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Complementary and Alternative Medical Therapies for Attention-Deficit/Hyperactivity Disorder and Autism
Abstract
Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism.
... The usual treatment for these children is the use of stimulant drugs such as methylphenidate and dextroamphetamine. Of course, patients using these drugs may experience side effects such as loss of appetite, insomnia, and abdominal pain, but despite the evidence that these stimulant treatments are sufficient, many parents are looking for alternative treatments, as some parents have reported that the behavior of these children has changed after taking these drugs (Weber & Newmark, 2007). ...
... According to Weber and Newmark (2007), the drug to cure this disorder is associated with side effects that will not please the parents and teachers of these children and teenagers. It is obvious that educational and instructive methods (intervention) are a more favorable method of treatment. ...
... Meanwhile, a wide range of complementary and alternative medicines are used; a study showed that 12% to 64% of ADHD patients received complementary and alternative medicine approaches, including nutritional intervention, herbal supplements, acupuncture, massage, and yoga. [13][14][15] As one of the most common form of complementary and alternative medicine, acupuncture is widely applied to treat various of conditions, [16] it is reported to improve attention and school performances on children, [17,18] and it is popular in treating ADHD in Asian countries. [19] Till today, it is still uncertain if acupuncture could improve the core symptoms in ADHD; thus, to access the safety and efficacy of acupuncture in the treatment of ADHD, we plan to conduct this systematic review and meta-analysis, hoping to provide further reference for future clinical practice. ...
... [27] On children with ADHD, the goals of treatment are symptom reduction, social and cognitive function improvement. [22] Along with medication and behavior therapy, complementary and alternative medicine (CAM) is widely applied in the treatment of ADHD, between 12% and 64% ADHD children received CAM, including nutritional interventions, electroencephalographic biofeedback, herbal and natural health products, massage and yoga, etc. [15] As a major form of CAM, acupuncture is reported benefit for ADHD children and being prevalent in the management of this condition. ...
Introduction:
The purpose of this paper is to evaluate the efficacy and safety of acupuncture in the treatment of childhood attention deficit hyperactivity disorder (ADHD).
Methods and analysis:
We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and grey literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating pediatric ADHD will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The scores of Revised Conners' Parent Rating Scale (CPRS-R), Conners Teacher Rating Scale (CTRS-R), and Child Behavior Checklist (CBCL) will be the primary outcomes. Besides, the scores of the Conners Continuous Performance Test, Internal Restlessness Scale, and Behavior Assessment System for Children (BASC), and the possible adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), while dichotomous data will be expressed in the form of relative risk with 95% CIs.
Ethics and dissemination:
The protocol of this systematic review (SR) does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences.
Systematic review registration:
OSF Registries, DOI: 10.17605/OSF.IO/XVYP9 (https://osf.io/xvyp9).
... The foregoing reported drastic increase in ASD prevalence could be attributed to the broadening of its diagnostic criteria that might have resulted in exaggeration of the numbers of included children under the diagnostic umbrella of ASD [11]. Also, none can deny the impact of increased awareness all over the world about how to pick autistic manifestations as well as the negative influence of exposure to some environmental hazards on such significant rise of ASD prevalence [12]. ...
... Finally, complementary and alternative approaches in the form of art, music, sports, animal therapy, etc. may improve communication and learning abilities of autistic children [11,50,51]. ...
Autism Spectrum Disorder (ASD) is one of the most puzzling disorders for which not only no exact cause has been identified but also no definitive cure has been found yet. Over the last few decades, its prevalence showed a dramatic rise; an observation that encouraged many researchers across the globe to try to explore all its aspects from etiology to diagnosis and treatment. Although autistic caregivers as well as physicians and researchers would like to know the exact cause of ASD and find a definitive cure for it, this goal still seems to be distant. Accordingly, the realistic achievable goal in dealing with ASD is to try to direct all the available resources to help its sufferers to improve their skills and functioning and get the utmost benefits of their strengths aiming at improving their quality of life. Socioeconomic support for autistic caregivers is also essential to empower them in helping their children across their journey for a better tomorrow. Lastly, we must believe that " whenever and wherever there is help, there is hope " .
... References in reviews and systematic reviews in the area generated by the search strategy were also reviewed for additional eligible trials. [14][15][16][17][18][19][20][21][22][23][24] Trials were additionally required to involve a therapy of interest, which for the sake of this article includes vitamins, minerals, natural supplements and herbal remedies. Specifically excluded from this review are non-pill-based treatment modalities such as neurofeedback, behavioral therapies, restriction or food color exclusion diets and chiropractic interventions. ...
... 60 A well-designed, randomized, placebocontrolled trial of 54 children with ADHD failed to demonstrate a significant benefit or a trend towards benefit in children taking St. John's Wort compared to placebo over 8 weeks of treatment. 24 Therefore, despite a plausible biological rationale for efficacy of St. John's Wort for ADHD, current evidence suggests that St. John's Wort is no better than placebo. St. John's Wort further has significant interactions with medications commonly prescribed for ADHD, depression and anxiety that has caused serotonin syndrome in rare cases. ...
Polyunsaturated fatty acid supplementation appears to have modest benefit for improving ADHD symptoms. Melatonin appears to be effective in treating chronic insomnia in children with ADHD but appears to have minimal effects in reducing core ADHD symptoms. Many other natural supplements are widely used in the United States despite minimal evidence of efficacy and possible side effects. This review synthesizes and evaluates the scientific evidence regarding the potential efficacy and side effects of natural supplements and herbal remedies for ADHD. We provide clinicians with recommendations regarding their potential use and role in overall ADHD treatment.
... Recent studies highlight the need for early identification of environmental risk factors and the importance of maternal mental health and early evidence-based focused maternal support to facilitate early intervention in those children at risk of developing ADHD. Parents frequently use complementary and alternative medicine (CAM) therapies for their children who have ADHD-related behaviours or autism spectrum disorders, and parents prefer homoeopathic treatment for ADHD [24][25][26][27] . However, presently, there are only a limited number of studies on the homoeopathic management of ADHD. ...
... Complementary alternative medical therapeutic systems suggest and treat the autistic disorders by mind-body medicine, energy medicine and biologically based manipulative and body-based practices. Also they suggest delay and discontinuation of immunizations / vaccination, chelation, anti-infective treatments and secretin, and recommends suitable appropriate diet and lifestyle regimen and therapeutic medication and cleaning of 19,20 the digestive tract, etc. ...
... Diversos estudos foram realizados comprovando a eficácia, efetividade e segurança do tratamento homeopático dentre os quais podemos citar: síndrome pré-menstrual 9 , na amigdalite viral aguda 10,11 , déficit de atenção e hiperatividade 12 , insônia 13 e dermatite atópica em pacientes pediátricos 14 , otite média aguda 15 e infecção de vias aéreas superiores 16 . Uma metanálise recente, que apreciou 24 estudos randomizados controlados que testaram a eficácia da homeopatia individualizada para o tratamento de diferentes condições clínicas, concluiu que o tratamento homeopático possui efeito terapêutico específico, superior ao placebo 17 . ...
The disease caused by the new coronavirus (SARS-CoV-2), denominated
COVID-19, has spread rapidly across five continents, and has been causing
serious health and socioeconomic implications for the affected
countries. Although most affected individuals have mild illness, vulnerable
patients can have interstitial pneumonia with serious or even fatal
complications. The objective of the present qualitative and quantitative
study was to collect and analyze, under a homeopathic perspective, the
symptoms of COVID-19, as well as to identify the homeopathic remedies
most similar to the symptomatic picture of the disease (epidemic
genius method). Forty-six individuals
from four Brazilian regions (Fortaleza,
Campo Grande, Florianópolis and São Paulo) were interviewed by
homeopathic physicians. There was a consistent pattern of symptoms
between the different centers, with little difference in frequency and
intensity of symptoms. The symptomatic analysis of the entire sample,
with the aid of different repertoire techniques, indicated the homeopathic
remedies Arsenicum album, Phosphorus and Bryonia alba as the
epidemic genius for this COVID-19 epidemic. Our results may provide
support information for the intervention experiments assessing the
effectiveness of Homeopathy in the prevention and treatment of
COVID-19.
... Çeşitli otizmli çocukların anne babalarının bir arada oldukları ortamlarda gluten ve kazeinden yoksun diyetlerin genellikle GİS semptonları konuşma, sosyalleşme ve diğer otistik davranışlarda olumlu değişmelerin olduğu görülmektedir. Diyetinin otizm tedavisinde etkinliğini gösteren 2 tane kontrollü çalışma vardır ve her ikisinin de olumlu sonuçları olduğu görülmektedir (Weber & Newmark, 2007). ...
... Shalts [32] claimed that homoeopathy work for autistic children when prescription is based on individualization and integrated with other therapies such as cranial therapy, sensory integration techniques, occupational therapy, and behavioral therapy. On the contrary, Weber, et al. [33] found no supportive evidence to use homoeopathy in autism while reviewing the use of complementary and alternative (CAM) treatment such as craniosacral therapy and other manipulative therapies, Reiki and other energy medicine modalities, biofeedback, and traditional Chinese medicine in ADHD and autism. However, there was no elaboration specific to homoeopathy. ...
... Past research showed that gluten and casein elimination from ASD patient diet is valuable for improving behavioral problems, increasing cognitive function, and correcting social relationships [14]. One acceptable hypothesis is relating that phenomenon with incapability of ASD patients to digest gluten and casein due to dipeptidyl-peptidase IV (DPP-IV) enzyme insufficiency. ...
Autism is a kind of pervasive developmental disorder that is related to many behavioral problems including perception, communication, motor development, and social disorder. World Health Organization (WHO) estimates that about six in 1,000 children worldwide are affected by an autism spectrum disorder. Nutritional regulation is one of the main concerns of children with autism due to many problems in the biochemical process, digestion process, and food allergy. Food selection in autistic children is not different from any other normal children, following standard requirement of a balanced diet, by implementing specific elimination and supplementation diet. There are many indications for dietary regulation in autistic children including developmental disorder, obvious digestion problems, and atopic signs. Implementing dietary regulation is not free from problems, inclusive of child factor, parent factor, and external factor.
... OSB olan cocukların bagȋrsaklarının asirı gecirgenligȋ nedeniyle bu proteinleri sindiremedigȋ icin bu diyeti uygulayan cocukların suẗ ve suẗ urunlerinin yerine soya suẗu, bugday unu yerine pirinç veya mısır unu tuketmeleri gerekmektedir (Meral, 2017;Öz, 2019;Uçar ve Samur, 2017). Bu diyeti uygulayan çocuklarda sosyal ilişkilerin arttığı ve yineleyici tekrarlı davranışların azaldığı belirtilmiştir (Knivsberg vd., 2002;Lucarelli vd., 1995;Weber ve Newmark, 2007). Epileptik nobetlerin sayısını ve siddetini azaltmak icin kullanılan ketojenik diyet, enerjinin buÿuk bir kısmının yagdan kullanılmasını saglamak icin minimum duzeyde protein ve cok kısıtlı karbonhidrat tuketimini icȩrmektedir. ...
