ADHD Appears To Affect Movement In Boys More Than Girls, New Study

Attention deficit hyperactivity disorder (ADHD) appears to affect movement in boys more than it does in girls, according to a study published in the November 4, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

ADHD is one of the most common mental disorders found in children. Symptoms include impulsiveness, hyperactivity, such as not being able to sit still, and inattention or constant daydreaming. Few studies have been done that compare ADHD and movement in both boys and girls. Researchers tested the movement abilities of 132 boys and girls with ADHD and 136 without the disorder. The children were between the ages of seven and 15 years and were tested for how fast and how well they could tap their toes, walk on their heels, maintain balance and keep a steady rhythm during a task compared to scores typical for their age.

The study was supported by the National Institute of Neurological Disorders and Stroke, Kennedy Krieger Institute's Developmental Disabilities Research Center and the Johns Hopkins University School of Medicine Institute for Clinical and Translational Research. The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.

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ADHD Stimulant Treatment May Decrease Substance Abuse Risk

Massachusetts General Hospital (MGH) researchers have found that treatment with stimulant drugs does not increase and appears to significantly decrease the risk that girls with ADHD will begin smoking cigarettes or using alcohol or drugs. Their report in the October Archives of Pediatrics and Adolescent Medicine parallels the findings of several earlier studies in boys, which needed to be confirmed in girls.

"Girls with ADHD actually tend to get into trouble with substance abuse earlier than do boys with the disorder, so confirming those results was not simply academic," says Timothy Wilens, MD, director of the Substance Abuse Program in the MGH Pediatric Psychopharmacology Department, who led the study. "This is also one of the first naturalistic studies showing reduced risk of cigarette smoking in adolescents being treated for ADHD and is consistent with a 2006 prospective trial of ours that found that participants receiving stimulant treatment had less risk of smoking than those not receiving stimulants."

It is well known that individuals with ADHD have a significantly increased risk for cigarette smoking and substance abuse, and concerns that treatment with stimulant drugs may increase the risk of drug or alcohol abuse have often been expressed. Wilens and his MGH colleagues have conducted several studies in boys and young men with ADHD, the overall conclusions of which are that stimulant treatment decreases the risk and delays the onset of substance abuse in adolescence but neither increases nor reduces the risk of using tobacco, alcohol or drugs in adulthood. Evidence on treatment's impact for girls has been limited and conflicting, with at least one study suggesting the ADHD-associated risk may persist in spite of treatment.

Using data from a larger, long-term investigation of the impact of ADHD on the risk of substance abuse in girls, the researchers analyzed information from 114 participants with ADHD who had enrolled at the ages of 6 to 18. Standardized assessments for the use, abuse and dependence on tobacco, alcohol, marijuana or other drugs were conducted 5 years after initial study enrollment. Comparing results from the 94 participants who received stimulant treatment with the 20 who had not been treated indicated that treatment cut in half the risk of smoking, drinking alcohol or drug abuse. In participants who did develop substance abuse, whether or not they had received stimulant treatment had no effect on factors like when they began using substances and the level of dependence.

"Right now we can't say if the observed protective effect of stimulant treatment will continue into adulthood or disappear as it did in our studies in young men," Wilens explains. "But we suspect that the longer a girl is successfully treated for ADHD, the more likely she is to be at reduced risk for smoking and substance use or abuse. We can confidently say that stimulant treatment does not increase the risk of future substance abuse or smoking in girls with ADHD and at least delays the onset of cigarette smoking and substance abuse." Wilens is an associate professor of Psychiatry at Harvard Medical School

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Why is Adderall prescribed?

Adderall is prescribed in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), the condition in which a child exhibits a short attention span and becomes easily distracted, overly emotional, excessively active, and highly impulsive. It should be used as part of a broader treatment plan that includes psychological, educational, and social measures. An extended-release form of the drug, called Adderall XR, is available for once-daily treatment of ADHD.

The regular form of Adderall is also prescribed for narcolepsy (uncontrollable attacks of sleep).

Most important fact about Adderall

Adderall, like all amphetamines, has a high potential for abuse. If used in large doses over long periods of time, it can cause dependence and addiction. Be careful to take Adderall only as prescribed.

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Adderall: A Stroke of Bad News

The problem Health Canada's decision last week to pull a popular attention-deficit drug off the market, citing reports linking it to 20 deaths between 1999 and 2003, has led parents to call their doctors to see if their kids should stop taking the stimulant. The U.S. Food and Drug Administration insists the drug, Adderall XR, made by Shire Pharmaceuticals, is safe when taken as directed.

The cautions According to the drug label, available at www.fda.gov, Adderall should not be given to patients with "structural cardiac abnormalities," such as heart murmurs; there have been reports of sudden death in children with such conditions. Adderall has not been tested in children under age 6. Fourteen of the deaths cited by Health Canada occurred in children; there were also 12 strokes (two of them in children).

The response Joseph Biederman, chief of pediatric psychopharmacology at Massachusetts General Hospital, said there was not enough data to link the deaths with Adderall XR. Even if Adderall were to blame, said Russell Barkley, professor at the Medical University of South Carolina and author of a book on ADD, "you have to put a denominator under this [death] number." According to the FDA, approximately 30 million prescriptions for Adderall were written during the four years in question. For a population this size, said the agency, this number of deaths is not unexpected.

But some doctors were exercising caution. Washington child psychiatrist Nora Galil said she was considering switching her patients to other drugs after fielding calls all day Friday. "You always have to be extra careful with kids, [and] if there's some smoke, you want to know if there's fire," she said.

What now? The FDA says it will continue to evaluate adverse event reports on Adderall. As always, consult with your doctor before you change a drug regimen. In two children's studies, stopping Adderall was tied to side effects including loss of appetite and insomnia.

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