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Research Updates
Study examines whether primary care physicians follow the practice guidelines in the care of children with ADHD. Dr. Jerry Ruston and colleagues sought to describe primary care diagnosis and management of ADHD, to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and to describe factors associated with guideline adherence. They conducted a mail survey of 1,374 primary care physicians in Michigan and heard from 60% of them. The majority (over 77%) were familiar with AAP guidelines on ADHD and many (61%) reported incorporating the guidelines into their practice with pediatricians (91%) reporting more familiarity with the guidelines in contrast to family physicians (59%). The majority of clinicians reported practices consistent with individual components of the guidelines for diagnosis and treatment. However, only about one quarter of the clinicians routinely used all four diagnostic components in the survey. Some physicians continue to use diagnostic modalities that are not currently recommended for routine evaluation of school-aged children with ADHD—continuous performance testing, neuroimaging, and laboratory tests (eg, thyroid, lead, or iron testing). With respect to ADHD treatment, 66% of respondents reported routine recommendation of pharmacotherapy and titration of medications in the first month when prescribed. However, just over half (53%) reported routine follow-up visits (3-4 times per year) for children who have ADHD and are taking medications. Another 53% of clinicians also recommended behavioral therapy . Pediatricians were more likely to recommend medication, but family physicians reported more frequent follow-up evaluations for children who receive medication. Only 32% agreed that their community had adequate, accessible mental health resources. About half of the clinicians reported that insurers limit coverage for assessment and treatment of ADHD. The study leaders concluded that primary care physicians generally report awareness of pediatric ADHD guidelines and follow these clinical practice recommendations. Rushton, J. L, Fant, K.E., & Clark, S. J. (2004). Use of practice guidelines in the primary care of children with attention-dficit/hyperactivity disorder. Pediatrics, 114, e23-e28.


Study examines brain activity in adolescents with ADHD. Schulz, Newcorn, Halperin, Fan, and Tang published the results of a study of brain activation gradients in the prefrontal cortex in teenagers with ADHD in the January, 2005 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. In the past research has pointed to the frontostraiatal brain regions and the inhibitory control functions that they affect as important in the pathophysiology of ADHD. Studies have noted the similarities between inhibitory deficits in individuals with ADHD and patients with frontal lobe lesions. Structural MRI studies of children with ADHD have consistently reported reduced volumetric measures of the prefrontal cortex and caudate nucleus as well as regions in the parietal cortex and cerebellum. Functional MRI studies have found differences in the cortical activity in young children and latency-aged boys with ADHD performing certain tasks related to response inhibition (go/no-go tasks).

In this study ten adolescents who were diagnosed with ADHD during childhood were scanned with fMRI while performing a go/no-go task. Half of these adolescents continue to meet full diagnostic criteria for DSM-IV ADHD (persisters) and half had experienced sufficient symptomatic remission to warrant a diagnose of ADHD in partial remission (remitters). A matched control group of five adolescent males with no history of ADHD was also scanned during performance of the go/no-go task. The researchers tested for brain activation gradients, predicting that ventral prefrontal cortex activation will be greatest in persisters and lowest in controls, with remitters falling between the two groups. They also expected that striatal activation will be lowest in persisters, somewhat greater in remitters, and greatest in controls.

They found that on the go/no-go task persisters made the most commission errors (33%) and showed the greatest activation, remitters made fewer commission errors (24%) and had lower activity, and activation was lowest in controls who made the fewest errors (13%). Researchers concluded that these preliminary results suggest that developmental changes in ADHD symptomatology are associated with functional changes in ventrolateral prefrontal cortex activity. Schulz, K.P, Newcorn, J.H, Fan, J. Tang, C. Y., & Halperin, J. (2005) Brain activation gradients in ventrolateral prefrontal cortex related to persistence of ADHD in adolescent boys. Journal of the American Academy of Child and Adolescent Psychiatry, 44(1) 47-54.

Survival Tips for Women with AD/HD
A recent review of Terry Matlen's new book, Survival Tips for Women with AD/HD, appeared in this month's issue of ADDitude Magazine. Reviewer, Chris Adamec, author of Moms with ADD, wrote:

"Most books on AD/HD are very linear and highly structured, just the way that linear and structured editors who don't have ADHD like them. That's fine for readers who want to understand AD/HD in others, but it's not so useful for people who actually have an attention deficit and whose creative and bouncing brains may leap from point A to point J and then Z and back again to A or J. (If you don't know what I'm talking about, you probably don't have AD/HD.) These books may have great advice, but few people with AD/HD have the patience to work their way through to find it. Now therapist Terry Matlen, who has ADHD herself, offers a highly entertaining and AD/HD-friendly book for women struggling with AD/HD. Survival Tips for Women with AD/HD: Beyond Piles, Palms & Post-Its (Specialty Press, 2005) is crammed with lists, practical advice and helpful hints from Matlen and other women with AD/HD."

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Free Teleconference • February 9, 2005, 8:30-9:30 PM
MyADHD.com and ADDvisor.com invite you to sign up for our next free live ADHD teleconference.This free teleconference entitled Medical Management of ADHD features Jefferson Prince, MD. Dr. Prince is on the faculty of Harvard Medical School and is a member of the Pediatric Psychopharmacology Clinic and Research Unit at the Massachusetts General Hospital. He is also Director of Child Psychiatry and Pediatric Psychopharmacology at North Shore Children’s Hospital. Find answers to your questions about medical management of ADHD and related conditions in children and adults.

February's Featured myADHD.com's Tools
Adults with ADHD can benefit from using this month's treatment tools to learn more about workplace accommodations and budgeting personal finances.
• 1201 Personal Budget Worksheet
• 1202 Monthly Budget Worksheet
• 1203 Requesting Workplace Accommodations
• 1204 Workplace Accommodation Ideas

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myADHD.com news is an e-publication of Health Link Systems, Inc. This publication is sponsored by myADHD.com, A.D.D. WareHouse, and the National Association for Continuing Education. Information presented here is not intended to replace the advice of a physician or other health care professional. Placement of an advertisement in this e-newsletter does not represent an endorsement of any advertised products or services or the validity of any claims advertised. Copyright 2005 by Health Link Systems, Inc. For comments or information, please send an email to: info@myadhd.com, subject line: myADHD.com News.