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The ADD / ADHD GAZETTE
The FREE online ezine all about the issues surrounding ADD
/ ADHD and co-morbid conditions and syndromes. This
wonderful community has now grown to 1,948 subscribers!
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*** ISSUE #13 *** July 17th 1999


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IN THIS ISSUE:

#1 -- NEWS & VIEWS

#2 -- ARTICLE: Medication treatment for child and adolescent
psychiatric disorders: What is the evidence?

#3 -- RESOURCES

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IMPORTANT DISCLAIMER
Items in this newsletter are published for educational and / or
informational purposes only. Any therapy, product, service, or
featured web site mentioned here, does NOT imply endorsement
or approval by The ADD / ADHD Gazette. The accuracy and
content of any web sites featured here cannot be guaranteed.
Thoughts, views and statements written by contributors are
not necessarily the views of The ADD / ADHD Gazette.
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# 1 News & Views

Phew! What a response to the survey I sent out the other week!
It will take me quite a few weeks to sort through them all but
already, skimming through I have noticed some wonderful
suggestions from readers and I WILL be taking note of your
opinions for improvements to The Gazette.

When I get the results, rather than using up an issue, and
possibly alienating new subscribers who sign up and then get
the results of some survey, I might put the results on
autoresponder, so anyone who wants to take a look at what
came out of the survey can do so at their leisure. Anyway, I
feel the survey has been most helpful and thereWILL be
changes in the future.

---------------

It has been a hectic few weeks! My Father has been in
hospital AGAIN this week, the fourth time in 6 weeks. He is
very ill and had to be put on life support for 2 days this
week. Also the school holidays are upon us here in Britain
(groan) so the kids are building up to it and I have already
got my hands full trying to keep my two apart!

Also, I am launching my new newsletter and website;
Homeworking Parents, "For parents everywhere who are
making their living from home, either on line or off"
http://www.onelist.com/subscribe.cgi/HomeworkingParents
so I have been very busy getting the launch issue off the
ground. I can assure you however, that the quality of
*this* newsletter will stay the same. Gail

-----------------------

Does anyone know if there is any info on ADD in other
languages. One of the children I am concerned about comes
from a multilingual family, but mother only feels comfortable
reading French/Portuguese. Thanks
kathleen_anne@...

-------------------------

NEW THERAPY COMING TO UK - AN HISTORIC
MOMENT FOR ALL CONCERNED ABOUT AD/HD

Imperial College School of Medicine is to start testing a
remarkable NEW THERAPY for attention problems from USA.
This is comes after two years of negotiations and a
transatlantic trip for Professor Gruzelier instigated and funded
by The Rescue Foundation.

The therapy requires no drugs, surgery or other invasive
procedures, just training the child to regulate their own brain.

It has been known for many years that children with attention,
hyperactivity and learning problems often have abnormal brain
waves (EEG) and that they can be trained to alter them. Professor
Lubar of Tennessee has demonstrated repeatebly that when
these children self-regulate their brain waves the symptoms of
inattention and hyperactivity diminish or disappear altogether!
But …. the first children that will have the opportunity to try
this remarkable therapy in the UK will be those enrolled on the
research programme that is validating the therapy for the UK.
The intention is to train appropriate professionals to make the
therapy more widely available hopefully through the NHS. But
frankly - that's at least three years off. What we need now is
financial support to match the £30 000 that The Rescue
Foundation is putting into this exciting project that could
mean a very positive future beyond 2000!

BECOME ONE OF THE PROJECT'S ANGELS BY
REGISTERING NOW:
For further details email haydn456@...

-----------------

There has been some concern recently about email addresses being
obtained and added to mailing lists. As you know this newsletter is
sent out via onelist.com and the following was obtained from
Onelist's bulletin this week. I hope this may allay readers'
fears about leaking email addresses.

"We are pleased to announce that TRUSTe has stamped
ONElist with its seal of approval for implementing a robust
set of privacy and anti-SPAM policies and practices.

"TRUSTe conducted a thorough review of ONElist's service
and found that its privacy policy meets TRUSTe's high
standards," said Bob Lewin, executive director at TRUSTe.
"TRUSTe and ONElist will work together to ensure that
ONElist's data collection and protection practices continue
to meet TRUSTe's guidelines."

All of us at ONElist are highly committed to ensuring
that our customers' privacy is protected at all times and
we continue to research new ways to implement even stricter
measures against SPAM.

http://www.onelist.com/info/privacyspam.html

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#2; Medication treatment for child and adolescent psychiatric
disorders: What is the evidence?

