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Posts tagged ADD
Consistent Use of ADHD Medication May Stunt Growth by 2 Inches

According to the article, "Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds", written by Dr. David Rabiner, "although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists". The Multimodal Treatment Study of ADHD (MTA Study) tested 600 7–9-year-old children with ADHD. These children were randomly assigned into one of these four groups: 
1. Carefully monitored medication treatment
2. Intensive behavior therapy
3. Medication treatment combined with behavior therapy
4. Community care (parents obtained whatever treatment they want)

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After 14 months, the study showed that those children who received carefully monitored medication treatment or medication treatment combined with behavior therapy had lower levels of overall ADHD symptoms and better overall adjustment compared to those children who received intensive behavior therapy or community care. The results stayed the same after an evaluation 10 months later. However, evaluation after 1 year and again after several groups showed no group differences based on the initial group treatment assignments. Therefore, the initial benefits of the medication had disappeared. The study continued annually through age 18 and then reduced visits to age 25. Within this group, individuals were categorized based on their medication usage:
a. Consistent, i.e,. those who had met the minimum threshold during each year;
b. Inconsistent, i.e., those meeting the minimum threshold in some but not all years; and
c. Negligible, i.e., below the minimum threshold in all years. 

At the last evaluation, age 25, participants self- and parent-reported, and doctors measured the patient's height compared to other individuals around the area that had not been diagnosed with ADHD in their childhood. Based off of the medication categorized above, only 14.3% of participants consistently used medication through age 18. After comparing the other participants, participants with ADHD maintained substantially higher ADHD symptoms over time regardless of their initial treatment. It was clear that ADHD symptoms in young adulthood are not related to patterns of medication use through adolescence. 

There was thus no indication that consistent medication treatment over a number of years had any persistent impact. However, there was a relationship found between persistent medication use and adult height. According to Dr. Rabiner, "Students in the Consistent and Inconsistent medication treatment groups had average heights — combined across these groups — that were about an inch shorter than those in the Negligible treatment group. And, participants in the Consistent Group were nearly an inch shorter on average than those in the Inconsistent group, i.e., nearly 2 inches shorter than those in the Negligible group". 

Overall, the study concluded there was substantial persistence of ADHD symptoms into adulthood and although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists. However, it is possible that some other factor that contributed to some participants taking medication more consistently, e.g., more severe symptoms, also explains the reduced height attainment in this group.

There are many take home messages:
1. Relatively few youth with ADHD use medication consistently over their development.
2. Many individuals with ADHD will continue to struggle with ADHD symptoms into adulthood. 
3. Although medication helps control symptoms in the short-term, it is not a cure.
4. It is unknown whether optimal medication treatment maintained over many years would have a greater impact.
5. Parents and clinicians need to balance the need for persistent treatment in some children with the likely consequences of reduced adult height. 

Due to the symptoms that may occur from using persistent medication, an optimal solution would be to find the lowest effective dose of medication, or combine medication treatment with other behavior therapy and/or other approaches.

If you have questions about ADHD and how it can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Rabiner, David. “Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds.” SharpBrains, SharpBrains, 28 Mar. 2018.

Broken Brain

Mark Hyman MD is the Director of Cleveland Clinic’s Center for Functional Medicine, the Founder of The UltraWellness Center, and a ten-time #1 New York Times Bestselling author. At the peak of his career, he suffered a broken brain, causing him to turn into someone he no longer recognized. He felt like he suffered from depression, ADD, and dementia all at once. 

The epidemic of the broken brain is something you feel, hide, and fear. It is the leading cause of disability and effects 1.1 billion people around the world. 1 in 6 children, 1 in 2 elderly, and 1 in 4 people during their lifetime are effected by this epidemic. Mark Hyman MD created a docuseries, Broken Brain, to help transform your understanding of brain health. It is a series describing everything he learned on his journey to curing his broken brain, as well as diving in to the top brain disorders and learning why they happen and how to address their main root causes. This docuseries reveals what conditions like Alzheimer's, Dementia, ADHD, Autism, Depression, Anxiety, and Brain Fog have in common. Many root causes of brain disorders are outside of the brain. The rest of the body can play a huge part on mood, memory, attention, and behavior problems. 

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Of all the highlights and benefits learned from this eight episode series, here are the top 5 take aways Mark Hyman MD and his team learned from the Broken Brain docuseries. 

