals can overcome obstacles and reach their potential.

To date, the most common treatment methods in ADD/ADHD have been stimulant medications such as Ritalin or Dexedrine combined with education, routine, and consistency.

Recent research has unveiled new discoveries about the biology behind ADD/ADHD and has also brought a new medication to the market for this condition.

Studies examining childhood behaviour problems among sets of twins support the conclusion that individual differences in impulsivity, hyperactivity, and inattention are largely due to genetic influences. They are highly heritable at all ages and in both genders. Children who do not display hyperactivity or attentional problems at a young age are unlikely to develop these problems at a subsequent age.

Using imaging technology such as magnetic resonance imaging (MRI) and positron emission topography (PET), researchers have discovered some interesting information about the biological differences in the brains of individuals with ADD/ADHD.

These studies show that ADD/ADHD brains are up to five per cent smaller than unaffected brains. Similar studies have shown a reduced volume and amount of activity in various areas of the brain in individuals with the condition.

Deficits in function and abnormal activation have also been found in areas that may affect the performance of cognitive functions and suggest widespread subtle deficits associated with ADD/ADHD.

One study even suggests that the neural circuits engaged during decision making are different for people with ADD/ADHD than for those without the condition. A better understanding of this could ultimately help to refine treatment strategies.

Although much still needs to be learned, it is becoming clear that there are objective, observable abnormalities in the brains of individuals with this condition.

Another recent development in the understanding and treatment of ADD/ADHD is the approval of the first non-stimulant medication for the condition.

Atomoxetine (also known by the brand name Strattera) is the only medication like it that is currently available and may mark the beginning of a new era in the treatment of this disorder. Known as a norepinephrine reuptake inhibitor, the drug affects the levels of the neurotransmitter, norepinephrine in the brain. This is one of the chemicals that is also known to be involved in other psychiatric disorders such as depression and anxiety.

Unlike stimulant medications, atomoxetine does not cause an immediate impact when it is taken, but takes some time for the body to adjust to it. Usually, effects will be noticed within a month of starting the medication.

Stimulant medications sometimes lose effectiveness at the end of the day as the drugs leave the body. This does not happen with atomoxetine - once the body has adjusted to the medication, the symptom management is even throughout the day.

With this new type of medication there is also no potential for abuse because there are no stimulant effects on the brain and certain side effects such as appetite suppression and insomnia are also avoided.

Atomoxetine has just been approved in Canada for both children and adults. It is not yet available in pharmacies but will be soon.

Okanagan Clinical Trials has a study on the use of atomoxetine in children between the ages of six and 12 who have ADD/ADHD. This will be a 12 week open label trial which means that all participants will receive atomoxetine for the 12 week period.

Examining new treatment methods and discovering the genetic and biological reasons for ADD/ADHD will go a long way toward helping individuals with the condition to function well in all areas of life.


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