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Teens with ADHD likely to stop medications on their own, may not restart
BALTIMORE – Almost all teenagers with attention-deficit/hyperactivity disorder (ADHD) stopped their medication at some point during their teen years, a study showed.
The stoppages happened for a variety of reasons, many of which stemmed from the normal curiosity and independence of adolescence, especially as teens got older.
Further, almost three-quarters of adolescents with ADHD did not restart medication after stopping, a concerning statistic given the often poor outcomes for youth with untreated ADHD, said Dr. William Brinkman, professor of pediatrics at the University of Cincinnati.
A better understanding of the reasons why adolescents come off and on ADHD medication may help physicians and families craft smart approaches to keep youth on track during the experimental teenage years, according to Dr. Brinkman, who presented his findings at the annual meeting of the Pediatric Academic Societies.
Using data from the National Institute of Mental Health–supported Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) trial, Dr. Brinkman and his collaborators collated and analyzed the responses of 394 participants who had ever taken medication for ADHD.
The MTA study was a 14-month randomized clinical trial with a community control group, a behavior therapy group, a medication management group, and a combined treatment group. Naturalistic longitudinal follow-up extended for 12 years. At the end of study follow-up, participants were a mean 21.0 years old; 78% were male, and most (67%) were white.
Using a self-report measure developed in the MTA study, participants reported the age when they last had stopped taking ADHD medication and/or had restarted it. They also used a 6-point Likert scale to endorse how “true” a variety of reasons were for them to have stopped, or restarted, their ADHD medication. Scale responses ranged from 1, “really true,” to 6, “not at all true.”
Dr. Brinkman and his colleagues dichotomized the responses so that responses from 1 to 3 were characterized as “true,” while responses from 4 to 6 were characterized as “not true” when descriptive statistics were used.
Nearly all teenagers – 95% (376/394) – reported stopping their medication at some point. Commonly reported reasons for stopping included “I felt I could manage without it” (81%), “I wanted to find out if I could manage without it,” (68%), and “I was doing so well I no longer needed it” (68%). Dr. Brinkman noted that these stoppage reasons all fell into the broad category of feeling the medicine was not helping, or being curious about what would happen when they stopped taking the medicine.
Another common reason was very simple, but not easily categorized: 69% of respondents who had stopped medication endorsed the statement, “I was tired of taking it.” Almost half (46%) of respondents reported that physical side effects were a contributor to stopping the medication, while others said they stopped for the summer (30%), or that their parents had made the decision to stop the medication (26%).
Only 28% of youth in the MTA study who had stopped their medication restarted it. Of those who did, most reported they did so because the medication helped them: More than 80% of respondents felt that it helped with concentration and focus at school or work, or that it made school or work easier. Some participants felt that ADHD medication helped them organize their thoughts (68%), while 36% felt it helped decrease impulsivity.
The age at which respondents reported they had stopped or restarted their medication was broken down into childhood, aged 5-12; adolescence, aged 13-17; and emerging adulthood, aged 18-22 years. This was done so that trends in the reasons for stopping and restarting could be tracked by age.
“Parent/doctor influence decreases, while teencentric reasons increase” through adolescence, said Dr. Brinkman. The effect of parental or physician decision making about stopping or restarting medication declined significantly over the course of adolescence. The steepest declines were seen in endorsements of the statements, “My parents decided to stop it” and “My parents decided to restart it” (P for both less than .0001). The reason with the steepest increase as adolescents became adults was “I was allowed to decide when to take it” (P less than .0001).
A safer way to get teens through the experimentation and drive for autonomy that are natural parts of growing up may be physician-supervised trials on/off medicine to help curious teens more objectively assess the continued need for medicine.
Study data were drawn from the National Institutes of Mental Health–funded MTA study. Dr. Brinkman reported no relevant financial disclosures.
On Twitter @karioakes
BALTIMORE – Almost all teenagers with attention-deficit/hyperactivity disorder (ADHD) stopped their medication at some point during their teen years, a study showed.
The stoppages happened for a variety of reasons, many of which stemmed from the normal curiosity and independence of adolescence, especially as teens got older.
Further, almost three-quarters of adolescents with ADHD did not restart medication after stopping, a concerning statistic given the often poor outcomes for youth with untreated ADHD, said Dr. William Brinkman, professor of pediatrics at the University of Cincinnati.
A better understanding of the reasons why adolescents come off and on ADHD medication may help physicians and families craft smart approaches to keep youth on track during the experimental teenage years, according to Dr. Brinkman, who presented his findings at the annual meeting of the Pediatric Academic Societies.
Using data from the National Institute of Mental Health–supported Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) trial, Dr. Brinkman and his collaborators collated and analyzed the responses of 394 participants who had ever taken medication for ADHD.
The MTA study was a 14-month randomized clinical trial with a community control group, a behavior therapy group, a medication management group, and a combined treatment group. Naturalistic longitudinal follow-up extended for 12 years. At the end of study follow-up, participants were a mean 21.0 years old; 78% were male, and most (67%) were white.
Using a self-report measure developed in the MTA study, participants reported the age when they last had stopped taking ADHD medication and/or had restarted it. They also used a 6-point Likert scale to endorse how “true” a variety of reasons were for them to have stopped, or restarted, their ADHD medication. Scale responses ranged from 1, “really true,” to 6, “not at all true.”
Dr. Brinkman and his colleagues dichotomized the responses so that responses from 1 to 3 were characterized as “true,” while responses from 4 to 6 were characterized as “not true” when descriptive statistics were used.
Nearly all teenagers – 95% (376/394) – reported stopping their medication at some point. Commonly reported reasons for stopping included “I felt I could manage without it” (81%), “I wanted to find out if I could manage without it,” (68%), and “I was doing so well I no longer needed it” (68%). Dr. Brinkman noted that these stoppage reasons all fell into the broad category of feeling the medicine was not helping, or being curious about what would happen when they stopped taking the medicine.
Another common reason was very simple, but not easily categorized: 69% of respondents who had stopped medication endorsed the statement, “I was tired of taking it.” Almost half (46%) of respondents reported that physical side effects were a contributor to stopping the medication, while others said they stopped for the summer (30%), or that their parents had made the decision to stop the medication (26%).
Only 28% of youth in the MTA study who had stopped their medication restarted it. Of those who did, most reported they did so because the medication helped them: More than 80% of respondents felt that it helped with concentration and focus at school or work, or that it made school or work easier. Some participants felt that ADHD medication helped them organize their thoughts (68%), while 36% felt it helped decrease impulsivity.
The age at which respondents reported they had stopped or restarted their medication was broken down into childhood, aged 5-12; adolescence, aged 13-17; and emerging adulthood, aged 18-22 years. This was done so that trends in the reasons for stopping and restarting could be tracked by age.
“Parent/doctor influence decreases, while teencentric reasons increase” through adolescence, said Dr. Brinkman. The effect of parental or physician decision making about stopping or restarting medication declined significantly over the course of adolescence. The steepest declines were seen in endorsements of the statements, “My parents decided to stop it” and “My parents decided to restart it” (P for both less than .0001). The reason with the steepest increase as adolescents became adults was “I was allowed to decide when to take it” (P less than .0001).
A safer way to get teens through the experimentation and drive for autonomy that are natural parts of growing up may be physician-supervised trials on/off medicine to help curious teens more objectively assess the continued need for medicine.
Study data were drawn from the National Institutes of Mental Health–funded MTA study. Dr. Brinkman reported no relevant financial disclosures.
