What is Using a Bedwetting Alarm Actually Like? Practical Tips and Pointers

 Enuresis is very common and can be especially difficult to conquer in a child who has ADHD.   Bedwetting alarms are a behavioral way of treating enuresis that has relatively high success rates and few side effects compared to medications and surgery.   We've recently started using a bedwetting alarm with one of our children so we thought we'd share some tips with you.

 When should you start?  Like many other things potty related, you should only start using a bedwetting alarm when your child is ready.  Bedwetting can be very tiring for a parent, but you need to have your child's buy-in or this technique will not work.  Getting up in the middle of the night is not fun for you or the child.  You need to have everyone be motivated for this or someone will quit before they are done.

Generally speaking, I would recommend waiting until your child is at least 6 or 7 before trying a bedwetting alarm, and I would also wait until your child talks to you about wanting to get out of diapers at night.  Prior to 5, most children do not need to go through this involved of a procedure to get dry at night.

The beginning stages of alarm use will be easiest if they take place at home and when your bedtime schedule and routine can be fairly normal.  However, once your child is fairly secure with alarm use,  it should be fine to go on vacation or stay up a little later than normal, provided the bed is protected in case of an accident.

 What type of alarm should you get?  There are many different types of moisture sensor alarms.   Some are pads that go under the child, and some clip to the underwear.  Pads are difficult because you have to make sure your child stays on the pad, which many ADHD kids will not, due to lots of in bed movements.  Pads also require a lot more liquid to come out which means bigger cleanups for the adult.  You should look for a secure clip, a fairly loud alarm (because the adult has to hear it, get up and get the child out of bed), and a wire that is long enough to extend from the underwear to the child's shoulder area, with a secure clip for the alarm to go on the pajamas.  If the alarm is not loud enough to wake you, you may need to use a baby type monitor in your child's room.
Some alarms have a variable feature, which could be handy if you or your child do not wake up to alarms after the first few nights of hearing them.  I can't say how likely this is, however.  I tend to wake up to an alarm more readily if it is the same one over and over again because it is a conditioned response.

 What else do you need to have to get started?
The alarm works best with tighter fitting underwear (i.e. briefs, not boxers).  Your child will have accidents, so a waterproof mattress cover is a must.  You can also try a waterproof pad, however, if it does not secure to the mattress it may slip off during the night.  Leftover waterproof pads from the crib could also be used if you still have them.

If your child sleeps with a sibling, the alarm probably will be loud enough to wake up everyone in the room.  If the sibling isn't good at getting back to sleep on their own, you may want to move one child to a different room.  It's not possible to predict how long the alarm will actually go off at night.  Some children only need it to go off for less than a week, but some will have alarms over several weeks time.

 How much parental involvement does it take?
At least one adult must get up when the alarm goes off to make sure the child does what he is supposed to do.  You should not count on your child doing this for herself.  Many children either do not wake up when the alarm goes off (until they are trained by force of habit to do so) or turn off the alarm and go back to sleep.  Even if your child does wake up fully, he may still have difficulty with taking the alarm off, going to the bathroom, and then reattaching it, or she may be unable to change her bed linens.  You should pick a time in your family's life where it will be ok if you miss a little sleep.

The first week or so, you may find it is better to sleep in the room with your child to make sure you learn to hear the alarm and can get to your child quickly.  After the first week, you can try sleeping in your own bed with the doors open or using a baby monitor to magnify the sound of the alarm in your room.

How do you know it isn't going to work?
If no adult is able to get up with the child despite using a loud alarm and a monitor, then this probably won't work.

Otherwise, it's a good idea to give it several months (up to 6) for your child to learn to hear the alarm and respond.  Most children will not have alarms every night for 6 months, so try not to envision the procedure that way! A more accurate way to think of it is this: typically if your child is making progress, having generally fewer and fewer alarms, it may take 6 months to be sure they are completely dry at night.

When should you stop?

A new habit takes at least 4 weeks to form, so you should continue use of the alarm for at least 4 weeks after the last accident, minor or major.  If there is an accident, you should restart your 4 week count.

ADHD Symptoms Worsen in the Winter

ADHD can definitely worsen in some patients during the winter months.   You might feel like you are succumbing to old wives tales and folk wisdom when you start to feel that January (or February or December) is getting to you.  However, many clinical studies point to the mental health of people with ADHD being worsened by winter.  Adults with ADHD are known to have a higher prevalence of Seasonal Affective Disorder (or SAD) than the general population (27% vs. 5%).  They also report more ADHD symptoms in the winter.   Although most of the research in this area has focused on adults, we do know that children with ADHD tend to seek fewer prescriptions during the summer and may see the doctor less for ADHD during the summer as well.  While these behaviors may reflect seasonal school attendance, the studies do not rule out other seasonal influences on ADHD.