ZET Problem Durumu ve Amaç: Otizm Spektrum Bozukluğu (OSB) olan çocuklarda beslenme üzerine yaygın endişeler olmasına rağmen ulusal ve uluslararası alanyazın incelendiğinde bu konuda yapılmış̧ çalışma sayısının sınırlı olması, ulusal alanyazında OSB ve beslenme konusunda var olan durumun ortaya konması, durumun ayrıntılarıyla açıklanması, aile ve uzmanların bilgilendirilmesi ve gelecekteki tartışmalar için zemin oluşturulması amacıyla bu çalışmaya gerek duyulmuştur. Bu çalışmada OSB ve beslenme yaklaşımları konusunda güncel yaklaşımlar hakkında eğitimci, aile ve ilgili uzmanlara bilgi vermek, bu kişiler arasında iş birliğinin önemini ortaya koymak ve çeşitli önerilerde bulunmak amaçlanmıştır. Yöntem: Bu çalışma, sistematik bir alanyazın taramasıdır. Çalışma kapsamında 13 çalışma incelenmiştir. İncelemeler içerik analizi yoluyla yapılmıştır. Bulgular: Bulgular beş temada açıklanmıştır. Çalışma konuları temasında beslenme özellikleri ve OSB belirti ve şiddeti; katılımcı özelliklerinde katılımcı yaşlarının 2-18 arasında değişmesi; araştırma desenleri temasında sıklıkla ilişkisel çalışmalar; araştırma sonuçları temasında OSB'ye özgü beslenmeye ilişkin sonuçlar, ölçüm sonuçları ve aileye ilişkin sonuçlar; öneriler temasında ise işbirliği, eğitim, danışmanlık, beslenme izlemi ve ileri araştırmalar yer almaktadır. Tartışma, Sonuç ve Öneriler: OSB'ye özgü kesin bir beslenme tedavisi yaklaşımından şimdilik söz etmek mümkün değildir. Ailelerin çocuklarının sağlık açısından ortaya çıkan beslenme sorunlarını gidermek amacıyla yaygın olarak farklı diyetler ve besin takviyelerine başvurdukları dikkat çekmektedir. Bu nedenle bireysel beslenme planı geliştirmek, başarılı bir uzmanlar arası iş birliği yaklaşımını gerektirmektedir. Oysa, ailelerin çocuklarının davranışsal ve sosyal açıdan ortaya çıkan davranış problemlerinin azaltılması için kanıt temelli uygulamalara başvurmaları önemlidir. Bu doğrultuda besin tedavisinde kullanılan diyetlerin geçerliliğini sınamak amacıyla deneysel ve boylamsal çalışmaların yapılması ve UDA temelli müdahale yaklaşımlarını kullanan daha ileri ve kapsamlı araştırmaların yapılması önerilebilir. Anahtar Sözcükler: Otizm spektrum bozukluğu, beslenme, diyet, beslenme bozuklukları, yeme bozuklukları, beslenme yaklaşımları Giriş Son yüzyılda ilgi duyulan yetersizlik türlerinden biri Otizm Spektrum Bozukluğudur (OSB). OSB, farklı bağlamlarda gözlenen sürekli bir sosyal iletişim ve etkileşim yetersizliği ile sınırlı ve yineleyici davranış, ilgi ve etkinlik örüntüleriyle karakterize edilen nörogelişimsel bir bozukluktur (APA, 2013). Günlük yaşam işlevlerinde aksaklıklara yol açan bu bozukluğun erken çocukluk çağında ortaya çıktığı, erkeklerde kızlara oranla beş kat daha fazla olduğu ve her 59 çocuktan birinde görüldüğü rapor edilmiştir (Center for Disease and Control [CDC], 2018). Her geçen yıl artış gösteren OSB'nin Türkiye'de genel nüfus içindeki oranları bilinmemekle birlikte yaygınlık oranının dünya geneline yakın olduğu tahmin edilmektedir. OSB'nin nedenlerine ilişkin olası etmenler arasında; genetik, biyokimyasal, nö roanatomik, nö rofizyolojik, ailesel ve çevresel bazı etmenler yer almaktadır. Tıbbi bozuklukların da sıklıkla bu bozukluk ile beraberliği, biyolojik nedenlerin varlığını iyice ortaya çıkartmaktadır. Heterojen bir yapıya sahip olduğu dü ş ü nü len OSB'nin ç ok sayıda birbiri ile etkileş en gen nedeniyle ortaya çıktığı ileri sü rü lmektedir (Pehlivantürk, Bakkaloğlu ve Ünal, 2003). Öte yandan çevresel risk faktö rleri olarak da ileri baba yaş ı, annenin gebeliğ inde yaş adığ ı sorunlar, beyin ü zerine toksik etkisi bulunan etmenler, hava kirliliğ i, beslenme, aş ılar ve D vitamini eksikliğ i ö n planda tutulmaktadır (Mukaddes, 2014). İ leri baba yaş ı, OSB iç in tek baş ına bir sebep olmamakla birlikte, biyolojik sü recin belirleyicisi olarak etki gö stermektedir. OSB ile ilgili bugü ne kadar en ç ok ç alış ılmış beyin ü zerine etkili ç evresel etkenler; ilaç lar, kurş un, cıva, manganez, pestisidler, tiroid bezi hasarına neden olduğ u dü ş ü nü len polibrominedifenil eterler, polisiklikaromatik hidrokarbonlardır. Endokrin ve bağışıklık sistemi (immun) sorunları da dolaylı yoldan nö rolojik geliş imi olumsuz etkileyerek OSB tablosuna yol aç abilmektedir (Diert, Diert ve DeWitt, 2011). Ancak günümüzde bu Problem Durumu ve Amaç: Otizm Spektrum Bozukluğu (OSB) olan çocuklarda beslenme üzerine yaygın endişeler
olmasına rağmen ulusal ve uluslararası alanyazın incelendiğinde bu konuda yapılmış̧ çalışma sayısının sınırlı olması, ulusal
alanyazında OSB ve beslenme konusunda var olan durumun ortaya konması, durumun ayrıntılarıyla açıklanması, aile ve
uzmanların bilgilendirilmesi ve gelecekteki tartışmalar için zemin oluşturulması amacıyla bu çalışmaya gerek duyulmuştur.
Bu çalışmada OSB ve beslenme yaklaşımları konusunda güncel yaklaşımlar hakkında eğitimci, aile ve ilgili uzmanlara bilgi
vermek, bu kişiler arasında iş birliğinin önemini ortaya koymak ve çeşitli önerilerde bulunmak amaçlanmıştır.
Yöntem: Bu çalışma, sistematik bir alanyazın taramasıdır. Çalışma kapsamında 13 çalışma incelenmiştir. İncelemeler içerik
analizi yoluyla yapılmıştır.
Bulgular: Bulgular beş temada açıklanmıştır. Çalışma konuları temasında beslenme özellikleri ve OSB belirti ve şiddeti;
katılımcı özelliklerinde katılımcı yaşlarının 2-18 arasında değişmesi; araştırma desenleri temasında sıklıkla ilişkisel
çalışmalar; araştırma sonuçları temasında OSB’ye özgü beslenmeye ilişkin sonuçlar, ölçüm sonuçları ve aileye ilişkin
sonuçlar; öneriler temasında ise işbirliği, eğitim, danışmanlık, beslenme izlemi ve ileri araştırmalar yer almaktadır.
Tartışma, Sonuç ve Öneriler: OSB’ye özgü kesin bir beslenme tedavisi yaklaşımından şimdilik söz etmek mümkün değildir.
Ailelerin çocuklarının sağlık açısından ortaya çıkan beslenme sorunlarını gidermek amacıyla yaygın olarak farklı diyetler ve
besin takviyelerine başvurdukları dikkat çekmektedir. Bu nedenle bireysel beslenme planı geliştirmek, başarılı bir uzmanlar
arası iş birliği yaklaşımını gerektirmektedir. Oysa, ailelerin çocuklarının davranışsal ve sosyal açıdan ortaya çıkan davranış
problemlerinin azaltılması için kanıt temelli uygulamalara başvurmaları önemlidir. Bu doğrultuda besin tedavisinde kullanılan
diyetlerin geçerliliğini sınamak amacıyla deneysel ve boylamsal çalışmaların yapılması ve UDA temelli müdahale
yaklaşımlarını kullanan daha ileri ve kapsamlı araştırmaların yapılması önerilebilir.
Anahtar Sözcükler: Otizm spektrum bozukluğu, beslenme, diyet, beslenme bozuklukları, yeme bozuklukları, beslenme
yaklaşımları
... The process of selection, the intensity of attention (focusing), and the length of attention to a particular stimulus (keeping the attention) are the components of attention that affect the "consciousness" of human beings at any moment [13]. The maintenance of attention has defined the controlled processing of a task, and thus the defect in keeping the children's attention eliminates the opportunity of processing, storing and recalling information [14]. Computer games are also able to foster the development of the cognitive capacity of children with intellectual disability and psycho-motor skills [15]. ...
... The process of selection, the intensity of attention (focusing), and the length of attention to a particular stimulus (keeping the attention) are the components of attention that affect the "consciousness" of human beings at any moment [13]. The maintenance of attention has defined the controlled processing of a task, and thus the defect in keeping the children's attention eliminates the opportunity of processing, storing and recalling information [14]. Computer games are also able to foster the development of the cognitive capacity of children with intellectual disability and psycho-motor skills [15]. ...
... In this respect, the inadequacy in interpretation, difficulty in the perception of the whole (sense), lack of paying attention to the desired point, concrete thinking, difficulty in combining ideas, weakness in executive function, lack of imitation skills, lack of symbolic play, and sensory difficulties are particularly seen in children with autism spectrum disorder. These features may also shape as parallel to each other (Toth, Munson, Meltzoff & Dawson, 2006;Whitman, 2004;Leekam, Nieto, Libby, Wing & Gould, 2007;Weber & Newmark, 2007). Also limited interest and behaviors can be seen in the area of feeding, sleeping etc with autism children. ...
This study was conducted to examine the effect of neuroPLAY on the developmental processes and parental interactions of children with autism spectrum disorder. A mixed method was used in the study. In the quantitative dimension of the study, 41 children with an autism spectrum disorder age 18-42 months, and in the qualitative dimension five children and their parents with autism spectrum disorder were included. The qualitative dimension of the study was used and the observation method was carried out in the institutional environment through individual participant and unattended and video recordings in the home environment. Observation was conducted both to determine the developmental process of the child and the parental interaction and to monitor the process of applying the parent/caregiver's neuroPLAYy method. In the quantitative dimension, experimental design is used. The experimental training period lasted at least 3 months as neuroPLAY. Prior to the start of the experimental training period, five days of training were given to parents and caregivers, and the experts provided feedback on the parent/caregiver through the process of observation. The results of the research show that neuroPLAY has positive effects on developmental processes and parental interactions of children with autism spectrum disorder.
... For instance, the treatment of childhood developmental disorders (CDD) commonly includes complementary and alternative medical (CAM) interventions such as nutritional supplementation, efforts to reduce environmental toxins and biofeedback (BFB). In addition to these treatments, neurofeedback (NFB), a noninvasive BFB approach shown to enhance neuroregulation and metabolic function in ASD is proving to be efficacious (4,6). Porges' polyvagal theory is used to emphasize the need to integrate NFB with BFB, that in turn influence dynamic brain circuitry (7,8). ...
Introduction: Children affected by autism spectrum disorder (ASD) often have impairment of social interaction and demonstrate difficulty with emotional communication, display of posture and facial expression, with recognized relationships between postural control mechanisms and cognitive functions. Beside standard biomedical interventions and psychopharmacological treatments, there is increasing interest in the use of alternative non-invasive treatments such as neurofeedback (NFB) that could potentially modulate brain activity resulting in behavioral modification.
