An individual with ADHD finds it much more difficult to focus on something without being distracted. He/she has greater difficulty in controlling what he/she is doing or saying, and cannot control how much physical activity is appropriate for a particular situation, compared to somebody without ADHD – in other words, a person with ADHD is much more impulsive and restless.

Health care professionals may use any of the following terms when describing a child (and an older person) who is overactive and has difficulty concentrating – attention deficit, attention deficit hyperactivity disorder, hyperkinetic disorder, hyperactivity.

ADHD in children is completely different from normal childhood excited and boisterous behavior. Many children, especially very young ones, are inattentive and restless without necessarily being affected by ADHD.

North Americans commonly use the terms ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder). In the UK hyperkinetic disorder is the official term – however, ADD and ADHD have become widely used.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 4.4 million children aged 4 to 17 have been diagnosed with ADHD in the USA by a healthcare professional. As of 2003 two-and-a-half million American children aged 4 to 17 are being treated for ADHD with medicines. The CDC adds that in 2003 7.8% of all school-aged American children were reported to have an ADHD diagnosis by their parent.

Three Types of ADHD

According to the CDC, there are three types of ADHD. They are defined according to which symptoms stand out the most.

1. Predominantly Inattentive Type
The person finds it very difficult to organize or finish a task. He/she finds it hard to pay attention to details. He/she also finds it difficult to follow instructions or conversations.

2. Predominantly Hyperactive-Impulsive Type
This person finds it hard to keep still – he/she fidgets a lot. He/she also talks a lot. A smaller child may be continually jumping, running or climbing. He/she is restless and impulsive – interrupts others, grabs things from others, speaks at inappropriate times. He/she has difficulty waiting his/her turn. He finds it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.

3. Combined Type
A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.

What are the general signs of ADHD?

- the child is restless, overactive, fidgety
- the child is constantly chattering
- the child is continuously interrupting people
- the child cannot concentrate for long on specific tasks
- the child is inattentive
- the child finds it hard to wait his/her turn in play, conversations or standing in line (queue)

The above signs may be observed in children frequently and usually do not mean the child has ADHD. It is when these signs become significantly more pronounced in one child, compared to other children of the same age, and when his/her behavior undermines his/her school and social life, that the child may have ADHD.

What Causes ADHD?

We are not sure. Studies reveal that a person’s risk of developing ADHD is higher if a close relative also has/had it. Twin studies have indicated that ADHD is highly heritable. We also know that ADHD is much more common in boys than girls. The scientific community generally agrees that ADHD is biological in nature. Many reputable scientists believe ADHD is the result of chemical imbalances in the brain.

Some studies have indicated that food additives, specifically some colorings, may have an impact on ADHD behaviors. July 2008, the European Union ruled that synthetic food colorings (called azo dyes) must be labeled not only with the relevant E number, but also with the words “may have an adverse effect on activity and attention in children” .

A 1984 study by Benton and team, demonstrated that sugar has no effect on behavior. A study in 1986 by Milich and Pelham, and another by Wolraich and team in 1985, also found no link between sucrose (sugar) and behavior impact on children with ADHD. However, most sugars found in sugary foods and sweets (candy) consumed by children are corn syrup and high fructose corn syrup – these sugars were not used in any of the above-mentioned studies.

Interesting link
- Possible causes of ADHD (New Zealand’s ADHD Online Support Group)

How do I know if I, my child, spouse or relative has ADHD?

ADHD cannot be diagnosed physically, i.e. with a blood test, urine test, brain scan or a physical check up. As most children have problems with self-control anyway, a proper diagnosis can be quite challenging.

An ADHD diagnosis has to be carried out by a specialist – usually a psychiatrist, psychologist or pediatrician. The specialist will observe the child and recognize behavior patterns – data regarding the child’s behavior at home and at school will also be studied. Only a specialist will be able to accurately detect whether other problems and/or conditions are resulting in ADHD-like behavioral characteristics.

Interesting link
- Diagnostic Criteria for ADHD (ADHD Information Services)

If you do not know how to find a specialist, ask your GP.

When does ADHD start? How long does ADHD last?

According to New Zealand’s ADHD Online Support Group, the onset of ADHD is usually before the person is 7 years old. For about 75% of ADHD sufferers, symptoms continue into adulthood. However, levels of hyperactivity tend to decrease as the person gets older.

Adult ADHD

It was not until the 1970s that researchers began to realize that what we today know as ADHD did not always go away during a person’s teen years. It was during that decade that it was also noticed that some ADHD symptoms were identified in the parents of children undergoing ADHD treatment. In 1978 ADHD was formally recognized as a condition that also afflicts adults, and the term Adult ADD began – the ‘H’ of ADHD was dropped because it seemed the adults were not as hyperactive as children.