The main causes for greater winter symptoms in ADHD adults seem to be SAD and delayed circadian phase sleep disorder.  SAD is mainly characterized by depressed mood and irritability, which is usually worse in the winter.  The person might even wake up earlier and be unable to get back to sleep, although some people with SAD sleep too much.   Other symptoms include worsened concentration, carb craving, fatigue, and feeling inappropriately guilty.

The main symptoms of delayed circadian phase sleep disorder are having a hard time waking up in the morning and having a tough time falling asleep at night because you don’t feel sleepy yet.  A person with a delayed circadian phase will usually not get enough sleep if they have to wake up in the morning for a job or school.  They are typical night owls, but as their sleep debt accumulates, they might start to be grouchy and feel down on themselves for being unable to get up in the morning and being late all day. 

In children, seasonal worsening may also have a social component to it.  The winter season typically brings a rise in holiday celebrations with accompanying over-stimulation, dietary disruptions, and schedule changes, as well as midterm examinations which can lead to a perfect storm for children, in addition to issues of SAD and circadian phase disruption.

Treatment for seasonal worsening of ADHD depends on the cause.  People with SAD are known to respond to bright morning light from full spectrum lighting.  Some health insurances will pay for special therapeutic lamps.  Antidepressants also are a possibility.  Circadian phase delay is treated with strict sleep hygiene, bright morning lights and possibly evening melatonin.

References:

Moses, MD Scott. "Delayed Sleep Phase." Family Practice Notebook. Family Practice Notebook, LLC, 05 Feb. 2017. Web. 05 Feb. 2017.

Moses, MD Scott. "Seasonal Depression." Family Practice Notebook. Family Practice Notebook, LLC, 05 Feb. 2017. Web. 05 Feb. 2017

.

Toothbrushing, Oral Hygiene, and ADHD

If your child with ADHD struggles with tooth brushing or flossing, you are not alone.  A new study by researchers at the University of Hong Kong demonstrates that children with ADHD in general have worse dental hygiene than their neurotypical peers.  This was found in a variety of measures of oral hygiene including amount of gum bleeding (a common sign of gingivitis), need for assisted brushing, and brushing for less than 1 minute.   This backs up a study from earlier in the month showing that hyperactivity and inattention scores correlate with a diet that promotes cavities and with poor oral hygiene, That same study showed that patients with oppositional tendencies showed a lower frequency of  tooth brushing.  Also, it explains why cavities, or dental caries, are more common in children with ADHD. Although ADHD medication can reduce salivary flow, this does not seem to add to dental caries risk in children with ADHD. 

For many parents of children with ADHD, these findings may not be at all surprising.  Consider the following: 

• It is difficult to get a child with ADHD to remember and be motivated to carry out anything tedious and boring, like an oral hygiene routine. 
• It is  difficult to get them to stay focused for long enough to complete that routine. 
• ADHD often co-occurs with handwriting difficulties and proper tooth brushing requires a lot of the same fine motor coordination that handwriting does. 

What you can do to improve your child’s oral hygiene. 

1)      Encourage your child to avoid foods which are known to cause cavities.  Sugary foods and drinks are the main culprits here.  However foods which are high in carbohydrates can also be an issue.  The body needs some carbohydrates to function, but it’s also ok to limit noshing on crackers and cookies and to provide something like carrot sticks or apple slices instead.

2)      Use external rewards to motivate your child to stick with an oral hygiene routine.  Using a reward system puts you on your child’s side.  Instead of saying, “Brush, or else I will punish you,” you are saying, “I want to help you get your reward, go brush.”  Be aware, however, that some children will “forget” and tell you they have brushed when they haven’t.  Smell their mouth or check the toothbrush and spit cup for dampness if you aren’t sure they are remembering properly.

3)      Encourage your child to brush for longer.  For younger children, it may take you brushing with them.  For older children, using a timer (either in their head or on the counter by the sink) may be helpful.  Some people also find that listening to music can help them continue to brush if they find the brushing itself boring.  Another technique may be to brush the entire mouth once, spit, reapply toothpaste and brush the entire mouth again.

4)      Make sure that your child is ok with their brush, toothpaste, and floss.  Sometimes resistance to brushing is due to the brush being uncomfortable (think sensory processing issues) or to the paste tasting wrong (minty tooth paste can actually be painful to younger children).  Floss also can be tricky due to taste.  Most kids with ADHD should probably floss with a flosser and not plain floss until you are certain they have adequate fine motor coordination. 