On Twitter @karioakes
BALTIMORE – Almost all teenagers with attention-deficit/hyperactivity disorder (ADHD) stopped their medication at some point during their teen years, a study showed.
The stoppages happened for a variety of reasons, many of which stemmed from the normal curiosity and independence of adolescence, especially as teens got older.
Further, almost three-quarters of adolescents with ADHD did not restart medication after stopping, a concerning statistic given the often poor outcomes for youth with untreated ADHD, said Dr. William Brinkman, professor of pediatrics at the University of Cincinnati.
A better understanding of the reasons why adolescents come off and on ADHD medication may help physicians and families craft smart approaches to keep youth on track during the experimental teenage years, according to Dr. Brinkman, who presented his findings at the annual meeting of the Pediatric Academic Societies.
Using data from the National Institute of Mental Health–supported Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) trial, Dr. Brinkman and his collaborators collated and analyzed the responses of 394 participants who had ever taken medication for ADHD.
The MTA study was a 14-month randomized clinical trial with a community control group, a behavior therapy group, a medication management group, and a combined treatment group. Naturalistic longitudinal follow-up extended for 12 years. At the end of study follow-up, participants were a mean 21.0 years old; 78% were male, and most (67%) were white.
Using a self-report measure developed in the MTA study, participants reported the age when they last had stopped taking ADHD medication and/or had restarted it. They also used a 6-point Likert scale to endorse how “true” a variety of reasons were for them to have stopped, or restarted, their ADHD medication. Scale responses ranged from 1, “really true,” to 6, “not at all true.”
Dr. Brinkman and his colleagues dichotomized the responses so that responses from 1 to 3 were characterized as “true,” while responses from 4 to 6 were characterized as “not true” when descriptive statistics were used.
Nearly all teenagers – 95% (376/394) – reported stopping their medication at some point. Commonly reported reasons for stopping included “I felt I could manage without it” (81%), “I wanted to find out if I could manage without it,” (68%), and “I was doing so well I no longer needed it” (68%). Dr. Brinkman noted that these stoppage reasons all fell into the broad category of feeling the medicine was not helping, or being curious about what would happen when they stopped taking the medicine.
Another common reason was very simple, but not easily categorized: 69% of respondents who had stopped medication endorsed the statement, “I was tired of taking it.” Almost half (46%) of respondents reported that physical side effects were a contributor to stopping the medication, while others said they stopped for the summer (30%), or that their parents had made the decision to stop the medication (26%).
Only 28% of youth in the MTA study who had stopped their medication restarted it. Of those who did, most reported they did so because the medication helped them: More than 80% of respondents felt that it helped with concentration and focus at school or work, or that it made school or work easier. Some participants felt that ADHD medication helped them organize their thoughts (68%), while 36% felt it helped decrease impulsivity.
The age at which respondents reported they had stopped or restarted their medication was broken down into childhood, aged 5-12; adolescence, aged 13-17; and emerging adulthood, aged 18-22 years. This was done so that trends in the reasons for stopping and restarting could be tracked by age.
“Parent/doctor influence decreases, while teencentric reasons increase” through adolescence, said Dr. Brinkman. The effect of parental or physician decision making about stopping or restarting medication declined significantly over the course of adolescence. The steepest declines were seen in endorsements of the statements, “My parents decided to stop it” and “My parents decided to restart it” (P for both less than .0001). The reason with the steepest increase as adolescents became adults was “I was allowed to decide when to take it” (P less than .0001).
A safer way to get teens through the experimentation and drive for autonomy that are natural parts of growing up may be physician-supervised trials on/off medicine to help curious teens more objectively assess the continued need for medicine.
Study data were drawn from the National Institutes of Mental Health–funded MTA study. Dr. Brinkman reported no relevant financial disclosures.
On Twitter @karioakes
AT THE PAS ANNUAL MEETING
Key clinical point: Teens and young adults with ADHD are likely to stop their medication on their own, and may not restart.
Major finding: Nearly all teenagers – 95% (376/394) – reported stopping their medication at some point. Only 28% of youth who had stopped their medication restarted it.
Data source: Naturalistic longitudinal follow-up of 394 patients with ADHD from the randomized Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder clinical trial.
Disclosures: Study data were drawn from the National Institutes of Mental Health–funded MTA study. Dr. Brinkman reported no relevant financial disclosures.
VIDEO: Children exposed to marijuana at risk for long-term neurocognitive issues
BALTIMORE – The legalization of recreational marijuana in certain states has brought with it a host of new challenges to health care professionals, particularly ob.gyns. and pediatricians, who may be faced with parents who use the drug but are unaware – or unwilling to recognize – the dangers of marijuana exposure to their children.
“A longitudinal, very good study that [showed] regular use [of marijuana] by adolescents [is] associated with about a 6-8 point reduction in adult IQ, and persistent neurocognitive deficits [that] may not even be fully reversible,” said Dr. Paula D. Riggs of the University of Colorado in Aurora.
In an interview at the annual meeting of the Pediatric Academic Societies, Dr. Riggs discussed this and other key studies that point to the dangers of marijuana exposure to children, both before and after birth, and how important it is that all health care professionals ask parents the right questions to ensure that children aren’t being put in danger of long-term cognitive repercussions of marijuana use.
Dr. Riggs did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BALTIMORE – The legalization of recreational marijuana in certain states has brought with it a host of new challenges to health care professionals, particularly ob.gyns. and pediatricians, who may be faced with parents who use the drug but are unaware – or unwilling to recognize – the dangers of marijuana exposure to their children.
“A longitudinal, very good study that [showed] regular use [of marijuana] by adolescents [is] associated with about a 6-8 point reduction in adult IQ, and persistent neurocognitive deficits [that] may not even be fully reversible,” said Dr. Paula D. Riggs of the University of Colorado in Aurora.
In an interview at the annual meeting of the Pediatric Academic Societies, Dr. Riggs discussed this and other key studies that point to the dangers of marijuana exposure to children, both before and after birth, and how important it is that all health care professionals ask parents the right questions to ensure that children aren’t being put in danger of long-term cognitive repercussions of marijuana use.
Dr. Riggs did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BALTIMORE – The legalization of recreational marijuana in certain states has brought with it a host of new challenges to health care professionals, particularly ob.gyns. and pediatricians, who may be faced with parents who use the drug but are unaware – or unwilling to recognize – the dangers of marijuana exposure to their children.
“A longitudinal, very good study that [showed] regular use [of marijuana] by adolescents [is] associated with about a 6-8 point reduction in adult IQ, and persistent neurocognitive deficits [that] may not even be fully reversible,” said Dr. Paula D. Riggs of the University of Colorado in Aurora.
In an interview at the annual meeting of the Pediatric Academic Societies, Dr. Riggs discussed this and other key studies that point to the dangers of marijuana exposure to children, both before and after birth, and how important it is that all health care professionals ask parents the right questions to ensure that children aren’t being put in danger of long-term cognitive repercussions of marijuana use.
Dr. Riggs did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE PAS ANNUAL MEETING
Cognitive impairment in ALL survivors
Photo by Bill Branson
New research indicates that survivors of pediatric acute lymphoblastic leukemia (ALL) suffer from brain injury even if they have no history of central nervous system disease or cranial radiation.
The study suggests the neurotoxic effects of chemotherapeutic drugs on the developing brains of young ALL patients may impair their cognitive functioning by disrupting the formation of neural networks that connect brain regions and transfer information.
Shelli Kesler, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and her colleagues reported these findings in Brain Connectivity.
