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Daily Dose

Omega-3 Fatty Acids

1:30 to read

Many of the patients that I see who have problems with attention and focus as well as other behavioral and learning issues have been started on all sorts of different medications. For some children their medications seem to be “working well”. But, for some children it has been difficult to find the “right” medication to alleviate all of their symptoms.  Studies have shown that anywhere from 10%- 30% of children with ADHD do not respond favorably to stimulant medications. Therefore,  it is not uncommon for their parents to inquire about the use of alternative or complementary medications. In several cases their parents have already started “dietary supplements”, which at times they are reluctant to admit to, or ask for my opinion.  

Interestingly, there is recent data regarding dietary supplements that parents and pediatricians should be paying attention to…and open to discussing.  A study that was presented last fall at the American Academy of Child and Adolescent Psychiatry showed that omega-3’s “could augment the response in children aged 7-14 years who were receiving psychotherapy for depression and bipolar disorders”. There have been  studies as well that have shown “significant improvements with Omega-3’s relative to placebo for problems including aggression as well as depression and anxiety symptoms”.  There are also numerous studies looking at ADHD symptom improvement in those using Omega-3’s, and again the results have been mixed, made even more difficult by the fact that ADHD is a subjective diagnosis.  

Another issue that requires more study is how these fatty acids actually work within the body and brain. Omega-3’s are an important building block of the brain and it is present in the brain's cell membranes, where it is thought to facilitate the transmission of neural signals.  Current thought is that these fatty acids may change the cell membrane fluidity and may also have anti-inflammatory effects….but a lot of research continues on the issue of mechanism of action. 

Several of the studies looked at dosage of the Omega 3 fatty acid supplements and “it seemed that there were more positive trials related to higher daily doses of  certain omega 3 fatty acids including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).  There need to be further studies to address the amount and ratio of these Omega-3’s as they are used for supplements. 

So while the research continues as to the effectiveness of Omega 3’s on focus, mood, behavior and learning it is important for all children to consume enough Omega-3 fatty acids in their diet. Eating fatty fish a few times a week would be beneficial for the health of all children - and the decision to supplement beyond that may be a topic for discussion with your own physician. 


Your Teen

Study: ADHD Drugs Don’t Increase Heart Problems for Kids

1.30 to read

A new study suggests that Ritalin and similar drugs, used to treat attention deficient hyperactivity disorder (ADHD), do not raise the risk of serious heart problems, stroke or sudden death.

That’s very good news for children who take ADHD drugs and their parents.

In the new study, researchers looked at the diverse medical records of 1.2 million children, ages 2-24 years old. They checked health records for evidence of heart problems, including heart attacks, strokes and sudden cardiac deaths, in children who were currently taking the drugs or who had taken Ritalin or Adderall in the past.

"We don't see any evidence of increased risk," said Dr. William Cooper of Vanderbilt University, whose study was published in the New England Journal of Medicine.

In 2006, U.S. and Canadian regulators received a number of reports of heart attacks, strokes and sudden cardiac arrest in children taking ADHD medications. This study is the first of three commissioned by the Food and Drug Administration. Also because of concerns about possible heart related problems, the American Heart Association issued guidelines suggesting that children who were just starting to take the drugs should be tested for potential underlying heart problems.

"There's such strong feelings around these drug and whether they are overused in children who might be helped by behavioral therapy alone,” Cooper said. "The potential safety questions have added another layer of concern."

The study was aimed at resolving safety questions. The team found no increased risk of heart problems for either current or past users of the drugs. Yet because there were so few cases of serious heart problems -- just 81 -- the study may not have been large enough to detect it.

But even if there were a risk of heart problems, it is extremely slight, Cooper said.

In a guidance document issued on Tuesday, the FDA said it continues to recommend that the drugs not be used in patients with serious heart problems. It added that patients should be monitored for changes in heart rate or blood pressure.

More than 5 million children in the United States have been diagnosed with ADHD.  Whether children are being over medicated or should even be taking stimulants at all to treat ADHD has long been a controversial subject. Some organizations and parents believe that supplying children with stimulants to treat ADHD is harmful.

For those parents that believe ADHD drugs are helping their children focus better in school and live more productive lives, this recent study should offer some reassurance that the drugs do not contribute to heart problems.

 "This study would suggest that their risk is remarkably low. And that's good news," noted Dr. Cooper.

Your Baby

Higher ADHD Risks Linked to Premature Births


The risk that a child will have Attention Deficit Hyperactivity Disorder (ADHD) is relatively low among the general population. However, a new study suggests that the more premature a baby is when born; the risk for ADHD increases significantly.