Methods: Eighty-three ASD subjects were randomized to an Active group receiving NFB using the Mente device and a Control group using a Sham device. Both groups used the device each morning for 45 minutes over a 12 week home based trial without any other clinical interventions. Pre and Post standard ASD questionnaires, qEEG and posturography were used to measure the effectiveness of the treatment.
Results: Thirty-four subjects (17 Active and 17 Control) completed the study. Statistically and substantively significant changes were found in several outcome measures for subjects that received the treatment. Similar changes were not detected in the Control group.
Conclusions: Our results show that a short 12 week course of NFB using the Mente Autism device can lead to significant changes in brain activity (qEEG), sensorimotor behavior (posturography), and behavior (standardized questionnaires) in ASD children.
... For instance, the treatment of childhood developmental disorders (CDD) commonly includes complementary and alternative medical (CAM) interventions such as nutritional supplementation, efforts to reduce environmental toxins and biofeedback (BFB). In addition to these treatments, neurofeedback (NFB), a noninvasive BFB approach shown to enhance neuroregulation and metabolic function in ASD is proving to be efficacious (4,6). Porges' polyvagal theory is used to emphasize the need to integrate NFB with BFB, that in turn influence dynamic brain circuitry (7,8). ...
... Autism is a neurodevelopmental condition which is usually Genetic factors seem to be important in the aetiology of autism. However, genetics alone cannot explain the 870% increase in the number of autism cases between 1990 and 2000 [2]. This leaves nutrients and toxins interacting with genetic factors as the most likely causes of this condition. ...
... The frequency of Complementary and Alternative Medicine (CAM) use in children who have Attention Deficit Hyperactivity Disorder (ADHD) ranges between 12% and 64%. A majority 83% of care givers noted that the herbal therapy was the main source of drug treatment when it was used [8]. Alternative and complementary treatments are needed to optimize the therapeutic benefits in ADHD, even though there are effective pharmaceutical intervention which is far from satisfactory because of incomplete benefit, treatment failures, and troublesome side effects [9]. ...
Attention deficit disorder (ADD) is one of the most common neurobehavioral disorders. It is first diagnosed in childhood and its symptoms often last in to adulthood. A person with ADD often avoids, dislikes, or does not want to do things that take plenty of mental effort for a long period of time. Till date there is no clear understanding about etiopathology, symptomatology and management of ADD in terms of Ayurveda. There is scarcity of literature on this topic in Ayurveda. The present article aims at better understanding of an Ayurvedic view of ADD. According to Ayurveda and Yoga, it is a well established fact that, vata influences the mind. Vata disturbance can cause instability of mind / wandering mind. Anavasthita chittata is a psychiatric condition caused by vata prakopa which resembles with ADD. Dhriti vibhramsha is the underlying pathological process of Anavasthita chittata which resembles with inattention of ADD. According to Hatha yoga pradipika, movement of praana leads to instability of mind. When praana is without movement, mind will also become steady. By this (steadiness of praana) the yogi attains steadiness of mind and should thus restrain the vayu (air)’. Vata shamana chikitsa of Ayurveda and meditation techniques of Yoga individually or together may provide satisfactory results in the management of ADD. There is a similarity found between ADD and Anavasthita chittatvam.
Keywords: Attention Deficit Disorder; ADD; Anavasthita Chittata; Meditation; Ayurveda; Yoga.
... [4] Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have ADHD or autism spectrum disorders and parents usually seek homoeopathic treatment for ADHD. [6][7][8][9] Lamont [10] conducted a double-blind placebo-controlled partial cross-over trial in which homoeopathic medicines in centesimal potency were superior to placebo and acted well in 200C potency. Frei and colleagues [11][12][13][14] used individualised homoeopathic medicines in LM (50 millesimal) potencies and the results appear to be similar to the effects of methylphenidate particularly in pre-school children. ...
... 16 They do not always agree with diagnoses made or treatment recommended (particularly fathers) 16,17 and commonly use complementary therapies. 18 A better understanding of parental attitudes regarding assessment, diagnosis and treatment of ADHD may lead to more sensitive communication of assessment findings and therapeutic recommendations, which in turn may result in improved adherence to treatment and better outcomes. ...
Aims:
In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD.
Methods:
Design:
cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis.
Setting:
private/public paediatric practices in Western Australia and Victoria, Australia.
Main outcome measures:
paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire.
Results:
Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD.
Conclusions:
Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician.
... behavioural therapy on the other hand is time consuming and resource intensive [7]. Therefore it is not surprising many parents seek alternative treatment such as nutritional supplements, elimination diet, herbal treatment, acupuncture and others for their ADHD children [8]. ...
Background
Attention Deficit/Hyperactive Disorder (ADHD) is often treated with medications but many parents seek alternative treatment for fear of adverse effects. Increased oxidative stress has been observed in children and adults with ADHD. We postulate that tocotrienol-rich fractions (TRF), a potent antioxidant from the natural Vitamin E family, may help children with ADHD. The objective of this study is to determine if supplementation of TRF has an effect on the symptoms of school-going children with ADHD. Methods
Children aged between 6 to 12 years with ADHD were randomized to TRF 200 mg or placebo daily for 6 months. We measured the NICHQ Vanderbilt ADHD Parent (VAPRS) & Teacher (VATRS) Rating Scales at baseline, 3 months and 6 months. Plasma tocotrienol levels were also measured at each of the corresponding time. We used ANOVA repeated measure and Spearman Rho’s for analysis. ResultsOne hundred forty-six children were randomized. The VAPRS showed significant improvement after 3 months and 6 months in both groups (n = 73 each). The VATRS revealed greater improvement in the TRF group but was not statistically significant (p = 0.07). The TRF group had higher levels of tocotrienols compared with the placebo group at 3 and 6 months. There was a small but significant correlation of the alpha and gamma tocotrienol levels with the change in VAPRS after 6 months. ConclusionTRF was not more effective than placebo in reducing the ADHD symptoms as measured by the VAPRS and VATRS. Possible reasons for this include placebo-effects and supplementations given too late in life. Future studies should consider using an objective outcome measurement (e.g. measuring attention-span) as well as earlier age of supplementation. Trial registrationClinicalTrials.gov NCT01855984, date of registration 10 May 2013.
... Complementary and Alternative Medical (CAM) therapies including yoga are commonly used in children diagnosed with attention deficit hyperactivity disorder, but little is known about the efficacy of these therapies. The frequency of the use of CAM therapies in children with ADHD ranges between 12 and 64 % [12][13][14]. CAM treatments in ADHD include electroencephalographic neurofeedback [15], nutritional interventions such as the Feingold diet [16], sugar avoidance [17], elimination of artificial food additives [18], the administration of essential fatty acids [19], vitamins and minerals [20], physiotherapy [21] and yoga. ...
The study aims to know the effect of an educational program in the ABCs of swimming on the improvement of the indicator of attention deficit hyperactivity disorder in autistic children, and to answer this problem, we used a case study approach 10 children aged 4–10 years old who had been diagnosed with both autism spectrum disorder and ADHD by outside psychologists, and the duration of the swimming educational program lasted ten weeks with two lessons per week. As a study tool, we relied on the Attention Deficit Hyperactivity Disorder Scale (Essalem, 2020) with an emphasis on the attention part, and after analyzing the data, we concluded that the autistic child improved most of the indicators under study and this is confirmed by other studies in the same specialty, and that is why he recommends Researchers should swim regularly for autistic children.
The study aims to know the effect of an educational program in the ABCs of swimming on the improvement of the indicator of attention deficit hyperactivity disorder in autistic children, and to answer this problem, we used a case study approach 10 children aged 4–10 years old who had been diagnosed with both autism spectrum disorder and ADHD by outside psychologists, and the duration of the swimming educational program lasted ten weeks with two lessons per week. As a study tool, we relied on the Attention Deficit Hyperactivity Disorder Scale (Essalem, 2020) with an emphasis on the attention part, and after analyzing the data, we concluded that the autistic child improved most of the indicators under study and this is confirmed by other studies in the same specialty, and that is why he recommends Researchers should swim regularly for autistic children.
Autism spectrum disorder (ASD) is neurodevelopmental disorder which is characterized by lack of social behaviors and impaired non-verbal interactions that start early in childhood. It can also lead to progressive neurodegeneration like schizophrenia disorder, Alzheimer's disease, Parkinson's disease, and dementia. Genetic studies of ASD have confirmed the mutations that interfere with neurodevelopment in mother's womb through childhood and these mutations are further involved in synaptogenesis and axon motility. Crucial role of amygdala is found to be deficit in ASD individuals whose association cognition with nucleus accumbens lead to impaired social behaviors and cognitive stimulus. Educational and behavioral treatments are considered the key steps used for its management along with pharmacological and interventional therapies. In this chapter, the author presents the etiology of ASD, proof of neurodegeneration in ASD, as well as the clinical feature and the management of ASD.
Ciprofloxacin hydrochloride (CPFH) is a very common antibiotic drug for the treatment of different types of bacterial infections. The activity of the drug depends on the complexation of the employed drug with different metals present in the body. In the current investigation, the complexation behavior of CPFH drug with numerous metal ions was explored by means of UV-Visible spectroscopic and density functional theory (DFT) techniques at various temperatures. The binding constants (Kf) of CPFH+metal ions complexes were determined from the Benesi-Hildebrand equation. The Kf values experience an alteration with the nature of metal ions employed and the change of temperature. The binding of CPFH with alkali earth metals decreases with the increase of metal size and increases with the increase of temperature, while the opposite effect of temperature was observed for transition metals. The Gibbs free energy of binding (ΔGo) for the complexation between CPFH and metal ions was negative in all cases, which reveals that the complexation phenomenon is spontaneous. The values of enthalpy and entropy connote the presence of both hydrophobic and electrostatic interactions. The complexation of CPFH was observed to be endothermic in the case of alkali earth metals while exothermic for transition metals. The intrinsic enthalpy gain (ΔIIo, *) values signify the higher stability of metal-drug complexes. The compensation temperature (TC) values were found to be comparable to the biological systems. DFT studies show the formulation of 1:1 complexes with transition metals as well as the square planar geometry of the complexes. HOMO and LUMO analyses reveal that the stability of CPFH-Ni complexes is higher than that of CPFH-Co/CPFH-Zn complexes.
In this chapter the treatment with stimulant and other medications for ADHD, also in combination with other psychiatric medications, is explained and practical tips for finding the right dosage and timing are offered. Also treatment of the delayed sleep phase with sleep hygiene, melatonin and light therapy in adults with ADHD is described.KeywordsTreatment of ADHD in adultsMedicationEvaluation of medical treatmentEffectSide effectsContra-indicationsPregnancyDrivingAlcohol and drug useMelatonin treatmentLight therapy
Objective
To identify interventions being used to manage attention-deficit/hyperactivity disorder (ADHD) in the UK.
Design
A survey within the Sheffield Treatments for ADHD Research project. A convenience sample of participants in the UK who consented to join an observational cohort were asked closed questions about medication, behavioural change programmes and service use, and an open-ended question about what else they used.
Setting
A broad variety of non-National Health Service, non-treatment seeking settings throughout the UK, including local authority organisations, schools, ADHD and autism spectrum condition support groups and social media.