The researchers used diffusion tensor imaging to analyze and compare the gray matter connectome of 31 pediatric ALL survivors and 39 matched control subjects.
The team found significantly greater cognitive impairment among the ALL survivors (P=0.027), as well as significantly lower connectivity, based on small-worldness (P=0.007) and network clustering coefficient (P=0.019).
The researchers noted that clustered connectivity was altered in the parietal, frontal, hippocampal, amygdalar, thalamic, and occipital regions in the ALL survivors.
The team also described a model that can be used to predict cognitive impairment in ALL survivors. The model’s classification accuracy was 89.39% (P<0.0001), its sensitivity was 95.83%, and specificity was 85.71%.
“As survival rates for cancer patients increase, issues related to survivorship, such as chemotherapy-induced cognitive impairment, become more important to the cancer research community,” said Christopher Pawela, PhD, co-editor-in-chief of Brain Connectivity and an assistant professor at the Medical College of Wisconsin in Milwaukee.
“Dr Kesler and colleagues are developing new MRI-based biomarkers to measure brain changes associated with the neurotoxic effects of chemotherapy in the brain. These biomarkers may find utility in providing insight into the mechanisms of brain damage caused by chemotherapeutic drugs and could be used to develop neuroprotective therapies to mitigate the harmful effects of these drugs on the brain.” 
Photo by Bill Branson
New research indicates that survivors of pediatric acute lymphoblastic leukemia (ALL) suffer from brain injury even if they have no history of central nervous system disease or cranial radiation.
The study suggests the neurotoxic effects of chemotherapeutic drugs on the developing brains of young ALL patients may impair their cognitive functioning by disrupting the formation of neural networks that connect brain regions and transfer information.
Shelli Kesler, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and her colleagues reported these findings in Brain Connectivity.
The researchers used diffusion tensor imaging to analyze and compare the gray matter connectome of 31 pediatric ALL survivors and 39 matched control subjects.
The team found significantly greater cognitive impairment among the ALL survivors (P=0.027), as well as significantly lower connectivity, based on small-worldness (P=0.007) and network clustering coefficient (P=0.019).
The researchers noted that clustered connectivity was altered in the parietal, frontal, hippocampal, amygdalar, thalamic, and occipital regions in the ALL survivors.
The team also described a model that can be used to predict cognitive impairment in ALL survivors. The model’s classification accuracy was 89.39% (P<0.0001), its sensitivity was 95.83%, and specificity was 85.71%.
“As survival rates for cancer patients increase, issues related to survivorship, such as chemotherapy-induced cognitive impairment, become more important to the cancer research community,” said Christopher Pawela, PhD, co-editor-in-chief of Brain Connectivity and an assistant professor at the Medical College of Wisconsin in Milwaukee.
“Dr Kesler and colleagues are developing new MRI-based biomarkers to measure brain changes associated with the neurotoxic effects of chemotherapy in the brain. These biomarkers may find utility in providing insight into the mechanisms of brain damage caused by chemotherapeutic drugs and could be used to develop neuroprotective therapies to mitigate the harmful effects of these drugs on the brain.”
Photo by Bill Branson
New research indicates that survivors of pediatric acute lymphoblastic leukemia (ALL) suffer from brain injury even if they have no history of central nervous system disease or cranial radiation.
The study suggests the neurotoxic effects of chemotherapeutic drugs on the developing brains of young ALL patients may impair their cognitive functioning by disrupting the formation of neural networks that connect brain regions and transfer information.
Shelli Kesler, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and her colleagues reported these findings in Brain Connectivity.
The researchers used diffusion tensor imaging to analyze and compare the gray matter connectome of 31 pediatric ALL survivors and 39 matched control subjects.
The team found significantly greater cognitive impairment among the ALL survivors (P=0.027), as well as significantly lower connectivity, based on small-worldness (P=0.007) and network clustering coefficient (P=0.019).
The researchers noted that clustered connectivity was altered in the parietal, frontal, hippocampal, amygdalar, thalamic, and occipital regions in the ALL survivors.
The team also described a model that can be used to predict cognitive impairment in ALL survivors. The model’s classification accuracy was 89.39% (P<0.0001), its sensitivity was 95.83%, and specificity was 85.71%.
“As survival rates for cancer patients increase, issues related to survivorship, such as chemotherapy-induced cognitive impairment, become more important to the cancer research community,” said Christopher Pawela, PhD, co-editor-in-chief of Brain Connectivity and an assistant professor at the Medical College of Wisconsin in Milwaukee.
“Dr Kesler and colleagues are developing new MRI-based biomarkers to measure brain changes associated with the neurotoxic effects of chemotherapy in the brain. These biomarkers may find utility in providing insight into the mechanisms of brain damage caused by chemotherapeutic drugs and could be used to develop neuroprotective therapies to mitigate the harmful effects of these drugs on the brain.”
After 2006 Recommendation, More Autism Diagnoses Made at Earlier Age
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
AT THE PAS ANNUAL MEETING
After 2006 recommendation, more autism diagnoses made at earlier age
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
On Twitter @mitchelzoler
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
On Twitter @mitchelzoler
BALTIMORE – The American Academy of Pediatrics’ 2006 recommendation to screen all children for autism spectrum disorder at age 18 months appears to have resulted in a substantially earlier age of diagnosis among children seen in at least one U.S. center.
Among children diagnosed with autism spectrum disorder (ASD) and referred to the Children’s Evaluation and Rehabilitation Center of Montefiore Medical Center in the Bronx, N.Y., the average age of initial ASD diagnosis fell from 45 months among 295 diagnosed children born in 2003 or 2004 to 31 months among 217 diagnosed children born during or after 2005, Dr. Maria D. Valicenti-McDermott said at the annual meeting of the Pediatric Academic Societies.
Expressed another way, the percentage of children first diagnosed with ASD at age 4 years or older fell from 67% of children born during 2003 and 2004 to 26% of those born during or after 2005, said Dr. Valicenti-McDermott, a developmental pediatrician at Montefiore.
Although the review did not examine the outcomes of those children, she said that earlier age at diagnosis has been proven in previously reported studies to make a “big difference” for prognosis.
“The earlier you start treatment, the better the outcomes,” Dr. Valicenti-McDermott said in an interview. “More and more literature shows that the age of diagnosis of ASD is very important.”
Interventions that seem to make a difference when begun earlier include applied behavioral analysis and intensive speech and language therapy. A recent study by Dr. Valicenti-McDermott and her associates at Montefiore documented that those early interventions reversed the ASD diagnosis in at least some children, although she noted that many of these children continue to have problems, such as academic difficulties. She also acknowledged that some of this “reversal” may result from “instability” of the ASD diagnosis when made at a relatively early age.
The findings she reported came from a review of all children diagnosed with ASD and seen at Montefiore during 2003-2012. The analysis also showed that the earlier age of diagnosis after 2006 occurred across racial and ethnic groups, with similar reductions seen among Hispanic, African American, and white children.
In a multivariate analysis, the odds ratio for a first diagnosis of ASD at age 4 years or older was fourfold greater among children born during 2003 or 2004, compared with those born during 2005 or after.
Dr. Valicenti-McDermott conceded it was impossible to fully credit the 2006 screening recommendation from the American Academy of Pediatrics for that shift, based on her observational study. Another possible factor was increased awareness among parents about ASD over the time frame studied. In addition, community physicians also may have helped drive earlier diagnosis.