5)      Visit the dentist regularly.  And see that the dentist and hygienist do their best to allay your child’s anxiety.   Not all dentists’ offices are the same in this area, and even pediatric offices may not be that well equipped to deal with a child with extreme anxiety, so if you feel uncomfortable about how your child is being handled, it’s ok to look for someone else.

Reference:

Osenberg, S. S., S. Kumar, and N. J. Williams. "Attention Deficit/hyperactivity Disorder Medication and Dental Caries in Children." Journal of Dental Hygiene 88.6 (2014): 342-47. Medline. Web. 12 Jan. 2017.

Everything ADHD Medical Disclaimer

Everything ADHD Privacy Policy

Tics, ADHD, and Medication

ADHD and tics often occur together.  Up to 50% of patients with ADHD may have an underlying tic disorder, while up 70% of patients with chronic tics may have ADHD.  Until very recently, many people in the ADHD community have felt that medication causes or worsens tics.  However, new research is challenging this widely held assumption and changing the face of treatment for people who have both disorders.

To understand the reversal in medical opinion, you must understand a little about tics.  The medical definition of a tic is an involuntary, nonrhythmic movement of any body part.  Tics can include throat clearing or blinking, vocalizations, or even complex actions such as repetitive phrases, picking at clothing, or brushing hair.

Tics come and go in response to a variety of triggers including stress, changes in body chemistry (such as thyroid hormone and blood sugar), or may be seemingly random.  The cause of tics can be genetic, structural (ie brain damage from stroke, trauma or other issues), or unknown.  Once they start, they can stop within a few weeks, months or longer.

Tics are very common in otherwise normal children.  One in 5 children will develop a tic at some point before they turn 10, and most of these children will get better without any treatment.  Because tics are very common, even in normal children, tics are likely to show up coincidentally around the time medication is started in many children.  Tics occur after the introduction of a stimulant in 1 in 5 children who have a known tic disorder and in about 6% of children who have ADHD and no known tic disorder.

Do stimulants cause tics?  NO.

In 2009, a metanalysis of 9 clinical trials in children with ADHD and tic disorder concluded that methylphenidate did not worsen the tic disorder.   Last year, 2015, saw a new metanalysis published, this time examining trials of all children with ADHD who were started on stimulants.  This metanalysis demonstrated that tics were very common, equally common, in fact, both in children who took the stimulant and in those who took placebo.  All of this points to tics not being caused by stimulant medication, even though tics do happen very regularly after medication is started.

Should ADHD be treated differently in patients with tics?  Maybe.

The second article suggests that stimulant medication not be withheld from children with ADHD who happen to have a family or personal history of tics, and that stimulants be continued if tics happen to arise during treatment since in all likelihood, the stimulant was an innocent bystander.

However, in the interest of keeping the number of medications low, patients who have tics and ADHD can be treated with clonidine or guanfacine, both of which are effective for both conditions, and both of which have a fairly safe side effect profile.  However, neither medication is the most effective medication for either ADHD or tics, and treating two conditions with one medication can make dose adjustment difficult.

Should tics be treated differently in patients with ADHD?  Maybe.

Generally speaking, unless tics are very noticeable, it’s best not to treat with medication since most tics will go away on their own.  However, if the tics are bothersome (for example if a child is picking through their skin and leaving scabs) or noticeable (causing disruption in a classroom or workplace) then active treatment may be a consideration.

Treatment for tics generally involves behavioral therapy.  This therapy focuses on habit reversal therapy as well as anxiety reduction/relaxation techniques and has an effectiveness which is comparable to medication, without the same risk of side effects.  The major down side is that it takes time for a patient to learn the techniques effectively.

Medications can be used but sometimes the medication is worse than the tics.  .  Clonidine and guanfacine have both been used effectively in patients with ADHD and tics, but the medication may not be very effective.   The most effective medications for tics, such as risperidone,  can leave a patient with a host of permanent side effects, and so they are reserved for patients who have the most disabling and unresponsive symptoms.  There are other treatments for tics but only clonidine and guanfacine are known to help with ADHD as well.

Overall, clinical trials are starting to point toward encouraging the use of the most effective approach in treating ADHD, toward not discontinuing medication if tics arise, and toward treating tics as an entity mostly independent of ADHD.  Parents of children who develop tics while on medication for ADHD can be reassured that the medication did not cause the tic and that the tic will likely resolve on its own, without change to ADHD therapy.