Participants
Families of children aged 5–18 with carer reported ADHD and Conners Global Index (CGI) T scores of 55+.
Results
Responses from 175 families were analysed. The mean age of the children was 10.21 (2.44), and two-thirds (n=114) had additional diagnoses. The majority used medications to manage ADHD (n=120) and had participated in a parenting class (n=130). Just over a quarter (28%, n=49) did not use ADHD medications, and used sleep medications. Just under half had consulted psychologists (n=83), and 32 had participated in other talking therapies such as psychotherapy, counselling and cognitive–behavioural therapy. A few used aids such as reward charts or fiddle toys (n=17) and participated in activities (mostly physical) (n=14). A substantial minority (78/175) had used non-mainstream treatments, the most popular being homoeopathy (n=32), nutritional interventions (n=21) and bodywork such as massage or cranial osteopathy (n=9).
Conclusions
Families reported use of a wide variety of treatments to help with management of their children with ADHD in addition to their use of mainstream treatments.
Otizm spektrum bozukluğu (OSB) gün geçtikçe görülme sıklığı artan, etiyolojisi tam olarak bilinmeyen ve erken çocukluk döneminde ortaya çıkan nörogelişimsel bir problemdir. Genetik ve çevresel faktörlerin etkili olduğu bilinen OSB'de doğum öncesi, sırası ve sonrasında annenin intestinal mikrobiyotasının da önemli rol oy-nadığı bildirilmiştir. OSB'nin etiyolojisinde bağırsak ve beyin arasındaki çift yönlü iletişimin rolü oldukça dikkat çeken ve son zamanlarda yoğun bir şekilde üzerinde durulan bir konudur. OSB'li bireylerde serum ve beyin dokusunda nörotransmitter seviyelerinin, özellikle serotonin düzeylerinin normal olmadığı rapor edilmiştir. Ayrıca otizmli bireylerde gastrointestinal sistem (GİS) problemleri sıklıkla görül-mektedir. GİS problemlerinin OSB'de görülen anormal davranışları tetikleyen bir faktör olabileceği belirtilmiştir. OSB'de görülen davranışsal semptomları ve GİS problemlerini hafifletmeye yönelik çeşitli beslenme yaklaşımları söz konusudur. Glutensiz-kazeinsiz diyet, ketojenik diyet, Feingold diyeti, düşük oksalat diyeti ve GAPS diyeti bu uygulamalara örnek olarak verilebilir. Uygulanan diyetlerin ortaya çıkardığı eksiklikleri ve OSB semptomlarını azaltmak amacıyla vitamin-mineral takviyeleri ve bazı probiyotik suşların kullanılabileceği önerilmektedir. Bu derleme-nin amacı OSB'nin intestinal mikrobiyota ile ilişkisine ve OSB'de güncel beslenme yaklaşımlarına değinmektir. Anahtar kelimeler: Otizm, Mikrobiyota, Bağırsak-beyin aksı, Diyet yaklaşımları. Abstract Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which has an increasing incidance, unknown etiology and emergs in early childhood. In ASD, which is known to be the effective cause of genetic and environmental factors, it has been reported that the intestinal microbiota of the mothers also play an important role before, during and after the birth. The role of bidirectional communication between the gut and brain in the etiology of ASD has been a highly striking issue. It has been reported that the neurotransmitter levels, especially the serotonin levels, in the serum and brain tissue are not normal in individuals with ASD. In addition, gas-trointestinal system (GIS) problems are frequently seen in individuals with autism. It is stated that the GIS problems may be a factor that trigger the abnormal behaviors seen in ASD. There are various dietary approaches to alleviate behavioral symptoms and GIS problems seen in ASD. Gluten-free and casein-free diet, ketogenic diet, Feingold diet, low oxalate diet and GAPS diet are examples of these practices. It is suggested that the vitamin-mineral supplements and some probiotic strains can be used to reduce the deficiencies caused by the applied diets and ASD symptoms. The purpose of this review is to touch upon the relationship of ASD with the intestinal microbiota and the actual nutritional approaches in ASD.
Autism is a complex neurodevelopmental disorder that is evident in early childhood and can persist throughout the entire life. The disease is basically characterized by hurdles in social interaction where the individuals demonstrate repetitive and stereotyped interests or patterns of behavior. A wide number of neuroanatomical studies with autistic patients revealed alterations in brain development which lead to diverse cellular and anatomical processes including atypical neurogenesis, neuronal migration, maturation, differentiation, and degeneration. Special education programs, speech and language therapy, have been employed for the amelioration of behavioral deficits in autism. Although commonly prescribed antidepressants, antipsychotics, anticonvulsants, and stimulants have revealed satisfactory responses in autistic individuals, adverse side effects and increased risk of several other complications including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, etc. have compelled the researchers to turn their attention toward herbal remedies. Alternative approaches with natural compounds are on continuous clinical trial to confirm their efficacy and to understand their potential in autism treatment. This chapter aims to cover the major plant-based natural products which hold promising outcomes in the field of reliable therapeutic interventions for autism.
עבודה זו עוסקת בשאלה "כיצד משפיעה התזונה על התפתחות המוח בשלבי החיים השונים, ובאיזה אופן היא משפיעה על ילדים ומתבגרים בעלי ADHD ו-ASD?"
מוצג בה הקשר המדעי בין התזונה למוח ולהופעתן של הפרעות נוירולוגיות, כמו גם סקירה של מקום התזונה בשלבים הראשונים של האדם – כעובר וכתינוק. פרק אחד מוקדש לתזונת האם, המהווה את מקור תזונתו של הילד בתקופות אלה ולאחר מכן ישנה סקירה של תקופות הילדות וההתבגרות, תוך חקירת השפעתם של רכיבי מזון שונים על הופעתם של תסמיני ADHD ו-ASD. העבודה חותמת בסממנים המאותתים כי התנהגות הילד עשויה להיות קשורה בתזונה ולאחר סיכום הדברים מציעה מסקנות יישומיות להורים.
Background:
This review focuses on the efficacy and safety of herbal medicines in the management of autism spectrum disorder (ASD) in humans and animals.
Method:
PubMed, Scopus, Google Scholar, Web of Science, and Science Direct databases were searched up to October 30, 2016. The key terms used were "ASD", "Asperger", "autism", "healing plants", "herbal medicine", and "medicinal plants". In each database, the searches consisted of each of three key terms describing the disorder and subtypes plus each of the terms describing the therapy. All human and animal studies on the effects of herbs with the key outcome of change in autism symptoms were included. In vitro studies were excluded.
Results:
From the publications perused in the initial database, 3157 results were identified, reviewed and a total of 23 studies were included. Preclinical studies using critically validated models were conducted, with some promising preliminary results. Data availability on controlled clinical studies is currently very limited. The use of different methodologies and the very small number of patients raise doubts about the effects of these preparations.
Conclusion:
Available data do not yet allow us to suggest the effectiveness of herbal medicines as an add-on in the treatment of ASD symptoms.
Fragile X syndrome (FXS) is a common inherited form of intellectual disability caused by the absence or reduction of the fragile X mental retardation protein (FMRP) encoded by the FMR1 gene. In humans, one symptom of FXS is hypersensitivity to sensory stimuli, including touch. We used a mouse model of FXS (Fmr1 KO) to study sensory processing of tactile information conveyed via the whisker system. In vivo electrophysiological recordings in somatosensory barrel cortex showed layer-specific broadening of the receptive fields at the level of layer 2/3 but not layer 4, in response to whisker stimulation. Furthermore, the encoding of tactile stimuli at different frequencies was severely affected in layer 2/3. The behavioral effect of this broadening of the receptive fields was tested in the gap-crossing task, a whisker-dependent behavioral paradigm. In this task the Fmr1 KO mice showed differences in the number of whisker contacts with platforms, decrease in the whisker sampling duration and reduction in the whisker touch-time while performing the task. We propose that the increased excitability in the somatosensory barrel cortex upon whisker stimulation may contribute to changes in the whisking strategy as well as to other observed behavioral phenotypes related to tactile processing in Fmr1 KO mice.
This chapter guides the reader through the first part of the treatment of ADHD in adults. Treatment always starts with psychoeducation, and the special attitude of the therapist treating patients with ADHD is first discussed. Frequent asked questions and answers about ADHD and the treatment are addressed, as well as different forms of psychoeducation to patients and to the public, and at different phases of the treatment. Psychoeducation is regarded as a continuous process to empower patients to make their own well-informed decisions during treatment.
The part on medication treatment gives an overview of the available medications for ADHD. The effect of medication on the brain and on addiction is discussed. The order of treatment in case of comorbidity, how to deal with alcohol and cannabis use while on medication, contraindications, the physical exam before starting, measures to evaluate efficacy, dosing, and duration of action of different short- and long-acting stimulant preparations are all reviewed, as well as how to deal with pregnancy and driving issues while using medication for ADHD. The combination of stimulants with other psychopharmacotherapeutical treatments and finally treatment with melatonin for the delayed sleep phase in ADHD are described in a practical way for everyday clinical practice. Finally, the place of complementary and alternative treatments is shortly reviewed.
Autism is the first book on the condition that seeks to combine medical, historical and cultural approaches to an understanding of the condition. Its purpose is to present a rounded portrayal of the ways in which autism is currently represented in the world, It focuses on three broad areas: the facts of scientific research, including new ideas surrounding research into genetics and neuroscience, as well as the details of diagnosis and therapy; the history of the condition as it developed through psychiatric approaches to the rise of parent associations, neurodiversity and autism advocacy; and the fictional and media narratives through which it is increasingly expressed in the contemporary moment. Accessible and written in clear English, Autism is designed for student audiences in English, Disability Studies, Cultural Studies, History, Sociology, and Medicine and Health, as well as medical practitioners and the general reader. Autism is a condition surrounded by misunderstanding and often defined by contestation and argument. The purpose of this book is to bring clarity to the subject of autism across the full range of its manifestations.
Introduction
Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavioral problem. The purpose of this study was to evaluate the effectiveness and safety of acupuncture in patients with ADHD.
Methods
The study was randomized, waitlist-controlled, and unblinded. A total of 93 participants with ADHD were enrolled. The acupuncture group received acupuncture treatment twice per week for 6 weeks. The waitlist group did not receive acupuncture during the first six weeks, and then underwent acupuncture treatment during the next six weeks. The primary outcome measure was the ADHD-rating scale. The computerized neurocognitive function tests (CNTs) was conducted as an objective measurement.
Results
The results of the primary analyses were equivocal. Additional analyses were conducted after data were stratified according to ADHD medication. The acupuncture group not taking ADHD medications demonstrated significantly better performance in the CNTs compared to the waitlist group: the backward digit span test (p = 0.026), backward visual span test (p = 0.044), correct hit/omission error of auditory continuous performance test (CPT) (p = 0.021), standard deviation of response time of visual CPT (p = 0.048). The clinical global impression-severity score decreased significantly in the acupuncture group after treatment compared to that in the waitlist group (p = 0.000). There was no statistically significant difference between both groups taking ADHD medications, except for verbal learning test in which waitlist group experienced a higher increase than acupuncture group. No adverse effect was reported.
Conclusions
Acupuncture positively influences cognitive function in patients who are not on ADHD medication.