On Twitter @mitchelzoler
AT THE PAS ANNUAL MEETING
Key clinical point: Diagnosis of autism spectrum disorder occurred significantly earlier for children born in 2005 or later, compared with children born in prior years, suggesting an impact from the 2006 U.S. recommendation for universal screening at age 18 months.
Major finding: Age at autism diagnosis fell from 45 months in children born in 2003 or 2004 to 31 months in those born later.
Data source: Review of 512 children diagnosed with autism spectrum disorder at one U.S. center during 2003-2012.
Disclosures: Dr. Valicenti-McDermott had no disclosures.
Hepatitis B vaccine in infancy provides long-term protection into adolescence
Pediatric doses of hepatitis B vaccine can provide long-term protection against hepatitis B up to 15-16 years, and also can produce strong immune memory, according to Dr. Olivier Van Der Meeren of GlaxoSmithKline Vaccines, Wavre, Belgium, and his associates.
The researchers looked at 303 healthy adolescents who had received three doses of monovalent pediatric hepatitis B vaccine (containing 10 mcg hepatitis B surface antigen, HBsAg) in infancy. Of the 293 patients analyzed, 71% were seropositive (anti-HBs antibodies greater than or equal to 6.2 mIU/mL) before the challenge dose and 65% remained seroprotected (anti-HBs antibodies greater than or equal to 10 mIU/mL) after challenge. One month after the challenge dose, the percentage of seroprotected subjects increased to 99%, and 91% of those patients had anti-HBs antibody concentrations greater than or equal to 100 mIU/mL.
The study also looked at safety and reactogenicity. The researchers stated that it was well tolerated, with pain and fatigue the most frequently reported adverse effects.
“Despite declining levels of circulating anti-HBs antibodies, the vast majority of subjects in our study were able to mount a rapid and robust anamnestic response after a challenge dose (more than 150-fold increase in GMC [geometric mean concentration]) regardless of their pre-challenge serostatus,” the researchers concluded. “This confirms that maintaining anti-HBs antibody concentrations greater than 10 mIU/mL may not be essential for protection against clinically significant breakthrough hepatitis B infection.”
Find the study in Vaccine (doi:10.1016/j.vaccine.2016.04.013).
Pediatric doses of hepatitis B vaccine can provide long-term protection against hepatitis B up to 15-16 years, and also can produce strong immune memory, according to Dr. Olivier Van Der Meeren of GlaxoSmithKline Vaccines, Wavre, Belgium, and his associates.
The researchers looked at 303 healthy adolescents who had received three doses of monovalent pediatric hepatitis B vaccine (containing 10 mcg hepatitis B surface antigen, HBsAg) in infancy. Of the 293 patients analyzed, 71% were seropositive (anti-HBs antibodies greater than or equal to 6.2 mIU/mL) before the challenge dose and 65% remained seroprotected (anti-HBs antibodies greater than or equal to 10 mIU/mL) after challenge. One month after the challenge dose, the percentage of seroprotected subjects increased to 99%, and 91% of those patients had anti-HBs antibody concentrations greater than or equal to 100 mIU/mL.
The study also looked at safety and reactogenicity. The researchers stated that it was well tolerated, with pain and fatigue the most frequently reported adverse effects.
“Despite declining levels of circulating anti-HBs antibodies, the vast majority of subjects in our study were able to mount a rapid and robust anamnestic response after a challenge dose (more than 150-fold increase in GMC [geometric mean concentration]) regardless of their pre-challenge serostatus,” the researchers concluded. “This confirms that maintaining anti-HBs antibody concentrations greater than 10 mIU/mL may not be essential for protection against clinically significant breakthrough hepatitis B infection.”
Find the study in Vaccine (doi:10.1016/j.vaccine.2016.04.013).
Pediatric doses of hepatitis B vaccine can provide long-term protection against hepatitis B up to 15-16 years, and also can produce strong immune memory, according to Dr. Olivier Van Der Meeren of GlaxoSmithKline Vaccines, Wavre, Belgium, and his associates.
The researchers looked at 303 healthy adolescents who had received three doses of monovalent pediatric hepatitis B vaccine (containing 10 mcg hepatitis B surface antigen, HBsAg) in infancy. Of the 293 patients analyzed, 71% were seropositive (anti-HBs antibodies greater than or equal to 6.2 mIU/mL) before the challenge dose and 65% remained seroprotected (anti-HBs antibodies greater than or equal to 10 mIU/mL) after challenge. One month after the challenge dose, the percentage of seroprotected subjects increased to 99%, and 91% of those patients had anti-HBs antibody concentrations greater than or equal to 100 mIU/mL.
The study also looked at safety and reactogenicity. The researchers stated that it was well tolerated, with pain and fatigue the most frequently reported adverse effects.
“Despite declining levels of circulating anti-HBs antibodies, the vast majority of subjects in our study were able to mount a rapid and robust anamnestic response after a challenge dose (more than 150-fold increase in GMC [geometric mean concentration]) regardless of their pre-challenge serostatus,” the researchers concluded. “This confirms that maintaining anti-HBs antibody concentrations greater than 10 mIU/mL may not be essential for protection against clinically significant breakthrough hepatitis B infection.”
Find the study in Vaccine (doi:10.1016/j.vaccine.2016.04.013).
FROM VACCINE
Adrenal gland tumors linked to ADHD diagnosis
Pediatric patients diagnosed with pheochromocytomas (PHEO) or paragangliomas (PGL) were nearly three times as likely to also carry a diagnosis of attention deficit hyperactivity disorder (ADHD), compared to pediatric patients without PHEO or PGL, investigators reported.
In addition, in 33% of the patients with PHEO and PGL, ADHD symptoms were resolved following surgical removal of the tumor.
PHEO and PGL are rare tumors of the adrenal gland. About 10% of PHEO and PGL cases occur in patients younger than 18 years. PHEOs form inside the adrenal gland in the adrenal medulla while PGLs form outside the adrenal gland. Both tumors cause excess secretion of epinephrine and norepinephrine resulting in high blood pressure, headaches, weight loss, excess sweating, anxiety, and depression. These tumors are most often surgically removed or treated with medication. Chemotherapy and radiation therapy have not been as effective in treating PHEO or PGL.
ADHD is a neurodevelopment disorder characterized by a pattern of inattention and hyperactivity or impulsivity. ADHD is associated with catecholamine dysregulation; the function of catecholamine receptors is impaired by either excess or deficient stimulation. ADHD has a prevalence of 7.2% in children aged 4-18.
In addition to the overlap in symptoms, “the stimulants used to treat ADHD may exacerbate the symptoms of the PHEO/PGL and potentially lead to a hypertensive crisis ... Amphetamines, the most widely used ADHD medication class, lead to release of stored catecholamines from vesicles, block reuptake of norepinephrine and dopamine, and block catecholamine degradation,” wrote Dr. M. Batsis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her associates (Horm Metab Res. 2016 May 12. doi: 10.1055/s-0042-106725).
“I noticed that a lot of patients with the same story as follows: [parents] went to their pediatrician when their child started having feelings of anxiety or their heart was racing. And these symptoms were attributed to ADHD, and the child was started on medications. It wasn’t until later symptoms – an abdominal mass or a hypertensive crisis – that the patient was ultimately found out to have a pheochromocytoma,” Dr. Maya Lodish, a pediatric endocrinologist and coauthor of the paper, said in an interview.
“In hindsight, it just was not picked up. ADHD medications in no way affect tumor growth. The substances that these tumors release are stimulants. Endocrine tumors release catecholamine which are naturally occurring hormones we release under stress. When you add on top of that a stimulant medication [to treat ADHD] that may causes the nervous system to go into overdrive,” she said.
