Developmental/Behavioral Disorders

Researchers funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) and National Institute on Child Health and Human Development (NICHD) have discovered that the brain's fear hub likely becomes abnormally small in the most severely socially-impaired males with autism spectrum disorder. New findings suggest that social fear in autism may initially trigger a hyperactive, abnormally enlarged amygdala, which eventually gives way to a toxic adaptation that kills amygdala cells and shrinks the structure, said Richard Davidson, Ph.D., and colleagues at the University of Wisconsin.

The keys to optimal use of psychostimulant and nonstimulant medications for attention deficit hyperactivity disorder are careful screening of patients, appropriate dosage regulation, and-most of all-close monitoring of both positive and adverse outcomes.

It's long been suggested by research that adolescents who have ADHD are more likely—nearly four times so—to be involved in a motor vehicle accident than unaffected drivers in the same age group. Furthermore, young adults with ADHD have a significantly higher rate of traffic violations and license suspensions than patients without ADHD.

New research reported at the annual meeting of the American Psychiatric Association in Toronto in May shows that Shire Pharmaceutical Group's methylphenidate transdermal system (Daytrana) appears a safe and well-tolerated alternative to OROS methylphenidate, and is equally efficacious.

The second of a four-part series on nutritional interventionsexamines evidence of a salicylate-elimination diet for ADHD.

A new study on potential interactions between genetic and environmental factors in ADHD suggests that current limits on lead exposure are too high. Lead exposure below the current limits allowed by Environmental Protection Agency regulations produced measurable impairment of executive functions, especially in boys, who have a specific variation in the DRD4 dopamine receptor gene.

The longest and most complex study of methylphenidate (Ritalin) in preschool children shows that it can be safe and effective for some children in that age group who have attention deficit hyperactive disorder (ADHD), according to the study's lead author.

The answer? We don't really know, according to Craig Newschaffer, PhD, associate professor at the Johns Hopkins School of Public Health. But fears of an autism epidemic have been overblown by the press and advocacy groups, said Dr. Newschaffer, speaking at the American Academy of Pediatrics National Conference and Exhibition today in Washington, D.C.

The US Food and Drug Administration (FDA) recently approved Adderall XR (an extended-release formulation of mixed salts of amphetamine) as a once-daily treatment for attention deficit hyperactivity disorder in adolescents 13 to 17 years old. That action bridges an "indication gap" between earlier approval of the product for patients 6 to 12 years old and for older (18 years) adolescents and adults.

An improved prognosis for children with autism depends on prompt and intensive intervention. That can happen only if the condition is screened for and diagnosed at a very young age.

Lately, I've spent a lot of time talking about the alleged link between thimerosal in pediatric vaccines and autism. Most of you have been asked by parents whether immunizations pose a risk of autism as well, and some parents are so frightened by rumors, press reports, and information on the World Wide Web that they forgo immunizations for their children altogether.

Q Parents of a 4 1/2-year-old boy in my practice are concerned because he takes too many risks. They report that he always seems to be doing something dangerous, which often results in injury.

At pediatricians' disposal today are numerous formulations of approved medications for ADHD--traditional psychostimulants and newer agents. We also have developed an appreciation of the value of a multipronged approach to this chronic disorder.

Step-by-step evaluation of an adolescent girl who may have ADHD highlights the strengths and limitations of the AAP diagnostic guidelines and offers insight into how to augment them.

Diagnosing and treating a child?s ADHD is often not enough. Most patients have coexisting developmental or psychiatric disorders that must be addressed.

Pediatric Puzzler: Weakness (thyrotoxic periodic paralysis)