There was a very important paper that appeared in the May,
1999 issue of the Journal of the American Academy of Child
and Adolescent Psychiatry on the use of medication for
treating psychiatric disorders in children and adolescents
(Jensen, P.J., Bhatara, V.S., Vitiello, B., Hoagwood, K., Feil, M.,
& Burke, L.B. (1999). Psychoactive medication prescribing
practices for U.S. children: Gaps between research and clinical
practice). In this paper, the authors examine the frequency with
which different medications are prescribed in relation to what
research data exists for the safety and efficacy of the different
meds. Although this encompasses disorders other than ADHD,
I think this is quite an interesting and important paper to include
in ADHD RESEARCH UPDATE.

There are 8 classes of medications that were looked at in this
paper. Each class of medication, examples of brand name
meds from each class, and the type of disorder it is typically
prescribed for are presented in the table below. The problem(s)
each class of medication are prescribed for is listed under
each general medication class. (Note: The medications listed in
the Selected Examples column are just examples of medications
from the general category.)

Medication class/ Selected Examples
Problem prescribed for

STIMULANTS Ritalin, Adderall

ADHD

SSRIs (Selective Fluoxetine (Prozac)
serotonin reuptake
inhibitors) sertraline
Major depression, obsessive compulsive disorder, and
other anxiety disorders

CENTRAL ADRENERGIC
AGONISTS Clonodine
guanafacine
Tourette's and ADHD

ANTICONVULSANT Valproate, carbamazepine
MOOD STABILIZERS
bipolar disorder

TRICYCLIC ANTIDEPRESSANTS Elavil, imipramine
major depression and ADHD

BENZODIAZEPINES alprazolam, clonazepan
used to treat anxiety disorders

ANTIPSYCHOTICS Risperidone, haloperidal
used to treat childhood schizophrenia and other psychotic
disorders, and Tourette's

LITHIUM
used to treat bipolar disorder and sometimes used for aggressive
behavior disorders

In terms of the frequency with which these different classes
of medication are prescribed, the numbers differed somewhat
depending on which national data base the estimates are
based on. Not surprisingly, stimulant medications are far
and away the most frequently prescribed medication in child
psychiatry. The best estimates available are that stimulant
medications were prescribed in nearly 2 million visits for
patients under the age of 18 during 1995. This is between 5
and 10 times the next most-frequently prescribed class
of medications, the SSRIs. Even the least-frequently
prescribed medication in this listing was estimated to have
been dispensed to thousands of children, however.

One clear conclusion made by the authors is that it is really
quite difficult to obtain accurate estimates of just how often
psychoactive medications are being prescribed to children and
teens in this country. In fact, the best data that exists is
probably on the prescription of stimulant medications for ADHD.
Clearly, having more accurate data on the use of such medication
for children and teens would be very useful to have.

What about the evidence supporting the efficacy and safety
for the use of such medications in youth? The authors examine
this in relation to what is known about both short- and long-
term efficacy, and short- and long-term safety. The grading
scale they used, and the criteria for the different grades are
shown below:

Efficacy Ratings
A - Efficacy supported in at least 2 or more randomized, controlled
trials. These would be studies in which children's response to
medication was compared to how they responded to a placebo;

B - Efficacy supported in at least 1 randomized controlled trial;

C - Efficacy supported by "informed" clinical opinion, case reports,
or non-placebo controlled trials. This would generally be
considered only an initial stage in documenting the efficacy of a
pharmacologic treatment;

Safety Ratings

A - Low incidence of adverse event reports to the FDA. That is,
adverse effects that could be attributed to the medication have
been infrequently reported.

Note: This is not the same as having safety data established based
on long-term randomized and controlled clinical trials. As the
authors note, however, conducting such trials for for long-term
safety data may be neither ethical nor feasible.

B - Clinically significant adverse event reports restricted to case
reports and/or anecdotal reports, suggesting possible rare side
effects.

C - No data or minimal data supporting long-term adversity or
safety. In other words, little about the long-term impacts are
really know, one way or the other.

Using these criterion, the grades assigned by the authors based
on their review of the literature are shown below. Note that
STE=short-term efficacy, LTE=long-term efficacy, STS=short-term
safety, and LTS=long-term safety.

Medication STE LTE STS LTS
class

stimulants A B A A

SSRIs B C A C ratings for major depression
A C A C ratings for OCD
C C C C ratings for other anxiety
disorders besides OCD

Central B C B B for Tourette's
adrenergic C C C C for ADHD
agonists

Anti-convulsant C C A A for bipolar disorder
mood stabilizers

Tricyclics C C B B for major depression
B C B B for ADHD

Benzodiazepines C C C C for anxiety disorders

Antipsychotics B C B C for schizophrenia
A C B B for Tourette's

Lithium B C B B for bipolar disorder
B C C C for aggression

Please note that these grades are based on the authors' review,
and other experts in the field might conceivably come to somewhat
different conclusions. Overall, however, the ratings indicate
important gaps in current knowledge. As you can see, not a
single of the most frequently used medications for treating child
and adolescent disorders received grades of A across the board.
Stimulant medications for treating ADHD came closest, and I think
that soon-to-be-published studies on long-term efficacy will
turn this into an A grade quite shortly. In contrast, the long-term
efficacy grade for every other medication was a C.

Remember, this does not mean that these compounds are not
effective for the designated use. Instead, it means that solid
scientific data that documents long-term efficacy is not yet
available.

Practitioners are using these meds based on clinical opinion,
case reports, and uncontrolled trials. Even when it comes to
short-term efficacy, only two other classes of medication
received A grades for treating a particular disorder.

There are several important points that can be taken from this
excellent review paper. First, one could certainly make a case
that these medications are being over prescribed, given the
efficacy and safety data that is available to support their use.
For example, given the frequency with which antidepressant
medications are prescribed for children and teens, the relative
lack of scientific support for this is quite surprising. To date,
there has been but a single published study in which an
antidepressant produced significantly better effects than a
placebo in younger depressed patients (this was for fluoxetine -
the generic form of Prozac - and where the results were 56%
improved on fluoxetine vs. 33% on placebo). Clearly, there is
a pressing need for more scientific study of these medications
for treating children and teens.

Second, when one looks at the data above, it is surprising how
much controversy there continues to be about the use of
stimulant medications for treating ADHD relative to the use of
the other medications listed. Clearly, stimulant medications have
the best established efficacy and safety data available, even
though more work in this area is also called for. If as much
supportive data was available for these other medications as is
currently available for stimulants, however, we would be much
further along in our knowledge than we currently are.

Finally, I think these data suggest that one should be
cautious about using medications to treat most psychiatric
conditions in children and teens. With certain exceptions, the
data to support the use of medications is not so compelling that
one would not want to carefully explore other treatment options.

The authors - 3 of whom are child psychiatrists heavily involved
in research - close their paper with the following statement:

"The lack of safety and efficacy data for psychotropic
medications is of general concern, not just for parents of children
with mental illness and their physicians, but for all with a stake in
the future of the nation's children."

They lay out a set of recommendations for helping to close
these important gaps in knowledge that will hopefully be heeded
by researchers and pharmaceutical companies in the years ahead.

------------------------------------------------------------------------
------------
The above article comes from David Rabiner's ADHD RESEARCH
UPDATE. David Rabiner, PhD Licensed Psychologist. Visit
http://www.helpforadd.com for information and services designed
to help parents promote healthy development of children with ADHD.

Receive a FREE trial of ADHD RESEARCH UPDATE by going to
http://www.helpforadd.com/nresearch.htm

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#3 Resources

New e-mail group for Canadians who are touched by Asperger's
or related Syndrome. This could be yourself, family member,
teacher, case worker, youth worker etc...
http://www.egroups.com/group/canadianasperger/info.html

also

An Asperger's webring for anyone running a webpsite
about Asperger's. Join at
http://www.cgocable.net/~pblack/intro.html

For British parents of AS children there is a discussion
mailing list too. To subscribe go to
http://www.onelist.com/subscribe.cgi/AspergersUK
This is a very friendly list with some super people
involved. If you are in Britain, it is a must.

http://www.britesparks.com/currents/index.htm
Britesparks' Currents is a site for families and teachers of
gifted children with social, emotional and/or mental challenges.

Homeschooling Gifted Children Resources
http://www.britesparks.com/homeschl/index.htm
A site for those homeschooling gifted children and those
considering it. Lots of specialised resources in one place
and the strength of a greater community to help cradle those
feeling isolated.

Britesparks Education Resources
http://www.britesparks.com/education/index.htm
This is the new home of the Educational Sweets and the
Onestone Awards. (There's almost 100 new sweets links and
a new theme section on insects this month as well) Resources
for teachers and educators of gifted children also.

and

Profoundly Gifted Arsenal
http://www.britesparks.com/egpgadv/index.htm
Site dedicated to parents and advocates of exceptionally and
profoundly gifted children.

Results of a national survey show that American families with
severely mentally affected children show almost a quarter of
all parents are forced to give them up to get services.
http://www.intelihealth.com/enews?231699


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LINKS
If you have a website and are looking for links. I am happy to add
a reciprocal link to The ADHD (UK) Website. Take a look at my
site at http://www.gailmiller.clara.net and email me to swap links

BACKISSUES
You can now access on line back issues of the ADD / ADHD
Gazette at http://members.tripod.com/add_add_add

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SEE YA NEXT TIME ~ Gail Miller 1999 gailmiller@...