Visible symptoms can go undercover, UC Berkeley psychologists find

Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women.

However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide.

"Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood.
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Immaturity may lead to diagnosis of disorder

The youngest children in the classroom are significantly more likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) — and prescribed medication — than their peers in the same grade.

ADHD, which is often treated with prescription medication, is the most commonly diagnosed behavioural disorder in children. Two recent studies have shown a link between the relative age of children and diagnosis of ADHD and prescription of medication. Younger children in the same grade as children who may be almost a year older may appear to be immature compared with their older peers. This apparent lag in maturity has been called the "relative-age effect" and influences both academic and athletic performance.
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Attention-deficit/hyperactivity disorder (ADHD) affects 5-9% of youth and is frequently treated with stimulant medications, such as methylphenidate and amphetamine products. A recent safety communication from the US Food and Drug Administration advised that all patients undergoing ADHD treatment be monitored for changes in heart rate or blood pressure.

Amidst growing concern over the risks of stimulant use in youth, a study by Dr. Mark Olfson of the New York State Psychiatric Institute and Columbia University, and his colleagues, published in the February 2012 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, assessed the risk of adverse cardiovascular events in children and adolescents without known heart conditions treated with stimulants for ADHD. It is one of the largest studies to date focusing primarily on youth while controlling for pre-existing cardiovascular risk factors.

As reported in the study, Olfson and colleagues examined claims records from a large privately insured population for associations between cardiovascular events in youth with ADHD and stimulant treatment. In total 171,126 privately insured youth aged 6-21 years without known pre-existing heart-related risk factors were followed throughout the study.
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While pharmacologic agents have a demonstrated efficacy in children with Attention-deficit/hyperactivity disorder (ADHD), some children have suboptimal response to a single pharmacologic agent. A recent study by Dr. Timothy E. Wilens and colleagues, published in the January 2012 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), is the first randomized placebo-controlled trial designed to assess efficacy and safety of guanfacine extended release (GXR) as an adjunct to psychostimulants in children and adolescents diagnosed with ADHD who had a suboptimal response to a psychostimulant alone.

As reported in the article "A Controlled Trial of Extended-release Guanfacine and Psychostimulants for Attention-deficit/hyperactivity disorder," Wilens and colleagues conducted a nine week multicenter, double-blind, placebo-controlled, dose-optimization study, with participants in 59 study sites who continued their stable dose of psychostimulant given in the morning and were randomized to receive GXR in the morning, GXR in the evening, or placebo.
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