Due to the rarity of PHEO and PGL, their association with ADHD has not been well characterized. The purpose of this study was to therefore better assess the relationship between ADHD and PHEO/PGL development.
Investigators recruited 43 pediatric patients aged 6-17 who had been diagnosed with PHEO or PGL. Twenty-one percent (n = 9) of patients with PHEO/PGL carried a diagnosis of ADHD, compared to 7.2% in the general population (P = .0328).
Prior to the surgical removal of the tumors, eight of the nine patients had elevated levels of norepinephrine (n = 7), dopamine (n = 3), epinephrine (n = 1), metanephrine (n = 5) and/or normetanephrine (n = 7). In the remaining patient, levels were not measured.
Following the surgical removal of the tumors, three of the nine patients experienced both a resolution of their ADHD-related symptoms and a drop or normalization of their catecholamine and metanephrine levels. Two of those three patients showed no clinical signs of recurrent tumors while the third is under evaluation for a small pelvic lesion.
“These tumors are very rare and the vast majority of patients with ADHD are not affected by them, but they do occur. There are other organic conditions with the same symptoms – drug abuse, medications, Graves disease. If the child has symptoms attributed to ADHD and high blood pressure or family history of endocrine tumors then it is important to have a full organic workup to measure other causes of hypertension prior to starting stimulant medication,” Dr. Lodish said.
“My observation is that, and a lot of articles out there would agree, diagnoses of ADHD are on the rise and the prescribing of ADHD medication is also on the rise. I hope this is a bit of a wake-up call to practitioners that what’s common is common but there are some rare [conditions] to be aware of and so don’t have a knee jerk reaction to prescribing a medication for symptoms believed to be attributed to ADHD,” she said.
The Division of Intramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development supported the study. The investigators had no disclosures to report.
On Twitter @JessCraig_OP
Pediatric patients diagnosed with pheochromocytomas (PHEO) or paragangliomas (PGL) were nearly three times as likely to also carry a diagnosis of attention deficit hyperactivity disorder (ADHD), compared to pediatric patients without PHEO or PGL, investigators reported.
In addition, in 33% of the patients with PHEO and PGL, ADHD symptoms were resolved following surgical removal of the tumor.
PHEO and PGL are rare tumors of the adrenal gland. About 10% of PHEO and PGL cases occur in patients younger than 18 years. PHEOs form inside the adrenal gland in the adrenal medulla while PGLs form outside the adrenal gland. Both tumors cause excess secretion of epinephrine and norepinephrine resulting in high blood pressure, headaches, weight loss, excess sweating, anxiety, and depression. These tumors are most often surgically removed or treated with medication. Chemotherapy and radiation therapy have not been as effective in treating PHEO or PGL.
ADHD is a neurodevelopment disorder characterized by a pattern of inattention and hyperactivity or impulsivity. ADHD is associated with catecholamine dysregulation; the function of catecholamine receptors is impaired by either excess or deficient stimulation. ADHD has a prevalence of 7.2% in children aged 4-18.
In addition to the overlap in symptoms, “the stimulants used to treat ADHD may exacerbate the symptoms of the PHEO/PGL and potentially lead to a hypertensive crisis ... Amphetamines, the most widely used ADHD medication class, lead to release of stored catecholamines from vesicles, block reuptake of norepinephrine and dopamine, and block catecholamine degradation,” wrote Dr. M. Batsis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her associates (Horm Metab Res. 2016 May 12. doi: 10.1055/s-0042-106725).
“I noticed that a lot of patients with the same story as follows: [parents] went to their pediatrician when their child started having feelings of anxiety or their heart was racing. And these symptoms were attributed to ADHD, and the child was started on medications. It wasn’t until later symptoms – an abdominal mass or a hypertensive crisis – that the patient was ultimately found out to have a pheochromocytoma,” Dr. Maya Lodish, a pediatric endocrinologist and coauthor of the paper, said in an interview.
“In hindsight, it just was not picked up. ADHD medications in no way affect tumor growth. The substances that these tumors release are stimulants. Endocrine tumors release catecholamine which are naturally occurring hormones we release under stress. When you add on top of that a stimulant medication [to treat ADHD] that may causes the nervous system to go into overdrive,” she said.
Due to the rarity of PHEO and PGL, their association with ADHD has not been well characterized. The purpose of this study was to therefore better assess the relationship between ADHD and PHEO/PGL development.
Investigators recruited 43 pediatric patients aged 6-17 who had been diagnosed with PHEO or PGL. Twenty-one percent (n = 9) of patients with PHEO/PGL carried a diagnosis of ADHD, compared to 7.2% in the general population (P = .0328).
Prior to the surgical removal of the tumors, eight of the nine patients had elevated levels of norepinephrine (n = 7), dopamine (n = 3), epinephrine (n = 1), metanephrine (n = 5) and/or normetanephrine (n = 7). In the remaining patient, levels were not measured.
Following the surgical removal of the tumors, three of the nine patients experienced both a resolution of their ADHD-related symptoms and a drop or normalization of their catecholamine and metanephrine levels. Two of those three patients showed no clinical signs of recurrent tumors while the third is under evaluation for a small pelvic lesion.
“These tumors are very rare and the vast majority of patients with ADHD are not affected by them, but they do occur. There are other organic conditions with the same symptoms – drug abuse, medications, Graves disease. If the child has symptoms attributed to ADHD and high blood pressure or family history of endocrine tumors then it is important to have a full organic workup to measure other causes of hypertension prior to starting stimulant medication,” Dr. Lodish said.
“My observation is that, and a lot of articles out there would agree, diagnoses of ADHD are on the rise and the prescribing of ADHD medication is also on the rise. I hope this is a bit of a wake-up call to practitioners that what’s common is common but there are some rare [conditions] to be aware of and so don’t have a knee jerk reaction to prescribing a medication for symptoms believed to be attributed to ADHD,” she said.
The Division of Intramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development supported the study. The investigators had no disclosures to report.
On Twitter @JessCraig_OP
Pediatric patients diagnosed with pheochromocytomas (PHEO) or paragangliomas (PGL) were nearly three times as likely to also carry a diagnosis of attention deficit hyperactivity disorder (ADHD), compared to pediatric patients without PHEO or PGL, investigators reported.
In addition, in 33% of the patients with PHEO and PGL, ADHD symptoms were resolved following surgical removal of the tumor.
PHEO and PGL are rare tumors of the adrenal gland. About 10% of PHEO and PGL cases occur in patients younger than 18 years. PHEOs form inside the adrenal gland in the adrenal medulla while PGLs form outside the adrenal gland. Both tumors cause excess secretion of epinephrine and norepinephrine resulting in high blood pressure, headaches, weight loss, excess sweating, anxiety, and depression. These tumors are most often surgically removed or treated with medication. Chemotherapy and radiation therapy have not been as effective in treating PHEO or PGL.
ADHD is a neurodevelopment disorder characterized by a pattern of inattention and hyperactivity or impulsivity. ADHD is associated with catecholamine dysregulation; the function of catecholamine receptors is impaired by either excess or deficient stimulation. ADHD has a prevalence of 7.2% in children aged 4-18.
In addition to the overlap in symptoms, “the stimulants used to treat ADHD may exacerbate the symptoms of the PHEO/PGL and potentially lead to a hypertensive crisis ... Amphetamines, the most widely used ADHD medication class, lead to release of stored catecholamines from vesicles, block reuptake of norepinephrine and dopamine, and block catecholamine degradation,” wrote Dr. M. Batsis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and her associates (Horm Metab Res. 2016 May 12. doi: 10.1055/s-0042-106725).