Finnish researchers led by Dr. Minna Sucksdorff of the University of Turku compared more than 10,000 children with ADHD against more than 38,000 children without ADHD but similar in terms of gender, birth date and place of birth.

The researchers used birth medical records to see how far along in the pregnancy the mother was when the child was born. They also looked at whether the children were underweight or overweight for what is expected at that gestational age.

The study results showed that the risk of ADHD increased for each week earlier that a child was born. A full-term pregnancy is considered to be 40 weeks.

The odds of children with ADHD were 10 times greater when they were born during the 23rd to 24th week of pregnancy. Children born between the 27th and 33rd week of pregnancy were twice as likely to have ADHD compared to those without ADHD.

Other factors that affect gestational age and ADHD were also taken in account such as the mother’s age and whether she smoked or used drugs or alcohol. After these considerations, the findings remained the same.

In regards to birth weight, researchers found that infants born at very low or very high weight percentages were also at a higher risk for ADHD.

These findings imply that the pathways in the fetal brain may develop differently in children who are not adequately nourished, or are over-nourished, in the womb, or once a child is delivered prematurely, said Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

However, he added, this type of study cannot show that premature birth or growth rate in the womb actually causes ADHD. Symptoms of the common brain disorder include inattention, impulsive behavior and hyperactivity, which can affect a child's ability to learn and make friends.

Most early cesarean births happen because a mother and / or her infant are in distress and surgery is needed to protect one or the other or both of their health. Planned cesareans are typically scheduled close to the original due date and are unlikely to be associated to ADHD risk. However, the findings may give doctors something to consider when making a decision about cesarean birth.

"Since both gestational weight and gestational age have marked effects, clinicians may face difficult choices if a fetus is not thriving in the womb at an early gestational age," Elliott said. "Does one deliver the child early to enhance nutrition or delay to minimize the effects of premature delivery?"

The risk is still low overall that a child will have ADHD, and these findings are based on a child's relative risk of having the condition compared to others, Elliott added. The study suggests that the chance for ADHD appears to be greatest among the very premature babies.

The findings were published in the August 24th online edition of  the journal Pediatrics.

Source: Tara Haelle,

Your Child

Adult and Childhood ADHD Two Different Disorders?


A couple of recent studies are taking a new look at the differences in adult and childhood ADHD.

They suggest that adult ADHD is not just a continuation of childhood ADHD, but that the two are different disorders entirely.

In addition, the researchers say that adult-onset ADHD might actually be more common than childhood onset.

The two studies used similar methodology and showed fairly similar results.

The first study, conducted by a team at the Federal University of Rio Grande do Sul in Brazil, evaluated more than 5,000 individuals born in the city of Pelotas in 1993. Approximately 9 percent of them were diagnosed with childhood ADHD — a fairly average rate. Twelve percent of the subjects met criteria for ADHD in adulthood — significantly higher than the researchers expected — but there was very little overlap between the groups. In fact, only 12.6 percent of the adults with ADHD had shown diagnosable signs of the disorder in childhood.

The second study, which looked at 2,040 twins born in England and Wales from 1994-5, found that of 166 subjects who met the criteria for adult ADHD, more than half (67.5 percent) showed no symptoms of ADHD in childhood. Of the 247 individuals who had met the criteria for ADHD in childhood, less than 22 percent retained that diagnosis into adulthood.

These reports support findings from a third study from New Zealand, published in 2015. Researchers followed subjects from birth to age 38. Of the patients who showed signs of ADHD in adulthood in that study, 90 percent had demonstrated no signs of the disorder in childhood.

While the results from these studies suggests that the widely accepted definition of ADHD – a disorder that develops in childhood, is occasionally “outgrown” as the patient ages- may need to be reassessed.

However, not everyone is on board with the recent findings. Some experts suggest that the study’s authors may have simply missed symptoms of ADHD in childhood in cases where it didn’t seem to become apparent until adulthood.

“Because these concerns suggest that the UK, Brazil, and New Zealand studies may have underestimated the persistence of ADHD and overestimated the prevalence of adult-onset ADHD, it would be a mistake for practitioners to assume that most adults referred to them with ADHD symptoms will not have a history of ADHD in youth,” write Stephen Faraone, Ph.D., and Joseph Biederman, M.D., in an editorial cautioning the ADHD community to interpret the two most recent studies with a grain of salt. They called the findings “premature.”