References:

Thenganatt, Mary Ann, and Joseph Jankovic. "Recent Advances in Understanding and Managing Tourette Syndrome." F1000Research F1000Res (2016): n. pag. Web. 23 May 2016.

Diagnosing ODD (Oppositional Defiant Disorder) in a Child With ADHD

Oppositional defiant disorder is one of the most common comorbidities of ADHD.  It occurs in 40% of people diagnosed with ADHD and ADHD occurs in 16-40% of patients with ODD.  While signs often develop in early childhood, it can develop as late as the adolescent years. 

What are the symptoms of ODD?

ODD (Oppositional Defiant Disorder), according to the DSM-5 is “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting for 6 months or more”.    Examples include: frequent temper tantrums (which should be clearly beyond normal for age), being easily angered or irritated by things that would normally not touch someone else off (sometimes family reports feeling like they are “always walking on eggshells” due to not knowing what will set the patient off next), arguing with authority figures, actively defying rules, and deliberately annoying others.  People with ODD usually do not realize that they have a problem and will blame others for their anger and feelings of resentment.

How is ODD diagnosed?

There are no objective tests available for ODD.  That means, no MRI, EEG, blood test, or x-ray can tell for sure if ODD is present or absent.  However, some of the same questionnaires used to diagnose ADHD (Conners and Vanderbilt) are used to screen for ODD. 

There are many other disorders where a patient might have tantrums, be non-compliant, or show difficulty with anger.     A diagnosing professional will want to know about the following in order to distinguish ODD from other problems such as depression and anxiety:

1)      Is defiance present only in settings where sitting still or paying attention is required?

2)      Is the patient aggressive towards animals or other people?

3)      Does the person deliberately destroy property, steal things, or tell frequent lies?

4)      How severe are the temper tantrums and how frequent are they?

5)      Are there signs that the person may not understand or cannot hear you?

6)      Is there any suspicion that the person is afraid or anxious?  For example, are temper outbursts only around certain predictable issues?

Why is diagnosis important?

ODD can lead to serious complications.  Most patients with ODD go on to develop other problems such as anxiety, depression, and substance abuse.   Violent and criminal behavior can result in children whose ODD continues amid other social stressors such as family hostility and instability.  

Patients who undergo treatment with their families can often avert these disastrous consequences, or at least, they can access help as other issues arise.

References:

Riley, Margaret, Sana Ahmed, and Amy Locke. "Common Questions About Oppositional Defiant Disorder." American Family Physician 93.7 (2016): 586-91. Print.

This article is one in a series about ODD, including: Diagnosis, Treatment, and Prevention

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Dealing with ODD (Oppositional Defiant Disorder)

ODD, or oppositional defiant disorder, is a heartbreaking problem for parents of kids with ADHD.  It is difficult to treat and even more difficult to live with a child who is defiant, angry, and purposefully annoying, especially once they start to get into trouble with others or get suspended from school.  However, there is hope.  Much research has gone into treating ODD in the past 20 years and results are promising.

Medication:  Yes and No
Many children with ODD  see significant improvement with ADHD medications so it is worth a trial of medication if your child also carries the diagnosis of ADHD.  However, medications rarely treat ODD that is leftover after treatment for ADHD.  Some doctors will prescribe sedatives or antipsychotics to children who are aggressive.  However, this should always occur with family and/or individual counseling, not in place of it.

Counseling is Essential
Many children with ODD will not get completely better with medication alone.  Talk therapy is the cornerstone of treatment.   There are several kinds of therapy which may need to take place at once.
Family/parent therapy.  Teaches the parent how to respond to the child's negative behaviors in ways that do not escalate the negative behaviors and which hopefully motivate positive behaviors.  Two very different methods of therapy which have proven effective are the parent management therapy (including the Kazdin method) and the collaborative problem solving (Explosive Child) method.

School based interventions.  This includes accommodations based on the child's ODD and in school support services.  School gives children many opportunities for social interactions.  Working with the school can turn it into a behavioral training ground.

Individual therapy.  Usually focuses on cognitive restructuring and teaching of social skills as they pertain to handling what the child perceives as negative situations.   For example, a child with ODD might think, "The teacher is yelling at me.  He's against me."  But the therapist teaches them to think, "The teacher is trying to get my my attention.  If I answer quickly, he'll stop making so much noise."

It is important to realize that the effectiveness of counseling depends heavily on how well you and your child are able to bond with your therapist.  It doesn't mean that you need to like them, but it does mean that you feel your are being listened to, that you feel willing to try what they suggest at home, and that you understand what you are being asked to do.