“I noticed that a lot of patients with the same story as follows: [parents] went to their pediatrician when their child started having feelings of anxiety or their heart was racing. And these symptoms were attributed to ADHD, and the child was started on medications. It wasn’t until later symptoms – an abdominal mass or a hypertensive crisis – that the patient was ultimately found out to have a pheochromocytoma,” Dr. Maya Lodish, a pediatric endocrinologist and coauthor of the paper, said in an interview.
“In hindsight, it just was not picked up. ADHD medications in no way affect tumor growth. The substances that these tumors release are stimulants. Endocrine tumors release catecholamine which are naturally occurring hormones we release under stress. When you add on top of that a stimulant medication [to treat ADHD] that may causes the nervous system to go into overdrive,” she said.
Due to the rarity of PHEO and PGL, their association with ADHD has not been well characterized. The purpose of this study was to therefore better assess the relationship between ADHD and PHEO/PGL development.
Investigators recruited 43 pediatric patients aged 6-17 who had been diagnosed with PHEO or PGL. Twenty-one percent (n = 9) of patients with PHEO/PGL carried a diagnosis of ADHD, compared to 7.2% in the general population (P = .0328).
Prior to the surgical removal of the tumors, eight of the nine patients had elevated levels of norepinephrine (n = 7), dopamine (n = 3), epinephrine (n = 1), metanephrine (n = 5) and/or normetanephrine (n = 7). In the remaining patient, levels were not measured.
Following the surgical removal of the tumors, three of the nine patients experienced both a resolution of their ADHD-related symptoms and a drop or normalization of their catecholamine and metanephrine levels. Two of those three patients showed no clinical signs of recurrent tumors while the third is under evaluation for a small pelvic lesion.
“These tumors are very rare and the vast majority of patients with ADHD are not affected by them, but they do occur. There are other organic conditions with the same symptoms – drug abuse, medications, Graves disease. If the child has symptoms attributed to ADHD and high blood pressure or family history of endocrine tumors then it is important to have a full organic workup to measure other causes of hypertension prior to starting stimulant medication,” Dr. Lodish said.
“My observation is that, and a lot of articles out there would agree, diagnoses of ADHD are on the rise and the prescribing of ADHD medication is also on the rise. I hope this is a bit of a wake-up call to practitioners that what’s common is common but there are some rare [conditions] to be aware of and so don’t have a knee jerk reaction to prescribing a medication for symptoms believed to be attributed to ADHD,” she said.
The Division of Intramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development supported the study. The investigators had no disclosures to report.
On Twitter @JessCraig_OP
FROM HORMONE AND METABOLIC RESEARCH
Key clinical point: Pediatric patients with pheochromocytomas (PHEO) or paragangliomas (PGL) were more likely to also carry a diagnosis of ADHD, compared to pediatric patients without PHEO or PGL.
Major finding: Twenty-one percent of patients with PHEO/PGL carried a diagnosis of ADHD, compared to 7.2% in the general population (P = .0328). In 33% of the patients with PHEO and PGL, ADHD symptoms were resolved following surgical removal of the tumor.
Data source: Longitudinal study of 43 patients aged 6-17 who were diagnosed with PHEO and/or PGL.
Disclosures: The Division of Intramural Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development supported the study. The investigators had no disclosures.
HU improves lung function in young SCD patients
Photo courtesy of St. Jude
Children’s Research Hospital
SAN FRANCISCO—A new study has shown that hydroxyurea (HU) can improve lung function in young patients with sickle cell disease (SCD).
“Persons with sickle cell disease experience an annual decline in lung function that starts in childhood,” said study investigator Anya McLaren, MD, of The Hospital for Sick Children in Toronto, Ontario, Canada.
“This study is the first of its kind to look at the effect of hydroxyurea on lung function. We found that hydroxyurea improves annual pulmonary function decline in children with sickle cell disease by more than one-third.”
The study was presented at the ATS 2016 International Conference as abstract 7225.
For this study, Dr McLaren and her colleagues evaluated the effects of HU in 94 SCD patients. The patients’ average age at baseline was 11 (range, 6 to 20), 96% of patients had HbSS genotype, and 47% were male.
The patients were followed for 4 years after HU initiation. The investigators assessed lung function before and after HU initiation in a few ways.
They used the forced expiratory volume (FEV) test, which measures how much air a person can exhale during a forced breath. The amount of air can be measured during the first second of the forced breath (FEV1) and at later time points.
Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test. If the FEV1/FVC ratio is less than 80%, it indicates that an obstructive defect is present.
The investigators also assessed FEF25-75, or the forced expiratory flow at 25%–75% of FVC. This measurement helps determine if there is an obstruction in the airway.
In addition, the team measured total lung capacity.
Results
The investigators found no significant change in total lung capacity, FVC, or FEV1/FVC predicted measurements after patients began receiving HU.
However, there were significant improvements in both FEV1 and FEF25-75 after treatment.
The annual rate of decline in predicted FEV1 and FEF25-75 before patients started HU was -1.98%/year (95% CI -2.57 to -1.39) and -3.59%/year (95% CI -4.43 to -2.75), respectively.
After HU treatment began, there was a significant (P<0.05) improvement in the annual decline, to -1.28%/year (95% CI -1.79 to -0.76) and -2.88%/year (95% CI -3.49 to -2.28), respectively.
The investigators noted that changes in FEV1 and FEF25-75 were independent of a patient’s age at baseline and the time from HU therapy initiation.
Dr McLaren pointed out that HU is underused in SCD patients, likely because clinicians are concerned about patient non-compliance and afraid of potential side effects, particularly carcinogenesis. But some of those fears may be unfounded, she said.
“Long-term observational studies suggest beneficial effects [of HU] without excessive damage to bone marrow, deleterious effects on growth and development, altered fertility, accumulation of mutations, or increased carcinogenicity,” Dr McLaren said.
“Evidence that lung function may be better preserved while on hydroxyurea may encourage compliance and adherence to this medication for patients with sickle cell disease. In combination with the established safety data, it hopefully will promote physician recommendations for hydroxyurea initiation and encouragement of compliance.”
Photo courtesy of St. Jude
Children’s Research Hospital
SAN FRANCISCO—A new study has shown that hydroxyurea (HU) can improve lung function in young patients with sickle cell disease (SCD).
“Persons with sickle cell disease experience an annual decline in lung function that starts in childhood,” said study investigator Anya McLaren, MD, of The Hospital for Sick Children in Toronto, Ontario, Canada.
“This study is the first of its kind to look at the effect of hydroxyurea on lung function. We found that hydroxyurea improves annual pulmonary function decline in children with sickle cell disease by more than one-third.”
The study was presented at the ATS 2016 International Conference as abstract 7225.
For this study, Dr McLaren and her colleagues evaluated the effects of HU in 94 SCD patients. The patients’ average age at baseline was 11 (range, 6 to 20), 96% of patients had HbSS genotype, and 47% were male.
The patients were followed for 4 years after HU initiation. The investigators assessed lung function before and after HU initiation in a few ways.
They used the forced expiratory volume (FEV) test, which measures how much air a person can exhale during a forced breath. The amount of air can be measured during the first second of the forced breath (FEV1) and at later time points.
Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test. If the FEV1/FVC ratio is less than 80%, it indicates that an obstructive defect is present.
