The Archives of General Psychiatry published a study on October 15, 2012 which apparently emphasize and highlight the importance of appropriate and uninterrupted treatment. In the said study, about 300 young boys from New York City were followed by researchers for a long period of 33 years. About 150 young boys were diagnosed with ADHD in their childhood but they stopped their medications by the time they went to school. These young boys were recruited by a parent, teacher or a psychiatrist. The other 150 young boys were selected because they have no records of behavioral problems leading to the conclusion that they did not have ADHD.

The study showed the following findings:

• men with ADHD are 7 times more likely to discontinue schooling
• if employed, men with ADHD will make an average of less than US$40,000 per year compared with those who do not have ADHD.
• men with ADHD will likely end up in a divorce, twice more than non-ADHD men.
• 16 percent of men with ADHD showed signs of personality disorder while non-ADHD men showed none
• 36 percent of men with ADHD had been imprisoned at least once compared to the low 11 percent in men without ADHD.

Such findings reinforce the experts opinion that discontinued or interrupted treatment could have long-term impact on the person’s emotional and social wellness of men with ADHD many years after their diagnosis. It is surprising to see the difference in outcomes from ADHD and non-ADHD individuals. Mental healthcare providers should encourage and convince parents on the significance of continuous treatment in order to prevent the not-so-good outcomes.

Researchers say that a lot of children are diagnosed with ADHD when they should have been examined for sleep apnea a sleep disorder. Such confusion may be attributed to the many cases of ADHD diagnosed children. The result of such confusion is an aggravated problem due to the drug treatment recommended for those children.

The idea may have stemmed from the fact that the signs of sleep disorder overlap with ADHD symptoms. In adults, sleep deprivation could result to sluggish feelings and drowsiness while in children, sleep disorder can cause them to be moody, wired and obstinate aside from having difficulty in concentrating, getting along with friends or sitting still.

A study published in Pediatrics journal in March 2012, which connects sleep deprivation to ADHD symptoms. In said study, 11,000 British children were followed and observed for 6 years which started when the children were 6 months old. Children who snore when they sleep, or do mouth breathing or have apnea, will be 40% to 100% in the likelihood of developing ADHD-like behavioral symptoms than children who breathe normally. Also, children who had sleep disorder breathing that persisted throughout the study and most severe at age 2 1/2, are at higher risk of having ADHD-like behaviors.

Most parents do not know the signs of abnormal sleep behaviors; for instance, sleep apnea may considered as a sign of deep sleep by some parents. The parents need to be educated about the signs of abnormal sleep behaviors. The mental health providers need to explore more about abnormal sleep behaviors before giving the diagnosis of ADHD.

It is not easy to spot sleep deprivation signs in children. Parents have uniformed knowledge or impression about healthy habits of sleeping. This was highlighted in a study conducted in 2011 by Penn State University-Harrisburg researchers which was published in The Journal of Sleep Research which showed that out f 170 parents who participated in the study, less than 10% were able to correctly answer basic questions about healthy sleeping concerns.

Kimberly Anne Schreck, the study’s lead author and a Penn State behavioral analyst and psychologist noted that majority of the parents were clueless about what is normal sleep behavior and many parents thought that snoring means that their child was in deep and sound sleep.

http://well.blogs.nytimes.com/2012/04/16/attention-problems-may-be-sleep-related/

The study’s findings showed that school-based treatments have positive results on both behavioral and academic measures. More specifically, combined interventions of academic elements and contingency management had the most impact on academic accomplishment irrespective of the type of research and school setting. Contingency and cognitive behavioral methods were more efficacious at altering disruptive behavior. In addition, summer programs or private school resulted in improved behavior outcomes while more academic accomplishment public school environments resulted in more academic achievements.

While this research provides considerable proof for the justification of school-based interventions for ADHD, not one of the research or studies examined by Dr. DuPaul included any follow-up long term measures of school performance. This limitation is important because children with ADHD may response well to short-term treatment, but we need more data to make conclusion about the long term outcome especially in academic performance. This lacking element should be taken into consideration in future studies or research.

DuPaul, George J., Tanya L. Eckert, and Brigid Vilardo. The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis. 1996-2010.School Psychology Review41.4 (2012): 387-412. Print.

People who are diagnosed with ADHD in childhood years may have increased risk of problems with legal system, using illicit drugs or being less successfull in their adulthood.

2656 people witha diagnosis of ADHD were screened from Swedish national database to investigate whether taking ADHD medication play a role in patients’s participation in crimes. According to the study which was published in the New England Journal of Medicine, 41 percent of women and 32 percent of men who maintain medication for more than the 3-year study time frame were not quite likely to be involved and convicted of a crime compared to those who opted to skip medication. Crimes such as drug offenses, homicide, assault and other less serious crimes are some of those committed and medication taken by many was the stimulant Ritalin.

People with ADHD stand the chance of the likelihood to commit crimes but the studies suggested that those who took medication are less likely to end up with a conviction. In young adults where criminality is highly likely to occur, medication should be considered because it is more harmful for them to be involved in any way in criminal activities. On the other hand, psychiatrists are still debating whether they should prescribe ADHD drugs since drugs have different effects on individual persons and drugs sometimes do not work for everybody.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1203241

Mental health providers may be overly cautious to diagnose ADHD in patients who abuse drugs because of the possible misuse of stimulnat mediactions in these patient population.