Set a Time Table
Counseling should result in a significant improvement of symptoms within 6 to 12 months.   If things aren't improving at all by that point in time, you should consider a different form of therapy or a different provider.    Some children may require intensive management in a day hospital or residential setting, others just need a provider who meshes better with their personality.


References:
American Academy of Child and Adolescent Psychiatry. "ODD: A Guide for Families." (2009): n. pag. EAACAP ODD Resource Center. American Academy of Child and Adolescent Psychiatry. Web. 12 Apr. 2016.
Riley, Margaret, Sana Ahmed, and Amy Locke. "Common Questions About Oppositional Defiant Disorder." American Family Physician 93.7 (2016): 586-91. Print.

This article is part of a series on ODD including Diagnosis, Treatment, and Prevention.

Anesthesia and ADHD

Over the past several years, research has been accumulating linking anesthesia to cognitive deficits, including ADHD.  Should people with ADHD, or parents of children with ADHD worry about anesthesia worsening their symptoms?  Should the risk of anesthesia to an already stressed brain factor into decisions about whether to undergo surgery or procedures such as MRIs or EEGs?

Why anesthesia could worsen ADHD
Anesthesia has been shown to cause premature death of brain cells in exposed rats and other animals.  Scientists believe that anesthesia could also have the same effect in the brains of humans, especially younger children who are experiencing rapid brain growth and change.  Two large studies have demonstrated an association between exposure to anesthesia early in life (before the age of 3 or 4 years old) and increased risk of ADHD.  The risk was highest for children who had multiple exposures to anesthesia or for longer lengths of exposure ( more than 3 hours).  These studies did control for a number of possible confounding factors:  other neurological diseases (such as seizures and tics), the types of surgery, prematurity, etc.

What the research does NOT tell us
The studies done still do not prove causation.  While the studies were thorough in controlling for confounding factors, it is possible that something was missed.  For example, patients with ADHD may be more likely to undergo surgery and get anesthesia due to being accident prone.

Most of these studies were done on children who had surgery very early in life--earlier than ADHD is typically diagnosed.  The studies really do not address the question at all of whether anesthesia later in life has the same effect on ADHD.

These studies focus on the effects of general anesthesia.  They do not say anything about epidurals or other forms of local anesthesia.  They also do not address sedation.

What you should do if you are considering anesthesia and you have ADHD

• Don't get unnecessary procedures done.  "Unnecessary" here means a procedure whose purpose is primarily cosmetic, or which would result in information that would not change the course of treatment.
• Don't get general anesthesia unless it is necessary.  For example, at the dentist's office, if you can manage with a mild sedative, or just Novocaine, then don't go for laughing gas.
• If the procedure can safely wait until after age 5, then it may be best to wait.  However, if there are risks to waiting, it is probably better to get the procedure done in a timely fashion, since the risk of anesthesia toward ADHD is still theoretical at this time.
• Any procedure which is medically necessary at any time should not be denied to a patient solely on the basis of their ADHD.  Patients should always weigh the benefits of the procedure against its risks and not focus solely on risks.
• Always inform your anesthesia professional and the doctor ordering the procedure of your ADHD diagnosis and your concerns about anesthesia's risks to cognitive function.  

References:

Ko, Wen-Ru, Yung-Po Liaw, Jing-Yang Huang, De-Hui Zhao, Hui-Chin Chang, Pei-Chieh Ko, Shiou-Rung Jan, Oswald Ndi Nfor, Yi-Chen Chiang, and Long-Yau Lin. "Exposure to General Anesthesia in Early Life and the Risk of Attention Deficit/hyperactivity Disorder Development: A Nationwide, Retrospective Matched-cohort Study." Pediatric Anesthesia Paediatr Anaesth 24.7 (2014): 741-48. Web.

Sprung, Juraj, Randall P. Flick, Slavica K. Katusic, Robert C. Colligan, William J. Barbaresi, Katarina Bojanić, Tasha L. Welch, Michael D. Olson, Andrew C. Hanson, Darrell R. Schroeder, Robert T. Wilder, and David O. Warner. "Attention-Deficit/Hyperactivity Disorder After Early Exposure to Procedures Requiring General Anesthesia." Mayo Clinic Proceedings 87.2 (2012): 120-29. Web.

