The Cincinnati Children’s Hospital Medical Center issued the following
news release:

Exposure to lead, tobacco smoke raises risk of ADHD

Children exposed prenatally to tobacco smoke and during childhood to
lead face a particularly high risk for ADHD, according to research done
at Cincinnati Children’s Hospital Medical Center.

The study estimates that up to 35 percent of ADHD cases in children
between the ages of 8 and 15 could be reduced by eliminating both of
these environmental exposures. This could translate into up to 800,000

“Tobacco and lead exposure each have their own important adverse
effect,” says Tanya Froehlich, M.D., a physician in the Division of
Developmental and Behavioral Pediatrics at Cincinnati Children’s and the
study’s lead author. “But if children are exposed to both lead and
prenatal tobacco, the combined effect is synergistic.”

The study is to be published online Nov. 23 by Pediatrics.

“Although we tend to focus on ADHD treatment rather than prevention, our
study suggests that reducing exposures to environmental toxicants might
be an important way to lower rates of ADHD,” says Robert Kahn, MD, MPH.,
a physician and researcher at Cincinnati Children’s and the study’s
senior author.

The researchers found that children exposed prenatally to tobacco smoke
were 2.4 times more likely to have ADHD. Those with blood lead levels in
the top third had a 2.3 fold increased likelihood of ADHD, despite
levels well below the Centers for Disease Control action level of 10
micrograms per deciliter. Dr. Froehlich and her colleagues found the
risk of ADHD more than eight times higher for children exposed to both
tobacco and lead compared to unexposed children.

The study is based on data of 8 to 15 years olds gathered between 2001
and 2004 from the National Health and Nutrition Examination Survey
(NHANES) from the National Center for Health Statistics at the Centers
for Disease Control and Prevention. NHANES is a nationally
representative sample of the United State population, designed to
collect information about the health and diet of people in the U.S.

Prenatal tobacco exposure was measured by maternal reports of cigarette
use during pregnancy. Lead exposure was assessed using current blood
lead level. Some 8.7 percent of the 3,907 children in the study met
diagnostic criteria for ADHD. The diagnosis for ADHD was based on the
Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition,
considered the “gold standard” for defining specific mental health conditions.

The study was funded by grants from the National Institutes of Health
and the Academic Pediatrics Association, and a Robert Wood Johnson
Generalist Physician Faculty Scholars Award.

The front page of this morning’s *Washington Times* includes an article:
“Debate Over Drugs For ADHD Reignites; Long-Term Benefit For Children at
Issue” by Shankar Vedantam.

Here are some excerpts:

[begin excerpts]

New data from a large federal study have reignited a debate over the
effectiveness of long-term drug treatment of children with hyperactivity
or attention-deficit disorder, and have drawn accusations that some
members of the research team have sought to play down evidence that
medications do little good beyond 24 months.

The study also indicated that long-term use of the drugs can stunt
children’s growth.

The latest data paint a very different picture than the study’s positive
initial results, reported in 1999.

One principal scientist in the study, psychologist William Pelham, said
that the most obvious interpretation of the data is that the medications
are useful in the short term but ineffective over longer periods but
added that his colleagues had repeatedly sought to explain away evidence
that challenged the long-term usefulness of medication.

When their explanations failed to hold up, they reached for new ones,
Pelham said.

“The stance the group took in the first paper was so strong that the
people are embarrassed to say they were wrong and we led the whole field
astray,” said Pelham, of the State University of New York at Buffalo.

Pelham said the drugs, including Adderall and Concerta, are among the
medications most frequently prescribed for American children, adding:
“If 5 percent of families in the country are giving a medication to
their children, and they don’t realize it does not have long-term
benefits but might have long-term risks, why should they not be told?”

The disagreement has produced a range of views among the researchers
about how to accurately present the results to the public.


In August 2007, the MTA researchers reported the first follow-up data,
which by then no longer showed differences in behavior between children
who were medicated and those who were not.

But the data did show that children who took the drugs for 36 months
were about an inch shorter and six pounds lighter than those who did not.

A news release issued by the National Institute of Mental Health (NIMH)
at the time, however, presented the results in a more favorable light.

The release, dated July 20, 2007, was titled “Improvement Following ADHD
Treatment Sustained in Most Children.”


The release noted that the initial advantages of drug treatment were no
longer evident, but it quoted Jensen as saying this did not mean that
long-term drug therapy was ineffective.

Jensen said, “We were struck by the remarkable improvement in symptoms
and functioning across all treatment groups.”

And rather than saying the growth of children on medication was stunted,
the release said children who were not on medication “grew somewhat larger.”


Pelham, who has conducted many drug therapy studies, said the drugs have
a valuable role: They buy parents and clinicians time to teach
youngsters behavioral strategies to combat inattention and
hyperactivity. Over the long term, he said, parents need to rely on
those skills.

A yet-to-be-published study, Pelham added, found that 95 percent of
parents who were told by clinicians to first try behavioral
interventions for ADHD did so.

When parents were given a prescription for a drug and then told to
enroll their children in behavioral intervention programs, 75 percent
did not seek out the behavioral approaches.

[end excerpts]

Courtesy of Ken Pope

The article is online at:

ADHD in Adults – presenting complaints by patient

  • difficulty finding/keeping jobs
  • perform below level of competence on jobs
  • not perform at intellectual level at school
  • can’t concentrate
  • disorganized
  • can’t create and keep a routine
  • poor discipline
  • depression, low self esteem
  • forgetful or poor memory
  • confusion, trouble thinking clearly


Associated problems:

  • frequent moves
  • lots auto accidents
  • 25% are antisocial personality
  • theft, pranks,
  • increased substance abuse (not alcohol)
  • poorer memory, reaction time

Often see in ADD adults:

  • marital instability,
  • less academic/vocational success than expected for IQ,
  • alcohol/drug abuse,
  • atypical reaction to psychoactive meds,
  • family history with similar features,
  • family history of ADD,
  • alcoholism, drug abuse,
  • antisocial personality,
  • Briquet’s syndrome.


Another list of signs:

a. Fidgetiness or feeling restless

b. Difficulty remaining satisfied

C, Being easily distracted

d. Difficulty waiting your turn

e. Blurting out answers before the question is completed

f. Difficulty following through on or completing tasks

g. Sustaining attention in tasks

h. Frequently shifting from one task to another

i. Difficulty doing tasks alone

j. Talking too much

k. interrupting or intruding on others

1. Not listening to others

m. Losing important things or forgetting a lot

n. Engaging in physically daring activities

o. Always on the go, as if driven by a motor

p. making decisions too quickly or acting too quickly

q. impatient