Autism is one of the most common neurological disorders that affects the neurological development of children. Therapeutic interventions may intervene in communication disorders and stereotyped behaviors such as dancing, which as therapy can activate sensory pathways that enable gesture improvement. This study aimed to observe the effects of dance therapy in motor performance and gesture, body balance and gait, as well as in the quality of life of an adolescent with autistic disorder. It is a case study of a fifteen-year-old male who participated in 120 sessions of dance therapy, lasting 30 minutes, twice a week, on alternate days, over a period of one year. The assessment instruments used were the Motor Function Measure (MFM), Tinetti test and Childhood Autism Rating Scale (CARS). According to the MFM, the total score increased 27.08%; the Tinetti test regarding balance increased from 68 to 75%, and gait, from 16% to 66%. CARS changed from 41.5 to 34 points, changing the severe disorder to moderate within the proposed parameters. The dance therapy can optimize the psychomotor behavior of young people with autistic disorders.
Einleitung:
Die Hyperkinetischen Störungen stellen eines der häufigsten chronisch verlaufenden Krankheitsbilder im Kindes- und Jugendalter dar und nehmen auf viele Lebensbereiche Einfluss (Huss 2004). Deshalb rückt gerade das Thema Lebensqualität in letzter Zeit zunehmend in den Blickpunkt. Es ist nicht mehr ausreichend nur Symptome zu beachten, sondern es muss systematisch die Lebensqualität als Ganzes erfasst werden, um eine Qualitätssicherung von diagnostischen und therapeutischen Maßnahmen zu ermöglichen (Kramer 2007).
Zielsetzung:
Beurteilung des psychosozialen Funktionsniveaus (ICF) und der Lebensqualität (ILK) von Kindern/Jugendlichen mit hyperkinetischen Störungen.
Patienten/Methoden: Das psychosoziale Funktionsniveau von 30 Patienten mit F90.0/F90.1, im Alter von 5-13 Jahren (9,5 Jahre (± 1,8); 21 Jungen, 9 Mädchen) wurde in einer Elterneinschätzung mittels eines ICF Core-Sets erfasst. Zur Bewertung der Lebensqualität beantworteten alle Patienten und deren Eltern zusätzlich einen ILK-Fragebogen.
Ergebnisse:
ICF: Im Bereich Körperfunktionen hatten ≥ 50% der Patienten erhebliche Probleme (Median 3,0) bei: Funktionen der Aufmerksamkeit. Mäßige/leichte bis mäßige Probleme (Median: 2,0-1,5) ergaben sich bei ≥ 50% bei: Funktionen von Temperament und Persönlichkeit, Funktionen der psychischen Energie und des Antriebs, Psychomotorische Funktionen und Höhere kognitive Funktionen. Im Bereich Aktivitäten und Partizipation hatten ≥ 50% der Patienten mäßige bis erhebliche Probleme (Median 2,5) bei: Lesen lernen und Aufmerksamkeit fokussieren. Mäßige/ leichte bis mäßige Probleme (Median: 2,0-1,5) hatten ≥ 50% der Patienten bei: Schreiben lernen, Lesen, Schreiben, Probleme lösen, Mehrfachaufgaben übernehmen, Die tägliche Routine planen, Mit Stress und anderen psychischen Anforderungen umgehen, Diskussionen, Elementare interpersonelle Aktivitäten, Komplexe interpersonelle Interaktionen und Schulbildung. ILK: Die Kinder gaben Psyche als größtes Problem an, die Eltern zusätzlich noch Schule, Freunde und Gesamt (jeweils mit einer HPE von ≥ 50%). Die Selbsteinschätzung der HKS-Patienten war im Vergleich zur repräsentativen Schulstichprobe bei den Items Schule, Familie, Freunde, Psyche und Gesamt schlechter; hingegen bei Alleine und Körper schnitt sie besser ab. Bei der Elterneinschätzung waren im Vergleich zur repräsentativen Telefonstichprobe, bis auf das Item Körper (hier waren die Ergebnisse annähernd gleich), alle Bereiche schlechter.
Diskussion/Schlussfolgerung:
Die vorliegende Studie konnte im Vergleich mit der Allgemeinbevölkerung (Koolomuth 2010; Mattejat und Remschmidt 2006) signifikante Unterschiede liefern. In der Fremdeinschätzung zeigten HKS-Patienten deutliche Beeinträchtigungen im psychosozialen Funktionsniveau. Die Bewertung ihrer Lebensqualität fiel insgesamt schlechter aus als bei Gesunden, ergab aber in der Selbsteinschätzung noch etwas bessere Ergebnisse. Die gewonnenen Erkenntnisse können dabei helfen, das psychosoziale Funktionsniveau und die Lebensqualität zu verbessern, indem man versucht, identifizierte Stärken zu fördern sowie psychosoziale, diagnostische und therapeutische Interventionen besser auf den individuellen Bedarf abzustimmen. Die Resultate der Messinstrumente dienen hierbei der Zielsetzung und Überprüfung im Verlauf. Das Wohl der Patienten sollte stets im Vordergrund stehen!
Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.
1History and Epidemiology2Diagnosis3Clinical Presentation4Age of Onset5Gender6Comorbidities7Genetic Studies8Nongenetic Aspects Implicated in ADHD9Neurobiology of ADHD10Treatment11SummaryKeywords:proton magnetic resonance spectroscopy;1H-MRS;prefrontal cortex;pharmacological treatment;ADHD;Attention Deficit Hyperactivity Disorder;hyperactivity;inattention;impulsivity;comorbidities;conduct disorder;genetics;DSM IV;Diagnosis Statistic Manual Edition 4th;DSM III;Diagnosis Statistic Manual Edition 3rd;LCA;Latent Class Analysis;stimulant medication;Complementary and Alternative Medical Therapies;CAM
The use of complementary and alternative medicine in paediatric care is growing in popularity in North America; massage therapy is one of these popular modalities. Despite the increased use of massage therapy among paediatric patients, there remains a scarcity of evidence in comparison to adult populations; however, the paediatric evidence base is growing. This article provides a narrative overview of the evidence for massage therapy for infants and children, including a brief discussion of the safety of massage, potential mechanisms of action and directions for future research.
Autism and autistic spectrum disorder are chronic neuro-developmental disorders characterized by social and language impairments and stereotyped, repetitive patterns of behavior. The etiology of autism remains unknown; however, a strong genetic component has been detected and environmental factors may also be involved in their etiologies. In the current study, we reviewed evidence for the presence of prenatal and perinatal factors, gastrointestinal factors, food allergies, metabolic and heavy metal factors, and other nutritional factors that may represent risk factors for the development of autism and autistic spectrum disorder.
Large autism epidemics have recently been reported in the United States and the United Kingdom. Emerging epidemiologic evidence and biologic plausibility suggest an association between autistic spectrum disorders and mercury exposure. This study compares mercury excretion after a three-day treatment w ith a n o ral c helating a gent, m eso-2,3- dimercaptosuccinic acid (DMSA), in children with autistic spectrum disorders and a matched control population. Overall, urinary mercury concentrations were significantly higher in 221 children with autistic spectrum disorders than in 18 normal controls (Relative Increase (RI)=3.15; P < 0.0002). Additionally, vaccinated cases showed a significantly higher urinary mercury concentration than did vaccinated controls (RI=5.94; P < 0.005). Similar urinary mercury concentrations were observed among matched vacci- nated and unvaccinated controls, and no association was found between urinary cadmium or lead concentrations and autistic spectrum disorders. The observed urinary concentrations of mercury could plausibly have resulted from thimerosal in childhood vaccines, although other environmental sources and thimerosal in Rh (D) immune globulin administered to mothers may be contributory. Regardless of the mechanism by which children with autistic spectrum disorders have high urinary mercury concentrations, the DMSA treatment described in this study might be useful to diag- nose their present burden of mercury.
This study tested the hypothesis that commonly reported negative effects of sugar on children's behavior may be due to parental expectancies. A challenge study design was employed, in which thirty-five 5- to 7-year-old boys reported by their mothers to be behaviorally sugar sensitive, and their mothers, were randomly assigned to experimental and control groups. In the experimental group, mothers were told their children had received a large dose of sugar, whereas in the control condition mothers were told their sons received a placebo; all children actually received the placebo (aspartame). Mothers and sons were videotaped while interacting together and each mother was then questioned about the interaction. Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers. For several variables, the expectancy effect was stronger for cognitively rigid mothers.
Attention-deficit hyperactivity disorder (ADHD) is the diagnosis used to describe children who are inattentive, impulsive, and hyperactive. ADHD is a widespread condition that is of public health concern. In most children with ADHD the cause is unknown, but is thought to be biological and multifactorial. Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. We reported previously that a subgroup of ADHD subjects reporting many symptoms indicative of EFA deficiency (L-ADHD) had significantly lower proportions of plasma arachidonic acid and docosahexaenoic acid than did ADHD subjects with few such symptoms or control subjects. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n-3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n-3 fatty acids. The reasons for the lower proportions of long-chain polyunsaturated fatty acids (LCPUFAs) in these children are not clear; however, factors involving fatty acid intake, conversion of EFAs to LCPUFA products, and enhanced metabolism are discussed. The relation between LCPUFA status and the behavior problems that the children exhibited is also unclear. We are currently testing this relation in a double-blind, placebo-controlled intervention in a population of children with clinically diagnosed ADHD who exhibit symptoms of EFA deficiency.
The effectiveness of a megavitamin regimen utilizing a two-stage trial in 41 subjects with attention deficit disorders was studied. Stage 1 was a 3-month clinical trial of vitamins (daily maximum: 3 g of niacinamide and ascorbic acid, 1.2 g of calcium pantothenate, and 0.6 g of pyridoxine). State 2 consisted of four, 6-week, double-blind repeated crossover periods. Twenty-nine per cent of the subjects showed significant behavior improvement during stage 1, and these subjects were used in the double-blind crossover phase of the study to evaluate megavitamin therapy. Using analysis of variance methods for crossover studies, there was no significant difference (P greater than .05) in most behavior scores between children receiving vitamin and those receiving placebo during stage 2. Children exhibited 25% more disruptive classroom behavior when treated with vitamins v placebo (P less than .01). There was no significant difference in serum pyridoxine and ascorbic acid levels between subjects and control subjects. Forty-two per cent of subjects exceeded the upper limits of serum transaminase levels while receiving vitamins. It is concluded that megavitamins are ineffective in the management of attention deficit disorders and should not be utilized because of their potential hepatotoxicity.
The "Feingold diet," which eliminates artificial food colorings, has been claimed to be beneficial to hyperactive children. Previous studies have yielded equivocal results. We sought to maximize the likelihood of demonstrating behavioral effects of artificial food colorings by (1) studying only children who were already on the Feingold diet and who were reported by their parents to respond markedly to artificial food colorings, (2) attempting to exclude placebo responders, and (3) administering high dosages of coloring. The design was a double-blind crossover with randomized; 11 children maintained on the Feingold diet were challenged with food coloring and placebo (one each week). Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect.
Attention-deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism. The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects. Also, a subgroup of 21 subjects with ADHD exhibiting many symptoms of essential fatty acid (EFA) deficiency had significantly lower plasma concentrations of 20:4n-6 and 22:6n-3 than did 32 subjects with ADHD with few EFA-deficiency symptoms. The data are discussed with respect to cause, but the precise reason for lower fatty acid concentrations in some children with ADHD is not clear.