Tsai, C.-J., C. T.-C. Lee, S. H.-Y. Liang, P.-J. Tsai, V. C.-H. Chen, and M. Gossop. "Risk of ADHD After Multiple Exposures to General Anesthesia: A Nationwide Retrospective Cohort Study." Journal of Attention Disorders (2015): n. pag. Web.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Mortality higher in patients with ADHD: Accidental deaths blamed

A recent study in the Lancet showed that people with ADHD are most likely to die from accidents, and that the rate of accidents is elevated even if you take away interfering factors such as oppositional defiant disorder and substance abuse.   Adult women seemed to be at highest risk for accidental death.

Accidents are unavoidable in many cases.  However, when we see that a disease places us at higher risk, we have to ask if there is anything we can do to prevent more accidents from occurring.  How could ADHD place people at higher risk for accidental death?

The most important causes of accidental death are motor vehicle accidents and poisoning.  

People with ADHD are at higher risk for motor vehicle accidents for two important reasons.  One is inattention to the road.  The second is impulsive driving habits.  There are three things that we know can help lower the risk of death.

1)  Medication lowers the risk of automobile accidents in teens with ADHD.  Although the decision to use medication is a complex one, impulsive driving habits or inattention to the road are serious issues that need to be fixed soon for the safety of yourself and others.

2)  Seat belts save lives but don't change your risk of having an accident.

3)  Turning your cell phone off or having it in a mode where you are not tempted to text or answer the phone while you are driving also helps.

Another issue that can be a big problem for adult women drivers is driving with children.  It is very important to learn to pull over if you need to deal with your child's needs, or if you need to discipline your child.  

Poisoning includes all kinds of poisoning deaths except for suicides.  Accidental overdose of medications such as opiates are a big player here.  People with ADHD are prone to substance abuse, but even among those without an active substance abuse problem may have a higher risk of poisoning.  This might be due to patients impulsively taking more medication thinking "more is better", or due to forgetting and taking another dose when it wasn't needed.   It could also be due, in part, to mixing other medications with ADHD medications.  To reduce your risk of poisoning you can:

1)  Never mix your medications unless you know for sure it is safe.   Ask your doctor or pharmacist if you are unsure.  Better safe than sorry!

2)  Don't take medications that are not yours, especially prescription medications.

3)  Always ask your doctor how much pain medication you are allowed to take and never take more than is prescribed.   If your pain control is not adequate, try other methods, such as exercise, relaxation techniques, and counseling to try to manage your pain.   Ask your doctor for a referral to a pain management specialist to get started.  If you cannot control how much you take, it is better to be in pain than to die of overdose.

4)  Keep your medicines in a locked cabinet.  Put them in a pill minder box with the days of the week on it so that you know if you have taken your medication or not.

5)  Keep the number for poison control near your phone.

Other common ways adults can be poisoned include using household or automotive products or pesticides in an incorrect way.  Patients with ADHD may be less inclined to take the time to read directions or to take the time to purchase or locate personal protective equipment.  If you find you don't take the time to keep yourself safe consider the following actions:

1)  Keep personal protective equipment in several places in the house, near the hazardous substances.

2)  Minimize the use of toxic chemicals in your environment.   For example, there may be natural alternatives to pesticides or household cleaners.

3)  Ask a professional to handle toxic chemicals instead of doing it yourself.  Although a professional exterminator may be expensive, it may be well worth your while if you prevent yourself from being poisoned.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

ADHD and Mold

While indoor mold certain has negative health effects, is it a cause or exacerbant of ADHD?  If you receive a diagnosis of ADHD, should you have your house inspected or disinfected as a matter of course?

ADHD is like many other mental and neurological conditions.  The brain works much less well if any other part of the body is not functioning, especially if that part of the body has any contact with the brain.  People who suffer from indoor mold do complain of difficulty with concentration, tiredness (possibly manifesting as hyperactivity in younger children), and short tempers--all symptoms that could also be caused by ADHD.   This is because mold primarily exerts its effects on the human body via the immune system, which contacts all parts of the body, including the brain. What's the difference between mold induced illness versus garden variety ADHD?

People who have ADHD

• usually have had symptoms all their lives, or starting fairly early in life.  Adults can be diagnosed if symptoms were present before age 12, but if you dig deep you'll usually uncover unrecognized symptoms present from much earlier ages.
• often have a family history of the problem, but there are usually people who live with them who do not have symptoms.

People who have symptoms due to mold exposure

• usually have symptoms which start around the time when the mold exposure began--shortly after a move, or after new construction or remodeling, or after flooding or other moisture exposure, for example.
• usually find that many others living with them also have symptoms, but relatives who do not live with them are unaffected.

