Researchers seek objective
way to diagnose attention disorder
new study conducted at the U.Va.
Health System and Sweet Briar College is the first in the
United States to measure physical brain changes that could confirm
a child's having attention deficit and hyperactivity disorder
(ADHD), one of the most common behavioral problems in children.
"Unlike diabetes or hypertension, there is currently no way
to measure ADHD objectively," said Dr. Daniel Cox, director
of U. Va.'s Behavioral Medicine Center and principal investigator
of the study.
Doctors currently rely on subjective observations to diagnose
ADHD, he said. "As a result, medications for ADHD, such as
Ritalin, may be overprescribed for children who do not actually
have the condition."
study, recently published in the Journal of the American Medical
Association, reported a rapid increase in prescriptions of Ritalin
for children age 2 to 4 between 1991 and 1995.
currently rely on subjective observations to diagnose ADHD,
and as a result, medications for ADHD, such as Ritalin,
may be overprescribed.
Dr. Daniel Cox
Behavioral Medicine Center
with ADHD are thought to have more slow wave and less fast wave
activity in the brain. The stimulant Ritalin speeds up the brain
activity to match that of non-ADHD individuals... theoretically,"
to 5 percent of American children exhibit ADHD symptoms, according
to the Diagnostic and Statistical Manual of Mental Disorders,
published by the American Psychiatric Association. Of all child
referrals to mental health services, one-third to one-half are
due to ADHD, Cox said. A recent survey by the Center for Pediatric
Research found that in the Virginia cities of Portsmouth and Virginia
Beach, 10 percent of public school children in grades two through
five were taking ADHD medication.
and researchers from Sweet Briar developed a unique brain wave
measurement model based on research at NASA's Langley Porter laboratories
to measure the brain waves of fighter jet pilots. The test senses
changes that occur when subjects shift their attention from one
task to another.
In preliminary studies with children 9 to 11 years old, "we
have seen that the brain wave activity of a non-ADHD child is
stable when the child moves his attention from one task to another.
By contrast, the brain waves of children with ADHD are very chaotic
when they are shifting to another task," Cox said. The current
study, supported with a grant from the Virginia Commonwealth Health
Research Board, includes 80 children and will continue for four
months. Those with ADHD must cease taking any medication for at
least 24 hours before testing.
Studying the EEG readings was a slow-going, tedious task until
mathematician Boris Kovatchev, an assistant professor on the research
team, developed software to analyze the data. That's made all
the difference, Cox noted.
up with an objective diagnostic tool that firmly documents that
ADHD changes brain waves could also help with prescribing medications,
especially in making the appropriate dosage, which is hard to
determine, Cox said.
researchers are looking at this age group rather than younger
children because the brain has matured by the age of 9, and the
alpha brain waves are stable. If their results are confirmed,
they plan to analyze other groups, such as younger children, or
children with ADHD who are taking Ritalin compared with those
who are not, he added.
families interested in participating in the study, including children
with or without ADHD, should call 924-8655.
on prescribing ADHD drugs
James A. Blackman, director of research and professor of
pediatrics in the U.Va. Division of Developmental Pediatrics,
is researching medication guidelines for hyperactive children.
Blackman is compiling an online program for primary-care
physicians, called Informed Prescription of Stimulant Drugs
for ADHD, expected to be launched in May.
The program, to be offered through the department of pediatrics
web site, is being designed "to assist physicians in
managing double-blind trials with patients and in making
the best decisions for prescription,² Blackman said. They
will be able to check whether the drug and dosage are effective
over time. He hopes to see if the program results in physicians
altering past practices and to see if they feel it helps
them make better decisions, he added.
now, "we advise primary care physicians to consider
a patientıs age and other factors before prescribing stimulant
drugs for ADHD, and encourage family counseling as an essential
part of ADHD therapy," Blackman said.