According to uspharmacist.com, approximately 8 million adults in the USA have ADHD. An adult with ADHD who is untreated will tend to have a chaotic lifestyle – he/she may seem more disorganized, compared to people who are not afflicted with ADHD. Healthcare professionals believe there are millions of adults who have ADHD but do not know and remain untreated. Studies indicate that adults with ADHD benefit enormously from a combination of medication and behavior therapy.

Here is a list of some ADHD medications

Amphetamines
Adderal (two strengths, one for short period, one for longer periods)
Dexedrine (lower dosage – taken several times a day)

Methylphenidate
Ritalin
Ritalin LA (will last up to 12 hours)
Methylin
Focalin
Focalin XR (will last up to 12 hours)
Metadate CD

Others
Atomoxetine HCI (Strattera)
Bupropion (Wellbutrin XL)
Benzphetamine
Clonidine
Provigil

Useful Organizations
- CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), USA
- ADDISS (ADHD Information Services), UK
- ADHD Australia Incorporated
- CADDRA (Canadian ADHD Resource Alliance)
- ADHD.ORG.NZ, New Zealand

Sources
Royal College of Psychiatrists (UK)
ADHD Information Services (UK)
Centers for Disease Control and Prevention (USA)
ADHD.ORG.NZ (New Zealand)

Written by Christian Nordqvist

View drug information on Focalin; Metadate CD; Ritalin LA

This phase II randomized, double-blind, placebo- and active-controlled crossover analog classroom study in children aged 6 to 12 examined the efficacy and safety of VYVANSE (30 mg, 50 mg or 70 mg) and Adderall XR (mixed amphetamine salts extended-release: 10 mg, 20 mg or 30 mg) compared with placebo.

“This newly published research shows that VYVANSE provided a consistent time to maximum plasma concentration from patient to patient,” said Ann S. Childress, M.D., President of the Center for Psychiatry and Behavioral Medicine, Inc. in Las Vegas, Nev. “This prodrug stimulant also demonstrated significant efficacy up to 12 hours after administration, which is something that my patients’ parents are interested in as it may help to improve their family and homework time in the evening.”

VYVANSE is a therapeutically inactive prodrug in which d-amphetamine is covalently bonded to l-lysine, and after oral ingestion it is converted to pharmacologically active d-amphetamine. Release of the active ingredient in VYVANSE does not rely on gastrointestinal factors such as gastrointestinal transit time and gastric pH.

Study Results Showed that VYVANSE Demonstrated Significant Efficacy for Treatment of ADHD for up to 12 Hours VYVANSE demonstrated significant efficacy for treatment of ADHD for up to 12 hours post dosing, based on the study’s primary efficacy measure, SKAMP-D. Investigators observed a significant difference in patient behavior based upon the average of investigator ratings on the Swanson, Kotkin, Agler, M-Flynn and Pelham Rating Scale deportment (SKAMP-D) scores across eight classroom sessions held during a 12-hour treatment day between patients who received VYVANSE and patients who received Adderall XR, both compared to placebo. The SKAMP-D is a standardized, validated classroom assessment tool used for evaluating the behavioral symptoms of ADHD and higher SKAMP-D ratings reflect greater impairment.

Patients in the study taking VYVANSE also demonstrated significant improvement in math problems attempted as compared to placebo, as measured by the Permanent Product Measure of Performance (PERMP) Derived Measures. When patients were observed at the 12-hour time period, the LS mean change in PERMP math problems attempted from the first measurement was 49 for patients taking VYVANSE and 22 for patients taking Adderall XR, compared to – 24 for placebo. PERMP is an age-adjusted collection of math problems that provides an objective measure of performance based on the number of attempted and completed math problems. This study was not designed as a comparative trial between active treatments.

Low Interpatient Variability Demonstrated

In this study, pharmacokinetic parameters were also measured, which found that the coefficient of variance for time to maximum drug concentration for VYVANSE and Adderall XR were 15.33 and 52.77, respectively. The coefficient of variance is a measure used to determine how much variance there is in the data, with smaller numbers indicating less variability. The coefficient of variance of maximum observed drug concentration for VYVANSE and Adderall XR were 20.34 and 43.96, respectively. The relationship between pharmacokinetics and clinical benefit has not been established.

Safety Assessment

The majority of adverse events reported in this study were mild to moderate in severity. The most frequently reported adverse events for VYVANSE were insomnia (8 percent), decreased appetite (6 percent), anorexia (4 percent) and upper respiratory tract infection (2 percent); for Adderall XR they were decreased appetite (4 percent), upper abdominal pain (4 percent), insomnia (2 percent), upper respiratory tract infection (2 percent) and vomiting (2 percent).

VYVANSE is currently approved in the United States for the treatment of ADHD in children aged 6 to 12 years.