The attention deficit hyperactive disorder (ADHD) is a neurophysiologic problem that is detrimental to children and their parents. Despite previous studies on the role of foods, preservatives and artificial colorings in ADHD this issue remains controversial. This investigation evaluated 26 children who meet the criteria for ADHD. Treatment with a multiple item elimination diet showed 19 children (73%) responded favorably, P < .001. On open challenge, all 19 children reacted to many foods, dyes, and/or preservatives. A double-blind placebo controlled food challenge (DBPCFC) was completed in 16 children. There was a significant improvement on placebo days compared with challenge days (P = .003). Atopic children with ADHD had a significantly higher response rate than the nonatopic group. This study demonstrates a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD.
Both dietary sucrose and the sweetener aspartame have been reported to produce hyperactivity and other behavioral problems in children.
We conducted a double-blind controlled trial with two groups of children: 25 normal preschool children (3 to 5 years of age), and 23 school-age children (6 to 10 years) described by their parents as sensitive to sugar. The children and their families followed a different diet for each of three consecutive three-week periods. One diet was high in sucrose with no artificial sweeteners, another was low in sucrose and contained aspartame as a sweetener, and the third was low in sucrose and contained saccharin (placebo) as a sweetener. All the diets were essentially free of additives, artificial food coloring, and preservatives. The children's behavior and cognitive performance were evaluated weekly.
The preschool children ingested a mean (+/- SD) of 5600 +/- 2100 mg of sucrose per kilogram of body weight per day while on the sucrose diet, 38 +/- 13 mg of aspartame per kilogram per day while on the aspartame diet, and 12 +/- 4.5 mg of saccharin per kilogram per day while on the saccharin diet. The school-age children considered to be sensitive to sugar ingested 4500 +/- 1200 mg of sucrose per kilogram, 32 +/- 8.9 mg of aspartame per kilogram, and 9.9 +/- 3.9 mg of saccharin per kilogram, respectively. For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed.
Even when intake exceeds typical dietary levels, neither dietary sucrose nor aspartame affects children's behavior or cognitive function.
The etiopathogenesis of infantile autism is still unknown. Recently some authors have suggested that food peptides might be able to determine toxic effects at the level of the central nervous system by interacting with neurotransmitters. In fact a worsening of neurological symptoms has been reported in autistic patients after the consumption of milk and wheat. The aim of the present study has been to verify the efficacy of a cow's milk free diet (or other foods which gave a positive result after a skin test) in 36 autistic patients. We also looked for immunological signs of food allergy in autistic patients on a free choice diet. We noticed a marked improvement in the behavioural symptoms of patients after a period of 8 weeks on an elimination diet and we found high levels of IgA antigen specific antibodies for casein, lactalbumin and beta-lactoglobulin and IgG and IgM for casein. The levels of these antibodies were significantly higher than those of a control group which consisted of 20 healthy children. Our results lead us to hypothesise a relationship between food allergy and infantile autism as has already been suggested for other disturbances of the central nervous system.
How do 'stimulants' reduce hyperactivity in children and adults? How can drugs which raise extracellular dopamine result in psychomotor slowing of hyperactive children when dopamine is known to enhance motor activity, such as in Parkinson's disease? These apparent paradoxes are the focus of this brief review on the mechanism of action of stimulant medications used in the treatment of children, and of an increasing number of adults who meet diagnostic criteria for attention deficit hyperactivity disorder.
In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism.
A combination herbal product containing American ginseng extract, Panax quinquefolium, (200 mg) and Ginkgo biloba extract (50 mg) (AD-FX; CV Technologies, Edmonton, Alta.) was tested for its ability to improve the symptoms of attention-deficit hyperactivity disorder (ADHD).
Open study.
36 children ranging in age from 3 to 17 years who fit the diagnostic criteria for ADHD.
AD-FX capsules were taken twice a day on an empty stomach for 4 weeks. Patients were instructed not to change any other medications during the study.
At the beginning of the study, after 2 weeks, and then at the end of the 4-week trial, parents completed the Conners' Parent Rating Scale--revised, long version, a questionnaire that assesses a broad range of problem behaviours (and was used as an indication of ADHD symptom severity).
After 2 weeks of treatment, the proportion of the subjects exhibiting improvement (i.e., decrease in T-score of at least 5 points) ranged from 31% for the anxious-shy attribute to 67% for the psychosomatic attribute. After 4 weeks of treatment, the proportion of subjects exhibiting improvement ranged from 44% for the social problems attribute to 74% for the Conners' ADHD index and the DSM-IV hyperactive-impulsive attribute. Five (14%) of 36 subjects reported adverse events, only 2 of which were considered related to the study medication.
These preliminary results suggest AD-FX treatment may improve symptoms of ADHD and should encourage further research on the use of ginseng and Ginkgo biloba extracts to treat ADHD symptoms.
This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods.
The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule-Generic.
The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism.
The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.
We have reported lymphocytic colitis in children with regressive autism, with epithelial damage prominent. We now compare duodenal biopsies in 25 children with regressive autism to 11 with coeliac disease, five with cerebral palsy and mental retardation and 18 histologically normal controls. Immunohistochemistry was performed for lymphocyte and epithelial lineage and functional markers. We determined the density of intraepithelial and lamina propria lymphocyte populations, and studied mucosal immunoglobulin and complement C1q localisation. Standard histopathology showed increased enterocyte and Paneth cell numbers in the autistic children. Immunohistochemistry demonstrated increased lymphocyte infiltration in both epithelium and lamina propria with upregulated crypt cell proliferation, compared to normal and cerebral palsy controls. Intraepithelial lymphocytes and lamina propria plasma cells were lower than in coeliac disease, but lamina propria T cell populations were higher and crypt proliferation similar. Most strikingly, IgG deposition was seen on the basolateral epithelial surface in 23/25 autistic children, co-localising with complement C1q. This was not seen in the other conditions. These findings demonstrate a novel form of enteropathy in autistic children, in which increases in mucosal lymphocyte density and crypt cell proliferation occur with epithelial IgG deposition. The features are suggestive of an autoimmune lesion.
Autism is a collection of behavioral symptoms characterized by dysfunction in social interaction and communication in affected children. It is typically associated with restrictive, repetitive, and stereotypic behavior and manifests within the first 3 years of life. The cause of this disorder is not known. Over the past decade, a significant upswing in research has occurred to examine the biologic basis of autism. Recent clinical studies have revealed a high prevalence of gastrointestinal symptoms, inflammation, and dysfunction in children with autism. Mild to moderate degrees of inflammation were found in both the upper and lower intestinal tract. In addition, decreased sulfation capacity of the liver, pathologic intestinal permeability, increased secretory response to intravenous secretin injection, and decreased digestive enzyme activities were reported in many children with autism. Treatment of digestive problems appears to have positive effects on autistic behavior. These new observations represent only a piece of the unsolved autism "puzzle" and should stimulate more research into the brain-gut connection.
Impaired social interaction, communication and imaginative skills characterize autistic syndromes. In these syndromes urinary peptide abnormalities, derived from gluten, gliadin, and casein, are reported. They reflect processes with opioid effect. The aim of this single blind study was to evaluate effect of gluten and casein-free diet for children with autistic syndromes and urinary peptide abnormalities. A randomly selected diet and control group with 10 children in each group participated. Observations and tests were done before and after a period of 1 year. The development for the group of children on diet was significantly better than for the controls.
Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric condition for which evidence-based treatments have been established. This study describes use of complementary and alternative medicine among children with ADHD or at risk of having ADHD and explores possible predictors of use of such treatments.
A sample of 1,615 parents of elementary school students in a public school district were interviewed in a telephone screening survey of ADHD symptoms and use of traditional and nontraditional ADHD treatment. A total of 822 parents had a child with a diagnosis of ADHD, had a child in whom ADHD was suspected, or had a child about whose emotions or behavior the parents or school staff had general concerns.
Use of complementary and alternative medicine was significantly higher among children who had received a diagnosis of ADHD (12 percent) or in whom ADHD was suspected (7 percent) than among those about whom parents or school staff had general concerns (3 percent). Faith healing had been used for 4 percent of the 822 children. Nontraditional treatments were more likely to have been used among children with a diagnosis or a suspected diagnosis of ADHD and those whose parents used the Internet as a source of information than among other children.
Providers should inquire about nontraditional interventions and educate families about evidence-based approaches when treating children with ADHD.
The authors assessed the efficacy of once-daily atomoxetine administration in the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD).
In a double-blind study, children and adolescents with ADHD (N=171, age range=6-16 years) were randomly assigned to receive 6 weeks of treatment with either atomoxetine (administered once daily) or placebo.
Outcomes among atomoxetine-treated patients were superior to those of the placebo treatment group as assessed by investigator, parent, and teacher ratings. The treatment effect size (0.71) was similar to those observed in previous atomoxetine studies that used twice-daily dosing. Parent diary ratings suggested that drug-specific effects were sustained late in the day. Discontinuations due to adverse events were low (less than 3%) for both treatment groups, and no serious safety concerns were observed.
Once-daily administration of atomoxetine is an effective treatment for children and adolescents with ADHD.
One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.
Attention-deficit hyperactivity disorder (ADHD) is the diagnosis used to describe children who are inattentive, impulsive, and hyperactive. ADHD is a widespread condition that is of public health concern. In most children with ADHD the cause is unknown, but is thought to be biological and multifactorial. Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. We reported previously that a subgroup of ADHD subjects reporting many symptoms indicative of EFA deficiency (L-ADHD) had significantly lower proportions of plasma arachidonic acid and docosahexaenoic acid than did ADHD subjects with few such symptoms or control subjects. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n−3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n−3 fatty acids. The reasons for the lower proportions of long-chain polyunsaturated fatty acids (LCPUFAs) in these children are not clear; however, factors involving fatty acid intake, conversion of EFAs to LCPUFA products, and enhanced metabolism are discussed. The relation between LCPUFA status and the behavior problems that the children exhibited is also unclear. We are currently testing this relation in a double-blind, placebo-controlled intervention in a population of children with clinically diagnosed ADHD who exhibit symptoms of EFA deficiency.
This clinical practice guideline provides recommendations for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD). This guideline, the first of 2 sets of guidelines to provide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD. The Committee on Quality Improvement of the American Academy of Pediatrics selected a committee composed of pediatricians and other experts in the fields of neurology, psychology, child psychiatry, development, and education, as well as experts from epidemiology and pediatric practice. In addition, this panel consists of experts in education and family practice. The panel worked with Technical Resources International, Washington, DC, under the auspices of the Agency for Healthcare Research and Quality, to develop the evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for evaluation of the child with ADHD. Major issues contained within the guideline address child and family assessment; school assessment, including the use of various rating scales; and conditions seen frequently among children with ADHD. Information is also included on the use of current diagnostic coding strategies. The deliberations of the committee were informed by a systematic review of evidence about prevalence, coexisting conditions, and diagnostic tests. Committee decisions were made by consensus where definitive evidence was not available. The committee report underwent review by sections of the American Academy of Pediatrics and external organizations before approval by the Board of Directors. The guideline contains the following recommendations for diagnosis of ADHD: 1) in a child 6 to 12 years old who presents with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems, primary care clinicians should initiate an evaluation for ADHD; 2) the diagnosis of ADHD requires that a child meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria; 3) the assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment; 4) the assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions; 5) evaluation of the child with ADHD should include assessment for associated (coexisting) conditions; and 6) other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD but may be used for the assessment of other coexisting conditions (eg, learning disabilities and mental retardation). This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with ADHD. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decisionmaking. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.