A study was conducted in Sydney, Australia to investigate the nature and correlates of symptomatology consistent with adult ADHD among illicit psychostimulant users. The study involved 269 users who regularly take either cocaine or methamphetamineor both. All 269 used illegal psychostimulants weekly or more for one year. About 71% of the users used the illegal substance more than three times per week for 12 months and about 88% are psychostimulant dependent. The 269 users are aged from 19 to 62 years with an average of 35.6. About 86% had received treatment for substance dependence and 52% were undergoing treatment at the time the study is conducted and 88% were jobless.

About 45% were diagnosed to be positive for adult ADHD and 90% showed signs of inattention which is more common than hyperactivity/impulsivity which accounted for 57%. Those individuals with ADHD symptoms ar more prone to have serious polysubstance dependence, and higher early school drop rate.

The researchers pointed out that if ADHD is identified as comorbid, it may assist in planning the appropriate treatment options for substance abuse and will reduce the risk of non-compliance with treatment plans due to symptoms of impulsivity, disorganization and inattention. The study concluded that it is important to recognize the high risk of ADHD in patients who are seeking substance abuse treatment because if ADHD is not diagnosed and remained untreated, it may impact the retention, compliance and outcome of treatment.

http://onlinelibrary.wiley.com/doi/10.1111/add.12086/abstract

An estimated 3% to 7% of kids of school-age have ADHD or Attention Deficit Hyperactivity Disorder. Some studies, however, have estimated higher rates in community samples. The Centers for Disease Control and Prevention described people with ADHD as those who may have difficulty paying attention, may act without thinking of the consequences of his or her action, or being overly active. Such symptoms may be connected with school problems and can lead to offending or even lawless attitude.

The New England Journal of Medicine published a large study involving an estimated 26,000 Swedish people with the disorder showed that psychostimulants such as Ritalin and Adderall which are used as treatments for ADHD can mitigate criminal behavior. Results from the study showed that men taking the medications manifested a 32% reduction in crime rates while they were taking the drugs compared to periods when they were not. Similarly, women showed a 41% lower rate of criminality(New England Journal of Medicine, Nov. 22, 2012).

While ADHD medications prove beneficial in most cases of ADHD children, there are other research studies that show that such medications may be abused. This may be attributed to the increasing awareness about ADHD and how medications or stimulant drugs can provide immediate though temporary solutions to treat children’s erratic behaviors.

A recent study published in the journal Pediatrics, made an analysis of prescriptions for ADHD showing that about half of the youngest children in a class are more likely to be diagnosed, which can cast a doubt if these children are just less mature (Journal of Health Economics, 2010) than the older children in the same class, more than having the disorder.

The new research seems to fuel up current debate on the use or misuse of ADHD drugs to treat the disorder. A significant increase in the dispensed stimulant drugs has been observed along with ADHD diagnosis. The Centers for Disease Control and Prevention study made in 2010 reveals that an estimated 9.5% of kids aged 4 to 17 years have been determined to have ADHD. 5% of children in the US aged 6 to 12 years as of 2008 were using ADHD stimulant drugs to treat the disorder. This percentage has continued to rise since the 1980s. The number of drug prescriptions given to young people aged 10 to 19 increased to 26% or an equivalent 21 million yearly since 2007. This could easily imply that stimulant drugs used for ADHD may have been over-used which could be a result of ADHD children being over diagnosed.

There has been a nagging fear among critics, experts and the public about the effects of stimulants to children believed to be afflicted with ADHD. Critics are concerned that such psychostimulants simply drug children into submission and the youngsters are eventually into compliant robots softened by the effects of medication, as they showed no will to engage in defiant behavior. Unfortunately, only few documented studies on the effects of the drugs from the perspective of the children taking them are existent.

This was the core of the VOICES (Voices On Identity, Childhood, Ethics and Stimulants) study pursued by Ilina Singh of King’s College London along with her colleaguesLauren Baker and Katelyn Thomas. Said study involved 151 American and British children 9 to 14 years of age who were into prescription drugs for ADHD between 2008 and 2010 (Singh, I. (2012). VOICES Study: Final Report. London, UK). Interviews with the children concluded that stimulant drugs improve their capacity for moral agency. An 11 year old American girl told the researchers that medication allows them to be the same person but acting a little better and that stimulant drugs improve their emotional self-control, moral decision making and aggressive behaviors.

Out of the 151 children in the study, about 8% admitted having problems with their medications and they are more related to the side effects, and not causing them to comply even if they didn’t want to, or alter their personality (Time Health and Family, November 26, 2012). The stimulant drugs give the children time to deliberate which eventually leads to more thoughtful and better decisions, thus opening up more windows for success in overcoming the symptoms of ADHD and be able to have close to normal relationships and productive careers.

The Swedish study supports this perspective. ADHD has long been associated with an increased risk for crime and for drug addiction. By helping people with ADHD through medication, to think and assess their actions, they seem to succeed at avoiding avoid questionable and even criminal behavior. The same study also showed that non-medicated people with ADHD are four to seven times more likely than others to break the law.

The series of studies generally support the beneficial use of medication for ADHD patients, specifically for those with difficulties with impulsivity. The correct use of the medications enhances the quality of life and it brings down the risk of manifesting criminal actions at the same time. For people properly diagnosed with ADHD and without any unbearable side effects caused by the drugs, the results are increasingly clear and very promising – stimulant medications don’t turn kids into zombies or robots. Stimulant drugs can cause prevention of crime as the person with ADHD is relieved from having harmful or destructive urges. These stimulant medications are not in any way any form of a miracle drug that can cure everything and they are also not quick fix solutions to calm down edgy children.