Both patients with ADHD and patients with mold exposure

• may have symptoms that come and go.
• may have symptoms that do not respond to medication
• may have other allergic symptoms, as ADHD is associated with a higher rate of allergy and asthma

So, if you have been diagnosed with ADHD, should you have your home inspected for mold?

Probably yes

• You are an adult and your symptoms have come on recently.
• There is a reason to suspect your house is at high risk for mold, such as high levels of moisture in the house.
• You are buying a new house or condominium.

Maybe

• Your symptoms are not responding to more than one class of medication.
• You have had new or worsening allergic symptoms unexplained by other exposures.

Probably no

• You have had symptoms of ADHD most of your life with no recent, significant change.
• You have a strong family history of ADHD.
• You have no other allergic symptoms other than the symptoms of ADHD.  You should ask a family member to verify this for you because patients with ADHD often do not pay attention to symptoms such as red eye, infrequent cough, runny nose, and sinus headaches if they have them daily.

Treatment

Disinfection of your living or working space may or may not bring relief to your symptoms depending on how the mold was affecting you to begin with.

While there is one small trial of hyperbaric oxygen used to treat mold related symptoms in people with ADHD, it is too preliminary to comment on whether the results were due to chance rather than the treatment.  Hyperbaric oxygen has relatively few known side effects but can result in injury to the middle ear, lungs, and sinuses.  Therefore, hyperbaric oxygen is not recommended as therapy for mold induced worsening of symptoms of ADHD.

Everything ADHD Medical Disclaimer

Everything ADHD Privacy Policy

ADHD and Alcohol Do Not Mix For College Students

Alcohol often can seem like a tempting way to self medicate for ADHD, but in fact, it may do more harm than good, at least for college students.  College students with ADHD have their own share of academic struggles, but a new study done by Langberg, et al. suggests that alcohol plays a major role in who adjusts well to college life and who doesn't.  What's even more interesting is that alcohol played such an important role that it outperformed baseline ADHD symptoms and baseline measures of executive function as a predictor of successful adjustment by the end of the year.

How does alcohol do it, when it can often seem to calm the ADHD mind?  The researchers found the connection was that alcohol, as many depressants, seems to decrease motivation.

So, what's a college student to do?
Don't drink.  Real friends won't think less of you if you abstain, especially if it's for your future.  You can always blame your doctor ("doctor's orders!"), say it messes with your medication, or just say you prefer orange juice.

Pursue other means for learning to calm your mind, if that's an issue for you.

-Exercise is healthful and increases blood flow to the brain.  In elementary schools, exercise programs are being used to help promote concentration and better learning.

-Mindfulness is a less strenuous method that may work if you already are having difficulty getting motivated.

-If you're constantly anxious or can't get your mind to slow down on your own, seek medical help.   A therapist may be able to provide you with techniques and accountability to help you out in a healthier way than alcohol, or a doctor may suggest medication.

If you find you are not able to stay away from alcohol, get help.  If it hasn't affected your academic career, it is likely to do so in the future.  Your student health center may be a good place to start, but if you're not comfortable with that, you can look for a local chapter of Alcoholics Anonymous to point you in the right direction.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

ADHD, Obesity, and Eating Disorders

In a new article published in the International Journal of Eating Disorders, ADHD was found to be associated with obesity in 2 community pediatric mental health clinics.  When binge eating disorder was accounted for, the association was weaker.  In patients taking stimulants, the association was much stronger.  The average age of the patients in this study was 10.8 years old.

Some interesting points to take away from this study include the following:
1)  Binge eating is associated with ADHD, even in preteens, and even in those not taking medication.

2)  It isn't clear whether stimulants cause binge eating or whether people who need stimulants are also more likely to binge eat.  However, it is plausible that people who take stimulants are more likely to binge eat because they don't eat well during the day, and they are trying to make up for lost time.

Parents should be aware of this situation and be sensitive to their child's attitudes toward eating.  Some researchers believe that binge eating in ADHD is different from typical binge eating.  Typical binge eating disorder sometimes is related issues to feeling out of control, such as abuse or a perfectionist type of personality.   In ADHD related binge eating, researchers have noticed that some patients simply do not pay attention to the body's signals of fullness.  This may be why patients with ADHD suffer more from binge eating than from other eating disorders, such as anorexia.

There are some things parents can do to prevent obesity and binge eating disorder:

1)  Parents should teach their children to "listen to their body" and to avoid eating in situations where they may not be paying attention to how much they are eating, such as while watching TV, working/playing on the computer, or reading.    Unless your child is underweight, do not push him or her to eat when he or she is full.