Children with ADHD require more than 1.5 times more pri- mary care visits, 9 times more outpatient mental health visits, and 3 times more prescriptions per year, compared to children without ADHD. 4 The total annual health care costs for children with ADHD are estimated to be more than twice that of children without the disorder, and these costs become significantly larg- er when a child with ADHD is diagnosed with a comorbid con- dition. 4-6 In a study conducted in the United States using data from the 1996 Medical Expenditure Panel Survey, the unad- justed mean health care expenditures for a child with ADHD were $1,151, much higher than the $661 in expenditures incurred by a healthy child in that same year. 6 ABSTRACT BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a prevalent mental health condition, occurring in 3% to 5% of school-aged children. Although stimulant medications are a recommended treatment for this disorder, physi- cians' views of these medications have not been systematically evaluated. OBJECTIVE: This study examined physician-prescriber perceptions of using medications to treat ADHD symptoms in children or adolescents. METHODS: A survey was developed with 4 physicians expert in treating ADHD in children. The survey was pilot-tested with a sample of 10 practicing physicians. A sample of 1,000 physicians, with a history of prescribing stimulant medications to children or adolescents, was randomly selected and mailed a 30-item survey. Items were rated on a 7-point response scale (strongly agree, agree, slightly agree, undecided, slightly disagree, disagree, strongly disagree). RESULTS: A total of 365 physicians responded to the survey, for a 37% response rate. More than 92% of respondents strongly agreed or agreed that ADHD symp- toms cause problems in pediatric patients and stimulants are effective in treating ADHD. The stimulant drug side effects of decreased appetite or weight loss, sleep disruption, and exacerbation of anxiety were a concern (strongly agree or agree response) for 32%, 50%, and 22% of physicians, respectively. Diversion of ADHD medication was a concern for 19% of respondents. Physicians reported that con- trolled medications for children or adolescents with ADHD are a burden for them- selves (32% strongly agreed or agreed), for their staff (37% strongly agreed or agreed), and for parents (40% strongly agreed or agreed). Approximately 38% of physicians responded that they would prefer prescribing a nonstimulant medica- tion with a U.S. Food and Drug Administration indication for treating children or adolescents instead of a stimulant medication, and 58% would prefer prescribing a noncontrolled medication that does not have evidence of abuse potential ver- sus one that is controlled and has evidence of abuse potential. CONCLUSION: Although physicians overwhelmingly perceive stimulant medica- tions as being effective for treating ADHD symptoms in children or adolescents, many would prefer a nonstimulant medication. While many physicians consider the side effects of the stimulants easily managed, others are concerned about prescribing stimulants because of their side effects, risk of diversion, and admin- istrative burden. The majority of physicians would prefer to prescribe a noncon- trolled medication without abuse potential instead of a controlled medication to treat children or adolescents with ADHD.
Iron plays a role in the regulation of dopaminergic activity. In the present study, nonanemic children with attention deficit hyperactivity disorder (ADHD) were evaluated with regard to heme and nonheme iron metabolism and the effect of short-term iron administration on behavior. The study group consisted of 14 boys aged 7–11 years. All first underwent testing to rule out other psychiatric and medical problems. The severity of the ADHD symptoms was determined by parent and teacher scores on the Connors Rating Scale. Thereafter, each patient received an iron preparation (Ferrocal), 5 mg/kg/day for 30 days. Blood samples were taken before and after drug administration. Results showed a significant increase in serum ferritin levels (from 25.9 ± 9.2 to 44.6 ±18 ng/ml) and a significant decrease on the parents’ Connors Rating Scale scores (from 17.6 ± 4.5 to 12.7 ± 5.4). There were no changes in other blood parameters or in the teachers’ scores on the rating scale. The effect of iron supplementation on the behavioral and cognitive symptoms in noniron-deficient ADHD children merits further investigation using a placebo-controlled study.Copyright © 1997 S. Karger AG, Basel
Oh great. Another thing for us hypervigilant, overeducated parents to worry about. As if stranger danger and hot dogs cut horizontally instead of vertically and childhood obesity and the recommended daily allowance of Barney and whether the neighborhood sex offender is rated as level 1, 2, or 3 weren't all enough, now our children stand to suffer huge assaults to their very souls from nature-deficit disorder. Really. I’m glad Richard Louv, an author and columnist for The San Diego Union-Tribune, wrote this book about how children prefer instant messaging to playing outside; how parents, teachers, and policy makers perhaps unwittingly keep them indoors; and what kids lose in the process.
76 selected overactive children were treated with an oligoantigenic diet, 62 improved, and a normal range of behaviour was achieved in 21 of these. Other symptoms, such as headaches, abdominal pain, and fits, also often improved. 28 of the children who improved completed a double-blind, crossover, placebo-controlled trial in which foods thought to provoke symptoms were reintroduced. Symptoms returned or were exacerbated much more often when patients were on active material than on placebo. 48 foods were incriminated. Artificial colorants and preservatives were the commonest provoking substances, but no child was sensitive to these alone.
A food additive-free diet has been recommended as a component of the treatment of developmental/behavioral disorders in children. This diet was initially developed by Dr. Benjamin Feingold for the treatment of aspirin sensitivity in adults, and then extended by him to the management, particularly, of hyperactivity and learning disability in children. The rationale for this diet and the methods employed in investigating its use are described. The claimed therapeutic effects of this diet have been investigated in a number of well-designed studies reviewed here. These studies generally refute a causal association between food additives and behavioral disturbance in children. Suggestions are made regarding the approach towards food additive-free diet therapy in the management of developmental/behavioral disorders.
We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64% +/- 1.43 vs 0.38% +/- 0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.
Autoimmunity may be a pathogenic factor in autism, a behavioral disorder of early childhood onset. Circulating autoantibodies are produced in organ-specific autoimmunity; therefore, we investigated them in the plasma of autistic subjects, mentally retarded (MR) subjects, and healthy controls. Autoantibodies (IgG isotype) to neuron-axon filament protein (anti-NAFP) and glial fibrillary acidic protein (anti-GFAP) were analyzed by the Western immunoblotting technique. We found a significant increase in incidence of anti-NAFP (P = .004) and anti-GFAP (P = .002) in autistic subjects, but not in MR subjects. Clinically, these autoantibodies may be related to autoimmune pathology in autism.
Concerns have been raised regarding the validity of the diagnosis of attention-deficit hyperactivity disorder in adults. The purpose of this report is to evaluate critically whether this diagnosis in adults meets acceptable standards for diagnostic validity. A systematic search was conducted of the psychiatric and psychological literature for empirical studies dealing with adult attention-deficit hyperactivity disorder with childhood onset. These studies were examined for evidence of descriptive, predictive, and concurrent validity. The literature shows that this disorder can be reliably diagnosed in adults and that the diagnosis confers considerable power to forecast complications and treatment response. In addition, evidence is mounting for genetic transmission, specific treatment responses, and abnormalities in brain structure and function in affected individuals. Evidence from the literature is increasingly pointing to the validity of adult attention-deficit hyperactivity disorder.
To assess the validity of the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD).
Using structured diagnostic interviews and psychometric measures of cognitive and social functioning, the authors assessed 413 children and adolescents consecutively referred to a pediatric psychopharmacology clinic since 1991.
Marked psychiatric differences were found among DSM-IV subtypes of ADHD, but few differences were found in cognitive or psychosocial functioning. The greatest psychiatric differences were found between the combined-type subjects (who tended to show more impairment in multiple domains) and the other two subgroups. The inattentive patients, however, were more likely to have required extra help in school. The hyperactive-impulsive patients were not different from controls on rates of depression, Child Behavior Checklist measures of social functioning, or psychometric measures of intellectual functioning and academic achievement.
The results suggest that, regarding clinical features, combined-type patients have a more severe disorder than the other DSM-IV subtypes.
Etiologically unexplained disorders of language and social development have often been reported to improve in patients treated with immune-modulating regimens. Here we determined the frequency of autoantibodies to brain among such children.
We collected sera from a cohort of children with (1) pure Landau-Kleffner syndrome (n = 2), (2) Landau-Kleffner syndrome variant (LKSV, n = 11), and (3) autistic spectrum disorder (ASD, n = 11). None had received immune-modulating treatment before the serum sample was obtained. Control sera (n = 71) were from 29 healthy children, 22 with non-neurologic illnesses (NNIs), and 20 children with other neurologic disorders (ONDs). We identified brain autoantibodies by immunostaining of human temporal cortex and antinuclear autoantibodies using commercially available kits.
IgG anti-brain autoantibodies were present in 45% of sera from children with LKSV, 27% with ASD, and 10% with ONDs compared with 2% from healthy children and control children with NNIs. IgM autoantibodies were present in 36% of sera from children with ASD, 9% with LKSV, and 15% with ONDs compared with 0% of control sera. Labeling studies identified one antigenic target to be endothelial cells. Antinuclear antibodies with titers >/=1:80 were more common in children with ASD and control children with ONDs.
Children with LKSV and ASD have a greater frequency of serum antibodies to brain endothelial cells and to nuclei than children with NNIs or healthy children. The presence of these antibodies raises the possibility that autoimmunity plays a role in the pathogenesis of language and social developmental abnormalities in a subset of children with these disorders.
Our aim was to evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastrointestinal symptoms.
Thirty-six children (age: 5.7 +/- 2 years, mean +/- SD) with autistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. The most frequent gastrointestinal complaints were chronic diarrhea, gaseousness, and abdominal discomfort and distension.
Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duodenitis in 24. The number of Paneth's cells in the duodenal crypts was significantly elevated in autistic children compared with non-autistic control subjects. Low intestinal carbohydrate digestive enzyme activity was reported in 21 children (58.3%), although there was no abnormality found in pancreatic function. Seventy-five percent of the autistic children (27/36) had an increased pancreatico-biliary fluid output after intravenous secretin administration. Nineteen of the 21 patients with diarrhea had significantly higher fluid output than those without diarrhea.
Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients. The observed increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver. Further studies are required to determine the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder.
To identify the prevalence of use, the referral patterns and the perceived benefit of alternative therapy in children with attention-deficit hyperactivity disorder (ADHD).
A mailed questionnaire survey was undertaken in June 1993, of the use of various therapies by families of 381 children with ADHD. The respondent rate was 76%.
Of respondents, 69% were using stimulant medication and 64% had used or were using a non-prescriptional therapy. Diet therapies were the most commonly used alternative therapy (60%). There was no statistical difference in the prevalence of use of other therapies between the medicated and non-medicated groups. The non-medicated group reported more benefit from some alternative therapies. Physicians were commonly involved in the suggestion to try a modified diet. School teachers, family and friends were the main source of suggestion of alternative therapies.
Clinicians should be aware of the range of alternative therapies and of their frequent use by families of children with attentional problems.
Phospholipid fatty acids are major structural components of neuronal cell membranes, which modulate membrane fluidity and hence function. Evidence from clinical and biochemical sources have indicated changes in the metabolism of fatty acids in several psychiatric disorders. We examined the phospholipid fatty acids in the plasma of a population of autistic subjects compared to mentally retarded controls. Our results showed a marked reduction in the levels of 22: 6n-3 (23%) in the autistic subjects, resulting in significantly lower levels of total (n-3) polyunsaturated fatty acids (PUFA) (20%), without significant reduction in the (n-6) PUFA series, and consequently a significant increase in the (n-6)/(n-3) ratio (25%). These variations are discussed in terms of potential differences in PUFA dietary intake, metabolism, or incorporation into cellular membranes between the two groups of subjects. These results open up interesting perspectives for the investigation of new biological indices in autism. Moreover, this might have new therapeutic implications in terms of child nutrition.
