Comment: The need for knowledge
Nikos Myttas
pp 3-3
It is often the case that parents of children with a confirmed or suspected diagnosis of attention deficit hyperactivity disorder (ADHD) will volunteer, much to the embarrassment of their children, that the latter are ‘immature’. By that, they primarily mean a delayed socioemotional development that compromises interactions with their peers, resulting in them being avoided, bullied and/or excluded by their peer group. This is an early finding that peaks during middle childhood, when bullying incidents in schools are at their highest. The literature search by Kevitiyagala and Finlay sought to identify articles that found a correlation between ADHD, whether treated with medication or not, and delayed gonadal (pubertal) maturation, with the answer that no conclusive link has been demonstrated to date. Most studies looking at delayed puberty have found a constitutional component in about 50% of cases and there might be an association between ADHD (with or without hyperactivity) and delayed puberty among those with constitutional delay and functional hypogonadotropic hypogonadism, suggesting that future studies should look at the underlying mechanisms of ADHD and the factors that control the onset of puberty.
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ADHD and delayed puberty: is there a link?
Diluki Kevitiyagala and Fiona Finlay
pp 4-6
Over a three-month period in 2012, we saw four boys aged between 14 and 15 with attention deficit hyperactivity disorder (ADHD) in clinic with delayed puberty. Only one boy was on medication to treat his ADHD, while the mother of another said, ‘I thought he was delayed because of his ADHD’. This led us to ask ourselves whether there was a documented link between ADHD and delayed puberty. Delayed puberty is generally defined as a lack of secondary sexual characteristics from the age of 14 in boys and 13 in girls. In boys, this includes the absence of testicular development (testicular volume less than 4 ml) and, in girls, a lack of breast development. Most of the theories around whether ADHD is associated with delayed puberty focus on the use of stimulant medication. On the website Healthy Children (www.healthychildren.org), Dr Norman Spack states that a side-effect of the use of stimulant medication in ADHD is suppressed appetite, which, in turn, may lead to pubertal delay, either indirectly initiated or aggravated by the fact that the children are not consuming enough calories. A study to examine whether methylphenidate damaged DNA found, as an incidental finding, that high doses of the drug reduced the size of the testes and delayed the descent of testes in male monkeys younger than five years old, compared with monkeys not given the drug. The drug also reduced their testosterone levels at both low and high doses. However, the effects were not permanent.
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Executive function as an ADHD endophenotype
Tony Steffert and Beverley Steffert
pp 7-9
In an ever-changing world, a vital skill for survival is the preparation of possible actions, the monitoring of a selected action and the termination of an inappropriate action. Therefore, preparation, selection, monitoring and inhibition are all core aspects of executive function; they are also some of the key deficits in attention deficit hyperactivity disorder (ADHD). Psychometric measurements of executive function tend to capture only the behaviours, not the core symptoms of these deficits. Event-based electrophysiological brain measures can reveal the neural mechanisms of executive function and can distinguish subtypes of ADHD. The combination of the neurological and behavioural markers of executive dysfunction in ADHD can give an endophenotype diagnosis of condition and inform more personalised treatment plans.
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What schools need to know about ADHD
Andy Bloor
pp 10-12
It is an (erroneous) generalisation to think that all schools panic or are apprehensive when they hear that a child in the school has attention deficit hyperactivity disorder (ADHD). This is as outmoded a stereotype as the GP who hands out methylphenidate too frequently. However, it can still be said that many teachers may feel ill equipped to support a child with ADHD. There is a growing voice in some children’s disabilities lobbies (most notably in the dyslexia lobby) that says that all trainee teachers should have mandatory training in particular conditions. It is a compelling argument when figures such as 15–20% (of children have dyslexia and related specific learning difficulties) are used. As a lead in special needs in university-based initial teacher education (ITE) myself, I am aware of students’ concerns around such high-incidence conditions as dyslexia, ADHD and autism. I am also aware that when I empower our students to understand the complexity of supporting children with any special educational need or disability (SEND), I also help to reduce any potential anxiety in them as teachers.
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Abstract watch: Topical debates and new therapeutic research
Nigel Humphrey
pp 13-13
Welcome to our new regular column, featuring a collection of abstracts that highlight some of the new research in the field of attention deficit hyperactivity disorder (ADHD). Research into this field is diverse and rapidly expanding, and we will endeavour to give you a sample of new findings and trends. We have collated the abstracts from a number of peer-reviewed journals. Contact details and/or links to the full articles are provided, although you may need subscription access to view them. In this issue we highlight the complexities of co-morbidity, with Faraone examining a possible genetic continuum between ADHD, bipolar disorder and schizophrenia. We also look at the use of electroencephalography (EEG) feedback to augment and improve medication for ADHD. Our final two abstracts look at topical areas for discussion: the debate over whether video games lead to violent behaviour, and the potential comorbid effects of cannabis use and ADHD.
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Primary school teachers' ADHD knowledge: a study
Angel Adams, Alfred Perera and Radha Bhat
pp 14-17
Teachers influence the academic development of children as early as the age of six years, when children have an idea of the expectations teachers have of their academic outcome. Good and Brophy’s research showed that teachers may give less attention and praise to lower-achieving children, although nowadays it is likely that teachers in the UK would contest this point. Jones suggested that teachers’ attitudes towards children with attention deficit hyperactivity disorder (ADHD) may influence their interactions with them. In the USA, Hepperlen et al measured the attitudes and expectations toward 103 elementary school children using the Knowledge about ADHD (KADD) questionnaire. This questionnaire uses the ‘error-choice’ method for the indirect assessment of knowledge and attitudes. The study suggested that the average teacher experiences tension when approaching a child with ADHD, and has a ‘slightly positive attitude’ towards them.
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Book review: Can I tell you about ADHD? A guide for friends, family and professionals
Noreen Ryan
pp 18-18
When asked to review this book on having attention deficit hyperactivity disorder (ADHD), aimed at friends, family and professionals, I was particularly interested in looking at the book from a child’s perspective. There are many resources on ADHD available to children, parents and professionals, but not many telling the story from the perspective of the child. Therefore, I sought the help of the children I work with who have a diagnosis of ADHD, along with their parents. Initially, I could not work out the intended age range target for the book, but the cover states from seven years and above. I read the book with an eight-year-old girl and a nine-year-old boy. As we began to read through the book together, the children’s main comments were about the lack of colour and pictures in the book, meaning it really didn’t hold much interest for them. This led to further remarks that the book was ‘boring’ and the children quickly lost interest.
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Resources: HADD
pp 19-19
HADD Ireland has been in existence for more than 30 years. Our mission is to make life better for people affected by ADHD. We are a national organisation based in Dublin, operating throughout the Republic of Ireland.
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