1. The Gut-Brain Connection
According to Dr. Raphael Kellman, gut and brain expert, "Embryologically, the gut and the brain start out at the same point, and then one goes up and one goes down. When two cells start from the same place, they always retain a memory for each other. They’re constantly speaking to each other in so many different ways. They’re communicating messages to each other. These messages are part of a communication system that really outshines any type of communication system that we know of today with our modern technology." The gut is considered your second brain. Therefore, a healthy gut leads to a healthy brain. By keeping our intestines and microbiome healthy and clean, our brain will remain healthy. 

2. Brain Health is Connected to Blood Sugar
Blood sugar is related to a healthy brain, especially memory loss. Experts are calling Alzheimer's type 3 diabetes. Dr. Ann Hathaway states, "When your blood sugar is high, it pumps your insulin high, and insulin is inflammatory. Inflammation is a major factor in cognitive impairment and Alzheimer’s disease. Also, high blood sugar causes something called glycation, where the proteins throughout your body, including in your brain, get a sugar molecule added to them. That addition of a sugar molecule to a protein is damaging—that’s actual damage to that particular molecule in your brain." It is important to keep your blood sugar low so that no additional sugar molecules damage your brain. 

3. The Thyroid and Your Brain
An unhealthy thyroid can cause anxiety, depression, brain fog, and many other mental health disorders. Dr. Izabella Wentz suggests, "For people with Hashimoto’s and for thyroid disease, focus on eating a whole-food-based diet that’s minimally processed. I’ve seen the most benefit from patients going on a Paleo diet, as well as the Autoimmune Paleo Diet. We see symptoms like headaches, panic attacks, palpitations, weight gain, fatigue, all these symptoms begin to melt away when we get rid of the reactive foods and focus on eating organic, wild-caught, and real foods." 

4. The Role of Fats in Brain Health
A low-fat diet is not always the answer. By avoiding all fats, we avoid the good fats. Dr. John Ratey states "omega-3 fatty acids are perhaps as good a treatment for things like bipolar illness as are some of our bipolar drugs. With that came a whole lot of research looking at omega-3s as a way to treat mood, anxiety, ADD, and autism. It has a positive effect on all of those pervasive problems. Plus, it’s great for the heart, skin, bones, the connections in our body, and also treats arthritis and the like.” Don't cheat yourself of the fats your body and brain need to stay healthy.

5. The Role of Community in Brain Health
One of the biggest take aways these experts had from this docuseries is the importance of community. According to John Ratey, "real connection is vital, and I call this vitamin O—vitamin oxytocin. Oxytocin is the thing that mammals get when they’re in a community, touching one another, hugging, and they’re sitting down eating together. That sharing, that social bonding that happens, that glue that cements us together is really important." As we grow older, it is important to remember to take our prescribed medicine, get exercise, but most importantly stay social and connected to your community. 

Watch the entire 8 episode docuseries for free to learn more about your brain health. Watch episode 4 to learn more about ADHD and autism. Watch episode 5 to learn more about anxiety and depression.

If you have questions about these services and how they can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Hyman, Mark. “5 Things We Learned from the Broken Brain Docuseries.” Dr. Mark Hyman, Hyman Digital, 5 Jan. 2018, drhyman.com/blog/2017/10/27/5-things-learned-broken-brain-docuseries/.

Adult ADHD: How is it different than childhood ADHD?

As mentioned in a previous news post by Dr. Filizetti, Attention Deficit/Hyperactivity Disorder (ADHD) may "look" different in adults when compared to children. We know that ADHD persists into adulthood; however, it tends to affect adults differently than children. When we think of childhood ADHD, we often picture the hyperactive child that cannot sit still and struggles to focus in class. However, hyperactivity remits in adulthood, and is apt to interfere with ones performance in different ways. For example, adults with ADHD may be at higher risk for driving difficulties or speeding through traffic.  Adults may also struggle with reading comprehension or sustained attention while reading.

As required for a diagnosis of childhood ADHD, symptoms must be evident in multiple settings, and interfere with the person’s ability to succeed in a variety of areas. In children, ADHD interferes with  performance at school, home, and sports. However, adult ADHD may impact relationships, college  coursework, and/or ones ability to succeed in the workplace.

Adult ADHD: Assessment and Treatment

As with childhood ADHD, adult ADHD is evaluated and diagnosed by a psychologist. When you meet with the psychologist they will likely ask you about your personal history, observe you behaviorally, and administer a variety of tests to assess whether or not you meet criteria for ADHD. Upon completing an ADHD evaluation, the evaluator will recommend various types of treatments that best fit your individual needs. Treatment for adult ADHD includes: Neurofeedback, Biofeedback, Cognitive-Behavioral Therapy and/or medication management.

For more information about assessment or treatment of ADHD, feel free to contact Dr. Filizetti. Written by Dr. Kirstin Filizetti.