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Behavioral and Emotional Disorders
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Other Behavioral and Emotional Disorders

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Adderall vs. Methylphenidate (Ritalin) for Attention Deficit Hyperactivity Disorder

The most commonly prescribed medication for children with attention deficit hyperactivity disorder (ADHD) is methylphenidate (for example, Ritalin). However, its effects may be short-lived and some children do not respond to it at all. Researchers at the State University of New York at Buffalo recently compared the effectiveness (and effects of) methylphenidate (MPH) with another drug, Adderall, in 21 children with ADHD between the ages of 6 and 12 years old. The results from this small study showed that a single morning dose of Adderall resulted in the same changes in behavior throughout the school day as MPH taken twice a day. A single dose of MPH in the morning appeared less effective than taking MPH twice a day or taking one dose of Adderall, and its effects wore off by early to mid-afternoon.

Adderall may offer a good alternative for children when a two-dose per day regimen is a problem. This study was conducted in the context of an intensive summer treatment program that included behavioral elements as well. More research is needed to compare these medications and dosing options in a regular school setting.

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New Drug May Better Help Prevent Alcoholism Relapse

Opiate antagonists are drugs that can decrease the pleasurable effects of drinking alcohol and therefore can be useful for people trying to quit drinking, particularly during the first few months. Naltrexone (ReVia) is an opiate antagonist that has been shown to be effective in preventing drinking relapses but can cause intolerable nausea in some people. In addition, this drug may damage the liver as the dose is increased. This limits its usefulness because liver disease and a history of heavy drinking often go hand-in-hand.

A newer opiate antagonist, nalmefene, may offer a promising alternative. A recent study showed that over a 12-week treatment period, patients taking nalmefene were almost two-and-one-half times less likely to relapse compared with those taking a placebo. Also, there was no evidence that this medication caused liver problems or other serious side effects. While some patients taking nalmefene experienced nausea, none skipped their doses or stopped treatment for this reason. Nalmefene may become a good first-choice drug to help treat alcohol dependence.

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Guidelines for Diagnosis and Evaluation of Children with ADHD

Attention deficit hyperactivity disorder (ADHD) affects 7–10% of children, making it the most common neurobehavioral disorder among children. Over the past decade, the number of prescriptions for stimulant medication to treat ADHD in children has ballooned, creating fears of over-diagnosis. Surveys show a lack of uniform criteria for diagnosis of ADHD and variations in the amount of stimulants prescribed by physicians. In an effort to develop a standard national framework for diagnosis and evaluation of ADHD in children of 6 to 12 years of age, the American Academy of Pediatrics formed a committee to review the existing literature and develop consistent guidelines.

The committee recommends that primary care clinicians evaluate for ADHD children who are inattentive, hyperactive, impulsive, academic underachievers, and those who have behavioral problems. Because these symptoms are rarely obvious in a clinical setting, parents or other caregivers who notice these problems should inform the child’s physician. When parents don’t bring up these concerns, physicians should inquire about the symptoms of ADHD.

According to the guidelines, a diagnosis of ADHD requires that a child meet the specific criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. These involve displaying numerous symptoms of inattention, hyperactivity, and impulsivity in at least two settings. By completing ADHD-specific questionnaires, parents or caregivers and classroom teachers must provide evidence of the core symptoms of the disorder, duration of symptoms, the degree of functional impairment, and associated conditions. According to the guidelines, nonspecific questionnaires are not adequate for the diagnosis of children with ADHD. The guidelines recommend that evaluation for ADHD also include an assessment for coexisting conditions such as conduct and oppositional defiant disorder, mood disorders, anxiety disorders, and learning disabilities. Coexisting conditions affect roughly one-third of children with ADHD. Recommendations do not include the use of brain imaging, EEG, and thyroid hormone screens as diagnostic tests for ADHD.

These guidelines provide a starting point for clinicians in the assessment of ADHD in children of 6 to 12 years of age. Further research is necessary to develop guidelines for other age ranges.

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Young Men and Women with Anorexia Nervosa or Inflammatory Bowel Disease at Greater Risk for Osteoporosis

We usually think of osteoporosis as a condition that primarily strikes older women as a result of the aging process. However, certain disorders and medications can also lead to bone loss in younger people, both male and female. Two recent studies from the Annals of Internal Medicine show that bone loss is significantly more likely to occur in young men and women suffering from anorexia nervosa or inflammatory bowel disease than in the general population.

Researchers evaluated the loss of bone tissue in women with the eating disorder anorexia nervosa by measuring bone mineral density at different regions of the skeleton. More than 90% of the women had significant bone loss at one or more skeletal regions. Depending on the region measured, this bone loss put 13–24% of the women at risk for fractures. Physicians commonly prescribe estrogen to slow bone loss in postmenopausal women. Estrogen is also given to women who do not menstruate regularly, which is the case for many women with anorexia. Interestingly, in this study, women who used estrogen experienced the same levels of bone loss as women who did not. The researchers theorized that poor nutrition might decrease the effectiveness of estrogen in preserving bone. The results also showed that current weight, independent of other factors, is the best predictor of bone density in anorectic women.

In a separate study, researchers sought to determine the risk of bone fractures associated with osteoporosis in patients with inflammatory bowel disease. Results of the study showed that patients with the disease had a 40% greater risk of hip, spine, wrist, or rib fractures than healthy people. Researchers are still uncertain what factors contribute to bone loss in these patients. They speculate that corticosteroids, which are used to treat inflammatory bowel disease, may play a role, and that cigarette smoking, lower levels of sex hormones, and low dietary intake of calcium and vitamin D may also contribute to bone loss.

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