The investigators also assessed FEF25-75, or the forced expiratory flow at 25%–75% of FVC. This measurement helps determine if there is an obstruction in the airway.
In addition, the team measured total lung capacity.
Results
The investigators found no significant change in total lung capacity, FVC, or FEV1/FVC predicted measurements after patients began receiving HU.
However, there were significant improvements in both FEV1 and FEF25-75 after treatment.
The annual rate of decline in predicted FEV1 and FEF25-75 before patients started HU was -1.98%/year (95% CI -2.57 to -1.39) and -3.59%/year (95% CI -4.43 to -2.75), respectively.
After HU treatment began, there was a significant (P<0.05) improvement in the annual decline, to -1.28%/year (95% CI -1.79 to -0.76) and -2.88%/year (95% CI -3.49 to -2.28), respectively.
The investigators noted that changes in FEV1 and FEF25-75 were independent of a patient’s age at baseline and the time from HU therapy initiation.
Dr McLaren pointed out that HU is underused in SCD patients, likely because clinicians are concerned about patient non-compliance and afraid of potential side effects, particularly carcinogenesis. But some of those fears may be unfounded, she said.
“Long-term observational studies suggest beneficial effects [of HU] without excessive damage to bone marrow, deleterious effects on growth and development, altered fertility, accumulation of mutations, or increased carcinogenicity,” Dr McLaren said.
“Evidence that lung function may be better preserved while on hydroxyurea may encourage compliance and adherence to this medication for patients with sickle cell disease. In combination with the established safety data, it hopefully will promote physician recommendations for hydroxyurea initiation and encouragement of compliance.”
Photo courtesy of St. Jude
Children’s Research Hospital
SAN FRANCISCO—A new study has shown that hydroxyurea (HU) can improve lung function in young patients with sickle cell disease (SCD).
“Persons with sickle cell disease experience an annual decline in lung function that starts in childhood,” said study investigator Anya McLaren, MD, of The Hospital for Sick Children in Toronto, Ontario, Canada.
“This study is the first of its kind to look at the effect of hydroxyurea on lung function. We found that hydroxyurea improves annual pulmonary function decline in children with sickle cell disease by more than one-third.”
The study was presented at the ATS 2016 International Conference as abstract 7225.
For this study, Dr McLaren and her colleagues evaluated the effects of HU in 94 SCD patients. The patients’ average age at baseline was 11 (range, 6 to 20), 96% of patients had HbSS genotype, and 47% were male.
The patients were followed for 4 years after HU initiation. The investigators assessed lung function before and after HU initiation in a few ways.
They used the forced expiratory volume (FEV) test, which measures how much air a person can exhale during a forced breath. The amount of air can be measured during the first second of the forced breath (FEV1) and at later time points.
Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test. If the FEV1/FVC ratio is less than 80%, it indicates that an obstructive defect is present.
The investigators also assessed FEF25-75, or the forced expiratory flow at 25%–75% of FVC. This measurement helps determine if there is an obstruction in the airway.
In addition, the team measured total lung capacity.
Results
The investigators found no significant change in total lung capacity, FVC, or FEV1/FVC predicted measurements after patients began receiving HU.
However, there were significant improvements in both FEV1 and FEF25-75 after treatment.
The annual rate of decline in predicted FEV1 and FEF25-75 before patients started HU was -1.98%/year (95% CI -2.57 to -1.39) and -3.59%/year (95% CI -4.43 to -2.75), respectively.
After HU treatment began, there was a significant (P<0.05) improvement in the annual decline, to -1.28%/year (95% CI -1.79 to -0.76) and -2.88%/year (95% CI -3.49 to -2.28), respectively.
The investigators noted that changes in FEV1 and FEF25-75 were independent of a patient’s age at baseline and the time from HU therapy initiation.
Dr McLaren pointed out that HU is underused in SCD patients, likely because clinicians are concerned about patient non-compliance and afraid of potential side effects, particularly carcinogenesis. But some of those fears may be unfounded, she said.
“Long-term observational studies suggest beneficial effects [of HU] without excessive damage to bone marrow, deleterious effects on growth and development, altered fertility, accumulation of mutations, or increased carcinogenicity,” Dr McLaren said.
“Evidence that lung function may be better preserved while on hydroxyurea may encourage compliance and adherence to this medication for patients with sickle cell disease. In combination with the established safety data, it hopefully will promote physician recommendations for hydroxyurea initiation and encouragement of compliance.”
EPO may not benefit preterm infants long-term
Photo by Petr Kratochvil
Giving very preterm infants high-dose recombinant human erythropoietin (EPO) at birth does not improve neurodevelopmental outcomes at 2 years, according to a study published in JAMA.
Researchers found no significant differences between infants who received EPO and those who did not when it came to cognitive development, motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
Giancarlo Natalucci, MD, of the University of Zurich in Switzerland, and his colleagues conducted this study in 448 preterm infants who were born between 26 weeks’ gestation and 31 weeks 6 days’ gestation.
The subjects’ average gestational age was 29 weeks, and their average birth weight was 1210 g (2.7 lbs).
The infants were randomized to receive high-dose EPO (n=228) or placebo (saline, n=220) intravenously within 3 hours of birth, at 12 to 18 hours, and at 36 to 42 hours after birth.
Neurodevelopmental outcome data were available for 81% of the infants (n=365) at an average age of 23.6 months.
Cognitive development, as assessed with the Mental Development Index (MDI), was not significantly different between the EPO group and the placebo group. In an intent-to-treat analysis, the mean MDI was 93.5 in the EPO group and 94.5 in the placebo group (P=0.056). In the per-protocol analysis, the mean MDI was 93.9 and 94.5, respectively (P=0.70).
The researchers also found no significant differences between the treatment groups for secondary outcomes such as motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
The team assessed motor development using the psychomotor development index (PDI). In the intent-to-treat analysis, the mean PDI was 89.5 in the EPO group and 92.1 in the placebo group (P=0.15). In the per-protocol analysis, the mean PDI was 89.2 and 92.8, respectively (P=0.06).
In the intent-to-treat analysis, the incidence of cerebral palsy was 4% in the EPO group and 5% in the placebo group (P>0.99). In the per-protocol analysis, it was 5% for both groups (P=0.41).
In the intent-to-treat analysis, severe hearing impairment occurred in 1 EPO-treated patient and no placebo-treated patients (P>0.99). Severe visual impairment occurred in 2 and 0, respectively (P=0.50). The incidences were the same in the per-protocol analysis.
And there were no significant differences between the treatment groups (per-protocol or intent-to-treat) when it came to growth parameters such as head circumference, weight, or length.
The researchers said these results suggest that EPO may not have a neuroprotective role in very preterm infants, but follow-up is required to assess cognitive and physical problems that may not become evident until later in life.
Photo by Petr Kratochvil
Giving very preterm infants high-dose recombinant human erythropoietin (EPO) at birth does not improve neurodevelopmental outcomes at 2 years, according to a study published in JAMA.
Researchers found no significant differences between infants who received EPO and those who did not when it came to cognitive development, motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
Giancarlo Natalucci, MD, of the University of Zurich in Switzerland, and his colleagues conducted this study in 448 preterm infants who were born between 26 weeks’ gestation and 31 weeks 6 days’ gestation.
The subjects’ average gestational age was 29 weeks, and their average birth weight was 1210 g (2.7 lbs).
The infants were randomized to receive high-dose EPO (n=228) or placebo (saline, n=220) intravenously within 3 hours of birth, at 12 to 18 hours, and at 36 to 42 hours after birth.