Additional information about VYVANSE and Full Prescribing Information are available at http://www.vyvanse.com.

About ADHD

Approximately 7.8 percent of all school-age children, or about 4.4 million U.S. children aged 4 to 17 years, have been diagnosed with ADHD at some point in their lives, according to the U.S. Centers for Disease Control and Prevention (CDC). ADHD is one of the most common psychiatric disorders in children and adolescents. The disorder is also estimated to affect 8.1 percent of adults, or approximately 9.2 million adults across the U.S. based on a retrospective survey of adults aged 18 to 44, projected to the full U.S. adult population. ADHD is a neurobiological disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. To be properly diagnosed with ADHD, a child needs to demonstrate at least six of nine symptoms of inattention; and/or at least six of nine symptoms of hyperactivity/impulsivity; the onset of which appears before age 7 years; that some impairment from the symptoms is present in two or more settings (e.g., at school and home); that the symptoms continue for at least six months; and that there is clinically significant impairment in social, academic or occupational functioning and the symptoms cannot be better explained by another psychiatric disorder.

Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. The most common standard treatments include educational approaches, psychological or behavioral modification, and medication.

About VYVANSE

Tell the doctor about any heart conditions, including structural abnormalities, that you, your child, or a family member, may have. Inform the doctor immediately if your child develops symptoms that suggest heart problems, such as chest pain or fainting.

VYVANSE should not be taken if your child has advanced disease of the blood vessels (arteriosclerosis); symptomatic heart disease; moderate to severe high blood pressure; overactive thyroid gland (hyperthyroidism); known allergy or unusual reactions to drugs called sympathomimetic amines (for example, pseudoephedrine); seizures; glaucoma; a history of problems with alcohol or drugs; agitated states; taken a monoamine oxidase inhibitor (MAOI) within the last 14 days.

Tell the doctor before taking VYVANSE if your child is being treated for or has symptoms of depression (sadness, worthlessness, or hopelessness) or bipolar disorder; has abnormal thought or visions, hears abnormal sounds, or has been diagnosed with psychosis; has had seizures or abnormal EEGs; has or has had high blood pressure; exhibits aggressive behavior or hostility. Tell the doctor immediately if your child develops any of these conditions or symptoms while taking VYVANSE.

Abuse of amphetamines may lead to dependence. Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events. These events have also been reported rarely with amphetamine use. VYVANSE was generally well tolerated in clinical studies. The most common side effects reported in studies of VYVANSE were decreased appetite, difficulty falling asleep, stomachache, and irritability. Aggression, new abnormal thoughts/behaviors, mania, growth suppression, worsening of motion or verbal tics, and Tourette’s syndrome have been associated with use of drugs of this type. Tell the doctor if your child has blurred vision while taking VYVANSE.

SHIRE PLC

Shire’s strategic goal is to become the leading specialty biopharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on attention deficit and hyperactivity disorder (ADHD), human genetic therapies (HGT), gastrointestinal (GI) and renal diseases. The structure is sufficiently flexible to allow Shire to target new therapeutic areas to the extent opportunities arise through acquisitions.

Shire’s in-licensing, merger and acquisition efforts are focused on products in niche markets with strong intellectual property protection either in the US or Europe. Shire believes that a carefully selected portfolio of products with strategically aligned and relatively small-scale sales forces will deliver strong results.

http://www.shire.com.

The “Safe Harbor” Statement Under The Private Securities Litigation Reform Act Of 1995

Statements included herein that are not historical facts are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, Shire’s results could be materially affected. The risks and uncertainties include, but are not limited to, risks associated with: the inherent uncertainty of pharmaceutical research; product development including, but not limited to, the successful development of JUVISTA® (Human TGF?3) and GA-GCB (velaglucerase alfa); manufacturing and commercialization including, but not limited to, the launch and establishment in the market of VYVANSE™ (lisdexamfetamine dimesylate) (Attention Deficit and Hyperactivity Disorder (“ADHD”)); the impact of competitive products including, but not limited to, the impact of those on Shire’s ADHD franchise; patents including, but not limited to, legal challenges relating to Shire’s ADHD franchise; government regulation and approval including, but not limited to, the expected product approval date of INTUNIV™ (guanfacine extended release) (ADHD); Shire’s ability to secure new products for commercialization and/or development; and other risks and uncertainties detailed from time to time in Shire plc’s filings with the Securities and Exchange Commission, particularly Shire plc’s Annual Report on Form 10-K for the year ended December 31, 2006.