In both of these studies and in previous research, adult ADHD has been linked to high levels of criminal behavior, substance abuse, traffic accidents and suicide attempts. These troubling correlations remained even after the authors adjusted for the existence of other psychiatric disorders — proving once again that whether it develops in childhood or adulthood, untreated ADHD is serious business.

Both of the studies challenge conventional beliefs that childhood onset ADHD is more likely to continue into adulthood. Many experts would like to see more research on this topic to verify these findings

The two studies were published in the July 2016 issue of JAMA Psychiatry.

Story source: Devon Frye,

Daily Dose

Good Grades Pill

1.15 to read

There is a lot of pressure placed on students to succeed and many of them are turning to what teens call the “good grade pill”.  What is it?  Prescription stimulants that are commonly used to treat children with ADHD.  Teens that have not been diagnosed with ADHD have figured out that with the help of these drugs, they can focus and improve their grades.  

I see a lot of kids who have attentional issues and I evaluate and treat children for ADHD. With that being said, I also spend a great deal of time with each family looking at their child’s history, report cards, teacher comments, educational testing and subjective ADHD rating scales. 

While many families would like it if I just “wrote a script for a stimulant”, I feel it is my job to try and determine to the best of my ability, which children really fit the diagnosis of ADHD. (There are specific criteria for diagnosing ADHD). 

But in the last 3-5 years I personally have seen more and more teenage patients coming to me with complaints of “having ADHD”. These are successful teens who are now in competitive schools. 

In most of the cases there have never been any previous complaints of difficulty with focusing or inattentiveness. All are typically A and B students but are now having to work harder to keep their grades up, and to also keep up all of their extracurricular activities. They too all want to go to “great colleges” and their parents expect that of them as well. 

When I see these teens, I point out to them that there has never been mention of school difficulties throughout their elementary and middle school years. I also tell them that ADHD symptoms by definition are typically evident by the time a child is 7 years of age, and often earlier.  So what do you do? I don’t take out the script pad. 

I believe that stimulant medications are useful when used appropriately.  I am also well aware that these drugs are overprescribed and are also being abused. I have had parents (and teens) be quite upset with me when I decline to write a script for stimulant medication for their teen.  

I think that this problem is growing and (we) parents need to stop pressuring our children and (we) doctors need to be vigilant in deciding when stimulant medications are appropriate. 

It is a slippery slope, but the number of teens obtaining stimulants illegally is on the rise.  Why? They hear that this is a quick fix to getting good grades. It may help their grades for the short term, but what does their long term future look like? 

That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Monitor Your Child For ADHD Medication Abuse

Are teens abusing their ADHD medications? A new study reveals the answer.I read an interesting, albeit somewhat alarming article in an issue of Pediatrics. The article is entitled “Adolescent Prescription ADHD Medication Abuse is Rising Along with Prescriptions for these Medications”.

In a retrospective study of calls to the American Association of Poison Control Center’s National Data System, for the years 1998 – 2005, the authors noted a sharp increase in calls related to prescription ADHD medication abuse, out of proportion to other poison center calls. While attention-deficit/hyperactivity disorder (ADHD) is thought to affect between eight to 12 percent of children, there continues to be a significant increase in the diagnosis and treatment of ADHD with stimulant medications. Over the 8 year study period, estimated prescriptions for teens increased 133 percent for amphetamine products (one trade name Adderall), 52 percent for methylphenidate products (trade names such as Concerta, Ritalin, Metadate, Focalin), and 80 percent for both together. With the increase in prescriptions there is potentially greater use of these drugs for non-medical purposes. The Office of National Drug Control Policy and National Institute on Drug Abuse found that next to marijuana, prescription medications are teenagers drugs of choice for getting high. A study by The Partnership for Drug Free America found that nearly one in five (19 percent) of teenagers reported abusing prescription medications, at least once, that were not prescribed to them. In another study, nearly 30 percent of adolescents reported having a friend that abuses prescription stimulants. In the study in Pediatrics the authors found that amphetamine exposures and calls to Poison Control rose faster than amphetamine sales. In contrast, methylphenidate calls fell as sales rose. Amphetamine exposures were more frequently classified as moderate to severe than methylphenidate calls. It is inferred that there may be a shift toward amphetamine abuse and more severe side effects, with the greater availability of this medication. It is also noted that 42 percent of amphetamine stimulant ingestion cases presenting to the ER are girls, while the ratio of ADHD diagnosis is three to one boys to girls. All of these statistics are disturbing, alarming and plain scary. While stimulant medications do have a place in the treatment of ADHD, over diagnosis and availability of these medications may be leading to more abuse of these medications by teenagers. These drugs are used to produce a high, or to help with concentration or increase alertness. These drugs are also being taken with alcohol, which compounds the danger. The topic of abuse of prescription drugs among teens who have not been prescribed a medication seems to be another dinner table conversation. The consequences for taking another person’s medication are real. If your child takes a stimulant prescription there also needs to be a conversation regarding “sharing” medication. Parents should also monitor their child’s medications and refills. With increased availability there may continue to be a problem with abuse of these medications. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Back-to-School & ADHD

Back to school and ADHD. How soon can you tell if your child has attention problems?This is the first full week of school for many students across the country and with just a few days of school under their belt, parents have already begun dialing and texting their pediatrician about their child's attention issues and ADHD.  