To determine whether docosahexaenoic acid (DHA) supplementation for 4 months decreases the symptoms of attention-deficit/hyperactivity disorder (ADHD).
Sixty-three 6- to-12-year-old children with ADHD, all receiving effective maintenance therapy with stimulant medication, were assigned randomly, in a double-blind fashion, to receive DHA supplementation (345 mg/d) or placebo for 4 months. Outcome variables included plasma phospholipid fatty acid patterns, scores on laboratory measures of inattention and impulsivity (Test of Variables of Attention, Children's Color Trails test) while not taking stimulant medication, and scores on parental behavioral rating scales (Child Behavior Checklist, Conners' Rating Scale). Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance, controlling for age, baseline value of each outcome variable, ethnicity, and ADHD subtype.
Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group (4.85 +/- 1.35 vs 1.86 +/- 0.87 mol % of total fatty acids; P <.001). Despite this, there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms.
A 4-month period of DHA supplementation (345 mg/d) does not decrease symptoms of ADHD.
Numerous small clinical trials have been carried out to study the behaviourally defined efficacy and safety of short-acting methylphenidate compared with placebo for attention-deficit disorder (ADD) in individuals aged 18 years and less. However, no meta-analyses that carefully examined these questions have been done. We reviewed the behavioural evidence from all the randomized controlled trials that compared methylphenidate and placebo, and completed a meta-analysis.
We searched several electronic sources for articles published between 1981 and 1999: MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, HEALTHSTAR, Biological Abstracts, Current Contents and Dissertation Abstracts. The Cochrane Library Trials Registry and Current Controlled Trials were also consulted. A study was considered eligible for inclusion if it entailed the following: a placebo-controlled randomized trial that involved short-acting methylphenidate and participants aged 18 years or less at the start of the trial who had received any primary diagnosis of ADD that was made in a systematic and reproducible way.
We included 62 randomized trials that involved a total of 2897 participants with a primary diagnosis of ADD (e.g., with or without hyperactivity). The median age of trial participants was 8.7 years, and the median "percent male" composition of trials was 88.1%. Most studies used a crossover design. Using the scores from 2 separate indices, this collection of trials exhibited low quality. Interventions lasted, on average, 3 weeks, with no trial lasting longer than 28 weeks. Each primary outcome (hyperactivity index) demonstrated a significant effect of methylphenidate (effect size reported by teacher 0.78, 95% confidence interval [CI] 0.64-0.91; effect size reported by parent 0.54, 95% CI 0.40-0.67). However, these apparent beneficial effects are tempered by a strong indication of publication bias and the lack of robustness of the findings, especially those involving core ADD features. Methylphenidate also has an adverse event profile that requires consideration. For example, clinicians only need to treat 4 children to identify an episode of decreased appetite.
Short-acting methylphenidate has a statistically significant clinical effect in the short-term treatment of individuals with a diagnosis of ADD aged 18 years and less. However, the extension of this placebo-controlled effect beyond 4 weeks of treatment has not been demonstrated. Exact knowledge of the extent and definition of the short-term behavioural usefulness of methylphenidate is questioned.
The use of complementary and alternative medicine (CAM) in pediatrics has become widespread. Parents of young children with developmental and behavioral problems such as attention-deficit hyperactivity disorder (ADHD) are particularly drawn to CAM interventions to avoid or decrease use of psychotropic medications. This paper reviews the epidemiology of CAM use for ADHD, describes a conceptual model of CAM, discusses a variety of commonly used therapies for ADHD, and introduces a systematic, pragmatic approach to discussing CAM therapy use with parents.
To determine safety and the efficacy of carnitine treatment in children with attention-deficit hyperactivity disorder (ADHD). The ADHD behavior was observed by parents completing the Child Behavior Checklist (CBCL) and by teachers completing the Conners teacher-rating score, in a randomized, double-blind, placebo-controlled double-crossover trial. In 13/24 boys receiving carnitine, home behavior improved as assessed with the CBCL total score (P < 0.02). In 13/24 boys, school behavior improved as assessed with the Conners teacher-rating score (P < 0.05). Before treatment, the CBCL total and sub-scores were significantly different from those of normal Dutch boys (P < 0.0001). Responders showed a significant improvement of the CBCL total scores compared to baseline (P < 0.0001). In the majority of boys no side effects were seen. At baseline and after carnitine treatment, responders showed higher levels of plasma-free carnitine (P < 0.03) and acetylcarnitine (P < 0.05). Compared to baseline, the carnitine treatment caused in the responsive patients a decrease of 20-65% (8-48 points) as assessed by the CBCL total problem rating scale. Treatment with carnitine significantly decreased the attention problems and aggressive behavior in boys with ADHD.
Children with autism spectrum disorder (ASD) frequently reveal various gastrointestinal (GI) symptoms that may resolve with an elimination diet along with apparent improvement of some of the behavioral symptoms. Evidence suggests that ASD may be accompanied by aberrant (inflammatory) innate immune responses. This may predispose ASD children to sensitization to common dietary proteins (DP), leading to GI inflammation and aggravation of some behavioral symptoms.
We measured IFN-gamma, IL-5, and TNF-alpha production against representative DPs [gliadin, cow's milk protein (CMP), and soy] by peripheral blood mononuclear cells (PBMCs) from ASD and control children [those with DP intolerance (DPI), ASD siblings, and healthy unrelated children]. We evaluated the results in association with proinflammatory and counter-regulatory cytokine production with endotoxin (LPS), a microbial product of intestinal flora and a surrogate stimulant for innate immune responses.
ASD PBMCs produced elevated IFN-gamma and TNF-alpha, but not IL-5 with common DPs at high frequency as observed in DPI PBMCs. ASD PBMCs revealed increased proinflammatory cytokine responses with LPS at high frequency with positive correlation between proinflammatory cytokine production with LPS and IFN-gamma and TNF-alpha production against DPs. Such correlation was less evident in DPI PBMCs.
Immune reactivity to DPs may be associated with apparent DPI and GI inflammation in ASD children that may be partly associated with aberrant innate immune response against endotoxin, a product of the gut bacteria.
Impaired antioxidant mechanisms are unable to inactivate free radicals that may induce a number of pathophysiological processes and result in cell injury. Thus, any abnormality in antioxidant defence systems could affect neurodevelopmental processes and could have an important role in the etiology of autistic disorder. The plasma levels of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), and erythrocyte levels of GSH-Px were investigated in 45 autistic children and compared with 41 normal controls. Levels of erythrocyte SOD, erythrocyte and plasma GSH-Px were assayed spectrophotometrically. Activities of erythrocyte SOD, erythrocyte and plasma GSH-Px in autistic children were significantly lower than normals. These results indicate that autistic children have low levels of activity of blood antioxidant enzyme systems; if similar abnormalities are present in brain, free radical accumulation could damage brain tissue.
The diagnosis of allergic disease is performed by skin prick tests (SPT) or through the demonstration of specific IgE in a blood sample via an in vitro test. The measurement of IgE concentration against allergens provides critical information in clinical allergy. Standardized and reproducible methods contribute to the quality of diagnosis and treatment of allergic disease.
In this study we evaluated the performance of a new specific IgE method, developed by ALK-Abellò for Bayer Diagnostics to run on their ADVIA Centaur immunoassay system. One hundred and fifty-one children with allergic diseases (both food and inhalant allergies) were tested for specific IgE (sIgE) via SPT and in vitro tests (UniCAP system, Pharmacia, and ADVIA Centaur immunoassay system, Bayer Diagnostics) and the test results were correlated with the clinical data.
Statistical analysis revealed no significant difference between the two in vitro tests compared with clinical history. The sensitivities and specificities are similar, but the UniCAP system method has higher sensitivity. In the children with cow's milk allergy, the UniCAP system has sensitivity of 91% and specificity of 70%; the ADVIA Centaur immunoassay has sensitivity of 82% and specificity of 74%. In hen's egg allergy, UniCAP system has 94% sensitivity and 64% specificity, and the ADVIA Centaur system has 88% sensitivity and 52% specificity. In inhalant allergies, the two methods show statistically similar performances for both grass pollen allergies (UniCAP sensitivity 100%, specificity 73%; ADVIA Centaur sensitivity 95%, specificity 79%) and in the dust mites allergies (UniCAP sensitivity 91%, specificity 62%; ADVIA Centaur sensitivity 86%, specificity 64%). In cat allergies, the systems showed equivalent results (UniCAP sensitivity 100%, specificity 71%; ADVIA Centaur sensitivity 100%, specificity 70%). Using the UniCAP system, the geometric mean of sIgE values in children with clinical allergy is significantly higher than in sensitized ones. The ADVIA Centaur system shows a similar trend with the exclusion of cow's milk and Dermatophagoides farinae allergens. With this last method the mean value of sIgE is higher in sensitized than in symptomatic children.
The new ADVIA Centaur method compares favorably with the results obtained on the UniCAP system. If other studies continue to confirm this data, then the advantages are numerous: the use of only a small quantity of serum (25 micro l per allergen), rapid turnaround time, minimal hands-on time, and no interference from IgG.
To determine the prevalence and factors associated with complementary and alternative medicine (CAM) use for childhood attention and hyperactivity problems, we surveyed parents of children referred for evaluation of attention-deficit hyperactivity disorder (ADHD). Parents indicated whether they had used CAM therapies (e.g., acupuncture, nutritional supplements) in the past year and rated how important different reasons were in making their therapy decisions. Overall, 62 of 114 (54%) parents reported using CAM, most commonly expressive therapies, vitamins, and dietary manipulation, to treat their child's attention problems. Parents who used CAM rated a "natural therapy" and "having more control over treatments" significantly more important in their choice of therapy than parents who did not use CAM. Only 11% of parents discussed using CAM with their child's physician. Because parents often use CAM to treat their child's attention and hyperactivity problems without their pediatrician's knowledge, pediatricians need to initiate discussions of CAM use with patients and families.
To examine whether herbal medicines were given to children or adolescents receiving care for attention-deficit-hyperactivity disorder or depression.
Between October 2000 and July 2001, a 23-item questionnaire was administered in five community mental health centers in Texas. Parents or primary caregivers of children who received a psychiatric assessment were sought for participation. One hundred seventeen caregivers completed a questionnaire. The main outcome measure was primary caregivers' self-report of the use of herbal therapy in their children.
The lifetime prevalence of herbal therapy in patients was 20% (23 patients). Eighteen patients (15%) had taken herbal medicines during the past year. Recommendations from a friend or relative resulted in the administration of herbal medicines by 61% of 23 caregivers. Herbal medicines were given most frequently for a behavioral condition, with ginkgo biloba, echinacea, and St. John's wort most prevalent. Almost 83% of caregivers gave herbal medicines alone, whereas 13% gave herbal medicines with prescription drugs. Most caregivers (78%) supervised the administration of herbal therapy in their children; the children's psychiatrists (70%), pediatricians (56%), or pharmacists (74%) typically were not aware of the use.
Most caregivers supervised herbal therapy in their children, without communication with a health professional. A need exists for better communication between health professionals and caregivers regarding the use of herbal therapy.