ADHD is a developmental disorder characterized by age-inappropriate inattentiveness, hyperactivity and impulsivity. It is estimated that approximately 2 million children are affected by ADHD, but despite its prevalence, there is a lack of understanding about the neurobiological basis of the disorder. While prior studies conducted have examined the brains of children with ADHD, most previous imaging studies have focused on measuring the size (volume) of brain regions. In this study, researchers went further by utilizing computer generated images, or “brain maps” for each subject that allowed them to examine and measure other important structural features, including surface area, thickness and folding throughout the brain as well as within specific regions. Investigators hypothesized that children with ADHD would show decreased cortical volume, thickness and surface area, with the greatest abnormality localized to the frontal lobes, important for control of attention and behavior.

The study found that children with ADHD showed a greater than 7 percent reduction in total cerebral volume (TCV) compared to the control group of typically developing children, which is consistent with previous research findings. Additionally, children with ADHD showed reduced cortical volumes and surface area of the brain compared to typically developing children, with a reduction of more than 8 percent in each brain hemisphere. As the study looked beyond just volume, additional measures of brain structure revealed that children with ADHD showed a significant decrease in cortical folding across the entire cerebral cortex, even after accounting for the decrease in TCV. No significant difference in thickness was detected. These results indicate that cortical folding is an important contributing factor to the reduced cortical volume observed in ADHD.

“These findings are an important step towards understanding the origin and development of ADHD, providing a clearer picture of the brain structure abnormalities associated with the disorder,” said Dr. Stewart H. Mostofsky, senior study author and a pediatric neurologist in the Department of Developmental Cognitive Neurology at the Kennedy Krieger Institute. “Although the neurobiological basis of ADHD is yet to be established, our findings bring us one step closer to understanding how the disorder develops based on neurological features and not just the symptom profile.”

Cortical folding begins in early development of the fetus (around 16 weeks of gestation) and reaches its peak around 18 months of age, which is followed by a gradual leveling out to adult levels at about 23 years of age. During development, when the cortex can no longer expand radially due to the size of the skull, the only way to increase the surface area is if the cortex becomes more folded. Cortical folding, therefore, is critical to increasing the structural and functional capacity of the brain.

Researchers examined children ages 8-12 years, including: 21 children with ADHD and a control group of 35 typically developing children who matched in age and gender. Participants were recruited from outpatient clinics at the Kennedy Krieger Institute, local area pediatricians, local chapters of Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) and through advertisements in the community. While many prior imaging studies have included children with ADHD who had other associated (“co-morbid”) neuropsychiatric or developmental diagnoses, this study excluded children with ADHD who also had a history of other neuropsychiatric diagnoses including conduct disorder, mood disorder, generalized anxiety disorder, separation anxiety disorder and/or obsessive-compulsive disorder. Additionally, none of the children had a learning disability or a history of speech/language disorders.

In the future, Dr. Mostofsky and his colleagues hope to further examine the relevance and implications of cortical folding in ADHD and its potential applications for early diagnosis. Studies examining larger numbers of children will allow researchers to better understand the association between cortical folding and the behavioral features of ADHD. Furthermore, evaluating changes in cortical folding over extended periods of time, beginning in early childhood, will provide useful insight into the brain basis of the disorder.

About the Kennedy Krieger Institute

Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 13,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis.

Mezzacappa studied nine grade school students who had been diagnosed with ADHD as they completed the Cogmed Working Memory Training program. Each student was screened positively for ADHD based on teacher ratings and was not receiving any form of treatment for ADHD. The students used video-game software developed by Cogmed to perform verbal and spatial working memory tasks five days a week, for five weeks.

“Our pilot study indicated that the training of working memory in school settings may be a feasible, safe, and effective way to help children with ADHD that warrants further investigation,” Mezzacappa concluded in the study. “It offers the possibility of stimulating cognitive skills that are critical to mental health, to cognitive development and academic achievement. It may also be readily disseminated through schools so as to reach many children who might not otherwise receive treatment.”

“We are thrilled that researchers like Dr. Mezzacappa continue to put the Cogmed program to the test,” said Jonas Jendi, Cogmed’s chief executive officer. “Across several recent studies, the conclusion is clear: Cogmed Working Memory Training translates to measurable improvements in behavior and in the key areas for academic success for students with attention problems. Working memory is critical for learning, and it can be improved by training, properly designed and administrated.”

Dr. Mezzacappa presented the results during the American Academy of Child and Adolescent Psychiatry annual meeting in Boston, on October 24th. Dr. John C. Buckner, psychologist and also of Harvard Medical School and the Children’s Hospital in Boston, is co-investigator in the study.

About Cogmed

Cogmed has made a breakthrough discovery that individuals can train and improve their working memory, a key function of the brain that allows individuals to store information for brief periods of time. Cogmed Working Memory Training helps people with attention deficits improve focus, impulse control and complex problem solving. Through a combination of software-based working memory exercises and personal coaching, participants engage in a challenging program computer at home. Cogmed was founded in 2001 and is headquartered in Naperville, Ill. Cogmed’s services are provided by a growing network of more than 50 expert practices around the U.S.