I have to smile/laugh, as I have already received more than a handful of phone calls directly related to the subject of ADHD.  This happens every year, somehow it has become predictable, and I can only continue to be amazed that any parent would think that a few school days is enough to determine anything about how the school year is going to go!  I mean REALLY (like my teenage patients like to say), I think everyone has ADHD for at least the first 7–10 days of school. That includes most teachers, administrators, school nurses, and yes, the students! Despite the fact that we all talk about “getting ready” for back to school, and establishing the bedtime routines, and early morning awakenings, followed by a healthy breakfast and an afternoon snack and homework done at a reasonable hour, it takes some time to really get it together.  It brings to mind the movie 'Home Alone' when they are all so organized for their early morning trip and then it all falls apart when the alarm clock doesn’t work and the “rush” begins. I saw a lot of tired children yesterday, who admitted that they had not gotten to bed as early as had been planned, but have better intentions for the next night. That seems more like reality for most of us. So, how can a parent call after 1 day of school to say “Johnny went back on his medication today and I don’t think it is working”, or “Sarah seemed to be distracted at school today and did not bring the right book home for homework and I think we might need to have a conference about ADHD”.  Does that sound silly to you? It happens every year. Think about your first day on any “new” job, it is often unorganized, difficult to focus, hard to remember what you need to bring to the meeting, or what form you fill out next.  Yet alone finding out where the bathrooms are, where you park etc. It is the same thing for our children as they start a new year. They may be in a new school, or at least a new classroom, often filled to the brim as new students are added at the last minute. They have never met the teacher before, who is also going to be giving them numerous directions for his or her classroom rules and expectations. They have to find the bathrooms, cafeteria, library and playground. They may have lockers far away from their classes, the text book that they thought was going to be used might have already changed. The list is endless.  Getting back into a “good school routine” is a bit of a journey and not a race, and giving a child a few days to figure it out seems to be more appropriate to me. With that being said, I called each of my patients back and basically discussed waiting for a week or two to get everyone settled in before making medication changes, or having conferences with teachers or pediatricians about attention issues.  Patience seems to be the word that comes to mind and remembering that starting any new “job” takes a bit of time to become adjusted. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

ADHD Medication

1:30 to read

If your child takes medications for ADHD you may be noticing that your insurance company may be denying coverage for these prescriptions, or they are wanting to use a generic version of the medication your child may be taking.  It seems that this is becoming more and more prevalent and I get phone calls from patients asking what they should do?

Medications for ADHD have never been inexpensive and for some families, especially without insurance coverage, they are cost prohibitive.  For a child who has been diagnosed with ADHD, it is known that a combination of medication and behavior modification provides the best outcome.

When I begin a child on medication for ADHD I typically start with a brand name drug and do not use any generics.  I explain to parents that although I am a believer in generic drugs, and use them frequently, I want to make sure that any effects of the drug (positive or negative) are indeed due to medication and are not influenced by a difference in a generic drug.  Once a patient has been on medication and is doing well, if there is a generic available, I will often prescribe it in order to be more cost effective.

Over the years patients have commented to me that they do not feel as if the generic version of their given ADHD medication is working well. While these are anecdotal reports, they have not been uncommon. In that case some of my patients have opted to pay for the more expensive brand name medication.

The FDA just released an interesting article that states just that....studies have recently found that generic versions of the drug Concerta (by 2 different manufacturers) “may not provide the same therapeutic benefits for some patients” as does the branded medication.  While Concerta has a “drug releasing system” that provides 10 -12 hours of extended effectiveness, it seems that the generic drugs may relase more slowly, and the diminished release rate may not provide the same effect for the patient.

So, if your child is on these medications and you have tried a generic version and were concerned about their effectiveness, now is the time to discuss with you doctor.  This may not be the case for all, but it is certainly worth knowing there is now data on this subject.

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ADHD Drugs

ADHD Drugs: Brand Name vs. Generic

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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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