Neurodevelopmental outcome data were available for 81% of the infants (n=365) at an average age of 23.6 months.
Cognitive development, as assessed with the Mental Development Index (MDI), was not significantly different between the EPO group and the placebo group. In an intent-to-treat analysis, the mean MDI was 93.5 in the EPO group and 94.5 in the placebo group (P=0.056). In the per-protocol analysis, the mean MDI was 93.9 and 94.5, respectively (P=0.70).
The researchers also found no significant differences between the treatment groups for secondary outcomes such as motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
The team assessed motor development using the psychomotor development index (PDI). In the intent-to-treat analysis, the mean PDI was 89.5 in the EPO group and 92.1 in the placebo group (P=0.15). In the per-protocol analysis, the mean PDI was 89.2 and 92.8, respectively (P=0.06).
In the intent-to-treat analysis, the incidence of cerebral palsy was 4% in the EPO group and 5% in the placebo group (P>0.99). In the per-protocol analysis, it was 5% for both groups (P=0.41).
In the intent-to-treat analysis, severe hearing impairment occurred in 1 EPO-treated patient and no placebo-treated patients (P>0.99). Severe visual impairment occurred in 2 and 0, respectively (P=0.50). The incidences were the same in the per-protocol analysis.
And there were no significant differences between the treatment groups (per-protocol or intent-to-treat) when it came to growth parameters such as head circumference, weight, or length.
The researchers said these results suggest that EPO may not have a neuroprotective role in very preterm infants, but follow-up is required to assess cognitive and physical problems that may not become evident until later in life.
Photo by Petr Kratochvil
Giving very preterm infants high-dose recombinant human erythropoietin (EPO) at birth does not improve neurodevelopmental outcomes at 2 years, according to a study published in JAMA.
Researchers found no significant differences between infants who received EPO and those who did not when it came to cognitive development, motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
Giancarlo Natalucci, MD, of the University of Zurich in Switzerland, and his colleagues conducted this study in 448 preterm infants who were born between 26 weeks’ gestation and 31 weeks 6 days’ gestation.
The subjects’ average gestational age was 29 weeks, and their average birth weight was 1210 g (2.7 lbs).
The infants were randomized to receive high-dose EPO (n=228) or placebo (saline, n=220) intravenously within 3 hours of birth, at 12 to 18 hours, and at 36 to 42 hours after birth.
Neurodevelopmental outcome data were available for 81% of the infants (n=365) at an average age of 23.6 months.
Cognitive development, as assessed with the Mental Development Index (MDI), was not significantly different between the EPO group and the placebo group. In an intent-to-treat analysis, the mean MDI was 93.5 in the EPO group and 94.5 in the placebo group (P=0.056). In the per-protocol analysis, the mean MDI was 93.9 and 94.5, respectively (P=0.70).
The researchers also found no significant differences between the treatment groups for secondary outcomes such as motor development, cerebral palsy, hearing or visual impairment, and anthropometric growth parameters.
The team assessed motor development using the psychomotor development index (PDI). In the intent-to-treat analysis, the mean PDI was 89.5 in the EPO group and 92.1 in the placebo group (P=0.15). In the per-protocol analysis, the mean PDI was 89.2 and 92.8, respectively (P=0.06).
In the intent-to-treat analysis, the incidence of cerebral palsy was 4% in the EPO group and 5% in the placebo group (P>0.99). In the per-protocol analysis, it was 5% for both groups (P=0.41).
In the intent-to-treat analysis, severe hearing impairment occurred in 1 EPO-treated patient and no placebo-treated patients (P>0.99). Severe visual impairment occurred in 2 and 0, respectively (P=0.50). The incidences were the same in the per-protocol analysis.
And there were no significant differences between the treatment groups (per-protocol or intent-to-treat) when it came to growth parameters such as head circumference, weight, or length.
The researchers said these results suggest that EPO may not have a neuroprotective role in very preterm infants, but follow-up is required to assess cognitive and physical problems that may not become evident until later in life.
Invasive group A strep infection in the U.S. remains substantial
Invasive group A Streptococcus infection (GAS) in the United States caused 10,649-13,434 illnesses per year, and 1,136-1,607 deaths annually, during 2005-2012, according to researchers.
From January of 2005 to December of 2012, 9,557 cases and 1,117 deaths were reported to the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. GAS incidence was highest in people aged 65 and older, at 9.4 cases per 100,000, people younger than 1 year old at 5.3 per 100,000, and blacks at 4.7 per 100,000, said Dr. George E. Nelson and his associates.
Patients with septic shock were at the highest risk of death (odds ratio, 9.11), followed by necrotizing fasciitis (OR, 5.25). By age, adults aged 75 and older were at the highest risk of death (OR, 5.41).
“Invasive GAS remains a serious infection associated with high mortality. With no new effective tools for disease prevention, rates have remained unchanged over the last 13 years. In this setting, more rapid recognition of severe GAS infections and prompt and appropriate treatments are needed. Given that the initial presentation of invasive GAS infections [is] often nonspecific and can cause severe disease and death, vaccines are sorely needed.” the researchers concluded.
They reported no conflicts.
Find the study at doi: 10.1093/cid/ciw248.
Invasive group A Streptococcus infection (GAS) in the United States caused 10,649-13,434 illnesses per year, and 1,136-1,607 deaths annually, during 2005-2012, according to researchers.
From January of 2005 to December of 2012, 9,557 cases and 1,117 deaths were reported to the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. GAS incidence was highest in people aged 65 and older, at 9.4 cases per 100,000, people younger than 1 year old at 5.3 per 100,000, and blacks at 4.7 per 100,000, said Dr. George E. Nelson and his associates.
Patients with septic shock were at the highest risk of death (odds ratio, 9.11), followed by necrotizing fasciitis (OR, 5.25). By age, adults aged 75 and older were at the highest risk of death (OR, 5.41).
“Invasive GAS remains a serious infection associated with high mortality. With no new effective tools for disease prevention, rates have remained unchanged over the last 13 years. In this setting, more rapid recognition of severe GAS infections and prompt and appropriate treatments are needed. Given that the initial presentation of invasive GAS infections [is] often nonspecific and can cause severe disease and death, vaccines are sorely needed.” the researchers concluded.
They reported no conflicts.
Find the study at doi: 10.1093/cid/ciw248.
Invasive group A Streptococcus infection (GAS) in the United States caused 10,649-13,434 illnesses per year, and 1,136-1,607 deaths annually, during 2005-2012, according to researchers.
From January of 2005 to December of 2012, 9,557 cases and 1,117 deaths were reported to the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. GAS incidence was highest in people aged 65 and older, at 9.4 cases per 100,000, people younger than 1 year old at 5.3 per 100,000, and blacks at 4.7 per 100,000, said Dr. George E. Nelson and his associates.
Patients with septic shock were at the highest risk of death (odds ratio, 9.11), followed by necrotizing fasciitis (OR, 5.25). By age, adults aged 75 and older were at the highest risk of death (OR, 5.41).
“Invasive GAS remains a serious infection associated with high mortality. With no new effective tools for disease prevention, rates have remained unchanged over the last 13 years. In this setting, more rapid recognition of severe GAS infections and prompt and appropriate treatments are needed. Given that the initial presentation of invasive GAS infections [is] often nonspecific and can cause severe disease and death, vaccines are sorely needed.” the researchers concluded.
They reported no conflicts.
Find the study at doi: 10.1093/cid/ciw248.
FROM CLINICAL INFECTIOUS DISEASES