2)  Parents can encourage children to eat at the table, with family or friends, and to eat a certain portion, rather than taking freely from a central plate or from a box, bag or other container.

3)  Finally, if a stimulant is causing symptoms of binge eating, parents should discuss their concerns with their prescribing physician and perhaps get a dietician involved to determine reasonable intakes for their child.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Accident Prone and ADHD

A new study epublished today in Developmental Medicine and Child Neurology confirmed that children with ADHD are at increased risk for breaking a bone.  I was not surprised.  There have been many times when I wished that I could peel my daughter out of the tree in our front yard, or the bookcase in our living room, and place her, lovingly of course, in a padded box.

The study is a step in the right direction, and one of several that have noted increased risk of injury in children with ADHD.  What is needed, though, is a study to demonstrate what it is about ADHD that increases the risk of fracture?  Is it only that ADHD kids are more hyperactive, that they are inattentive to potentially dangerous situations--in which case medicated children would be expected to have a lower fracture risk?

Could brittle bones be a side effect of medication?  Another study done in 2012 suggested that chronic exposure to methylphenidate caused bones to weaken in adolescent rats.  No other studies have taken this direction of inquiry, but perhaps it needs to be done.

Until then, I guess I'll need to encase my child in toilet paper or something else soft to keep her out of the ER.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

Antihistamines and hyperactivity: Zyrtec trial update

This is an update on our experience with cetirizine (Zyrtec) and loratidine (Claritin).  As I posted previously, loratidine made our daughter even more hyperactive than she is normally.  This year, we tried it again, hoping she had outgrown that side effect, but in fact, she was worse.    So we switched antihistamines.

Cetirizine liquid, worked out very well for us.  Our first impression was that it was very drying and but that the lowest dose didn't work well enough.  DD was very hyper, but she also wasn't sleeping well.  We increased the dose and it worked wonderfully.  She slept through the night without postnasal drip and her hyperactivity was about the same as it always is!    The bottom line:  if you have side effects with one antihistamine, you might not with another.

We've tried both the grape and the bubble gum flavored liquids and both taste fine.  And bonus:  we were able to find a good price for the medication at Sam's Club--about 30% lower than Walmart.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy

ADHD and Anxiety

Our daughter recently came down with the shingles.  Shingles is rare in children under the age of 10, so we had to ask ourselves what could have triggered it, since her immune system isn't suppressed in any way.  The only thing that we could come up with is that our cat has recently been ill (she told us she was really worried about him).  It kind of hurts, as a parent, to realize that your child has literally worried herself sick.  And yet, this is what our daughter did.

Anxiety is a common comorbidity of ADHD.  That is to say, people with ADHD suffer with anxiety more commonly than the general population.  In fact, a recent study found that about 38% of children with ADHD also have anxiety.

Anxiety disorders can take many forms.  In pediatric ADHD the most common forms seem to be generalized anxiety (worrying about everything), social phobia (worrying about what people think of you), and separation anxiety (child has difficulty separating from parent).

Unfortunately, the treatment of anxiety with ADHD is still in experimental stages.   In some cases treatment of ADHD with ADHD medications can help the anxiety.  Experts also treat anxiety separately with traditional anti-anxiety therapies, such as talk therapy, book therapy, and medication.  Clinical trials on this subject are actively recruiting subjects.

Allergies and ADHD

People who have ADHD also tend to have allergies, asthma, and/or eczema.  No one is really sure why, although it may have to do with either overall body inflammation.  Or maybe people with allergies, asthma, and eczema don't sleep as well and just can't concentrate.  Or maybe its the medication that makes people sleepy and unable to focus.

Allergy season is definitely upon us where we live.  We can see the blossoming trees everywhere.  That is when we whip out the antihistamines and shut our windows (just when we were able to open them and get some fresh air!).  DD's ADHD seems to have gotten worse too.  She claims it is because she is always having to wipe her nose and its just one more distraction.  Last year, Claritin (loratidine) made her hyperactivity much worse, although she avoided any asthma attacks.  This year, the pediatrician suggested to try either Zyrtec (cetirizine) or nasal steroids.    We are trying our first dose of cetirizine tonight, so we'll see how things go.

I have noticed that there is a nasal steroid available over the counter, Nasacort 24 H.  Pricing seems on par with most of the brand name allergy medications, but I have a cousin who went blind from taking nasal steroids (it weakened her immune system and she got a fungal infection in her sinuses, which then spread to her brain).  I realize that my cousin's story is a rarity, but I just don't want to go that way unless there is no other choice.

Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy