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ADHD and Tic Disorders
May 14, 2011
Tic Disorders can co-occur with ADHD 8-15% of the time. In other words, children diagnosed with ADHD are at greater risk for developing tics than the general population. If you have a child with ADHD, know what to watch for. Tics can be either motor tics (involuntary muscle movements) or vocal tics often characterized by throat clearing, repetitive cough, or other involuntary noises. Motor tics frequently involve muscles around the face or neck area, but can occur anywhere. Vocal tics, particularly of the throat clearing/coughing type, tend to be initially mistaken as an allergy.
If your ADHD child does develop tics, don’t panic. Most of the time tics are benign and kids grow out of them even with no medical intervention. The peak age for symptoms of tics is approximately age 10 or 11 and then by adolescence usually the tics will begin to fade. Knowing that tics will generally improve on their own, how do you decide when to treat them? My simple answer – treat the tic if it’s bothersome to the individual and/or interfering with daily functioning. The decision should be a collaborative one among the patient, the patient’s family, and the treating physician.
Some of the medications we use to treat tics are actually blood pressure medications called clonidine and guanfacine. They work well to decrease the frequency and severity of tics. If you do decide to try these medicines, be patient. They take time to work and initially can cause some sedation, particularly in the first few weeks.
In children with combined ADHD and tics, prior studies have shown stimulant medications can exacerbate tics so the treatment may simply be to stop the stimulant. This is not to say that stimulant medications cause tics, in fact they don’t. Many patients with ADHD and co-existing tics are able to successfully take the stimulants. If however the stimulant medications do cause problematic side effects for your child, remember there are also non-stimluant medications for treating ADHD such as Strattera or Intuniv.
In summary, tics are fairly common with ADHD, are usually benign, and tend to improve by late adolescence even without treatment. Be able to recognize symptoms of motor and vocal tics in your ADHD child so you can talk to your doctor about treatment options.
Theresa Cerulli, M.D.
Brand vs. Generic Medications – Does It Matter?
February 23, 2011
Taking prescription medications can be cumbersome. It certainly challenges ones working memory skills to remember the names of medications we take, the dose, what time of day to take it, what the pill is for, the side effects, where we store it in the house so we can find it when we need it, when to call the doctor for a refill, the list goes on. To add more confusion to the mix, most prescriptions have two names, the brand name (like Benadryl) and it’s generic name (diphenhydramine). So I’ll share a question patients frequently ask me – does it matter?
Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!
When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.
Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.
Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.
Link found between APGAR scores at birth and future risk of ADHD
February 14, 2011
According to a recent study in the Journal of Pediatrics, Neonatal Health Can be Associated With Risk For AD/HD.
ADHD is known to be highly genetic. Approximately 77% of the time someone diagnosed with ADHD has the condition because of the genes they carry. However, genes are not the only factor. Researchers are finding other issues can “correlate” with ADHD. In this recent study published in January’s Journal of Pediatrics researchers show that neonatal health is an important risk factor for ADHD.
An astounding 980,902 children born in Denmark between 1988-2001 were monitored. The baby’s health immediately after birth was measured by commonly used Apgar scores. Then all children were followed from age 3 until a diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first.
The results – The lower the Apgar score the greater the risk for the child developing ADHD. Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children than with Apgar scores of 1 to 4 and 63% higher for those with Apgar scores of 5 to 6.
Doctors concluded from this study that a low Apgar score is associated with risk of ADHD in childhood. Perhaps low Apgar scores and ADHD share common causes, or a low Apgar score reflects at least one possible pathway leading to ADHD.
Working Memory and Public Speaking Anxiety
December 4, 2010
I have been helping speakers with their presentation skills for many years now, and the more I learn about working memory (WM) the more I wonder whether a weak WM can be a source of public speaking anxiety. WM is the ability to hold on to information while you use it in your thinking. A good WM can help a speaker screen out distractions while he/she addresses one point at time. If the mind is preoccupied with audience approval or thoughts of impending calamities, accessing that information no matter how well rehearsed may be faulty. This also goes for the Q and A session where one must screen out distractions, remember the question and relate an answer. Public speaking requires some fancy “multi-tasking” no doubt. The question is: would improving one’s working memory make one more comfortable in front of a crowd?
Rebecca Shafir M.A.CCC
ADHD Assets: Making a Difference
November 15, 2010
Some very successful people think of their ADHD as a tremendous asset. David Neeleman, CEO of JetBlue Airways, for example, credits ADHD with giving him the creativity that helped him develop an electronic ticketing system and pioneer several discount airlines.
So, when I read a recent Boston Globe article on Billy Starr, the founder of the Pan Mass Challenge, I instantly thought of many of my compellingly interesting, non-cookie cutter clients and their strengths.
You might also find it interesting, so I’ve attached it. (For those of you want to scan, I bolded the parts that made me wonder about ADHD, and took a few sentences out for brevity.)
Pedalers of Hope Boston Globe, November 12, 2010
The older I get, the more I realize how little I know, which is exactly what I was thinking as a guy named Billy Starr described the annual event he founded and runs known as the Pan-Massachusetts Challenge.
I had heard of it. Everyone’s heard of it. It’s a bike ride, a big one, in which cyclists in Spandex solicit money from friends to pedal unimaginable distances over a couple of days.
And then these maddeningly cheerful people give the proceeds to a worthy cause.
For the record, he looks like his name, with a mop of sandy hair parted Pete Rose-style in the middle and an athlete’s build that makes him look a decade younger than his 58 years. He is in constant motion, arms flailing, head bobbing, even when he thinks he’s sitting still. The guy rides his bike up Mount Washington on a Sunday with less effort than another man might lug a bowl of Brigham’s ice cream to the couch to watch the Patriots on TV.
His Pan-Mass Challenge headquarters is located in an utterly charmless single-story building in a generic Needham office park.
Things get worse inside. There were cords everywhere. The staff apparently collects trash for a hobby. There’s neither reason nor rhythm to how desks are scattered. The place makes the Globe newsroom seem like the Four Seasons Dorchester.
Billy Starr is proud of this, too. In his separate cinderblock office, I ask him how the Pan-Mass Challenge (PMC, in the lingo of those around it) compares to, say, the Avon Walk for Breast Cancer, or the Walk for Hunger.
He looks stunned.
“We raise more money in Massachusetts than all of them combined,’’ he said.
Where do you rank in terms of the biggest events like this in the country?
Now he looks hurt. “We’re the biggest in the world.’’
… tonight, at Fenway Park, he will present a check for $33 million to the Jimmy Fund and the Dana-Farber Cancer Institute, the entire proceeds from the August ride.
… the PMC’s total contribution to Dana-Farber to a mind-boggling $303 million in cold, hard, lovable cash over 31 years. Dana-Farber is the exclusive recipient of PMC money.
To put this in perspective, you would basically need a charity with $650 million in assets — nearly the size of the Boston Foundation — to reliably spin off $33 million a year in grants. And that charity is going to have a lot more than the half-dozen staffers that the PMC does — and a more expensive office.
Dana-Farber’s chief executive, Edward J. Benz Jr., is unequivocal in the importance of the PMC to his institution. “We couldn’t give the care we want to give, or have the cutting-edge research we want to conduct, if it wasn’t for the PMC,’’ he told me.
What began in 1980 with a group of 36 friends raising $10,000 has turned into 5,000 cyclists raising money from 230,000 contributors to ride as many as 190 miles over two days, all of it staffed by 3,100 volunteers. Starr founded the ride after his mother, cousin, and uncle died of cancer in the 1970s.…
Brian McGrory is a Globe columnist. He can be reached at mcgrory@globe.com
P.S. If you have ADHD, I hope this story helps you recognize and appreciate the gifts of your biology. And, for spouses and partners, please take a moment to recall what attracted you to the high-intensity, creative, different-minded man or woman you are with. Wouldn’t it be great if Billy Starr’s partner (if he has one, I didn’t research that!) was able to recognize how much his temperament (maybe ADHD, I don’t know) fueled the success of this amazing project.
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