New NIMH Research to Test Innovative Treatments for Children with ADHD

June 5, 2008 • Science Update

Two new grants funded by NIMH will focus on novel and innovative approaches to treating children who have attention deficit hyperactivity disorder (ADHD).

ADHD is a mental disorder linked with attention problems, impulsivity, and hyperactivity. It affects around 3 to 5 percent of U.S. children, although some studies suggest as many as 8.7 percent of children are affected.¹ Current diagnostic criteria include the presence of impairing symptoms by age 7, although children may not actually be diagnosed until later. While hyperactivity generally decreases with age, other symptoms tend to persist, and it is not uncommon for ADHD-associated impairments to continue through the teenage years and into adulthood.²

L.Eugene Arnold, M.D., and Nicholas Lofthouse, Ph.D., of The Ohio State University, will lead a study on the use of neurofeedback, also called EEG biofeedback, an alternative therapy sometimes used to treat ADHD and other disorders. While some early studies have suggested a potential value of this treatment, scientific evidence of its effectiveness remains limited. During neurofeedback, a person receives information concerning the frequency of his or her EEG brain waves, which then can be used to attempt to bring it into a range associated with healthy brain function to improve behavior. The feedback the person receives may be visual, like a wave pattern, or an audio cue, such as a beeping sound. The researchers will use a new technology in which the brain waves govern the controls of a videogame that the child plays unaware of the brain wave training that is going on in the background.

In their pilot study, Arnold and Lofthouse will randomly assign 36 boys and girls ages 6 to12 to receive either EEG neurofeedback in the context of computer games or a placebo EEG treatment. During the placebo treatment, the participant experiences pre-programmed game effects that are not affected by his or her brain wave activity. Participants in each group also will be randomly assigned to receive their treatment either twice or three times a week to assess the effects of treatment frequency. All participants will complete 40 treatments total. Parents and teachers of the participants will rate the child's ADHD symptoms regularly. The findings from this pilot study may help scientists develop a larger-scale, randomized controlled trial to assess this non-medication treatment for ADHD.

Another study, led by James Waxmonsky, M.D., of the University of Buffalo, will focus on children with ADHD who have symptoms that resemble those seen in children with bipolar disorder. These children have also been described as having severe mood dysregulation or SMD. According to Waxmonsky, children with ADHD who also show these symptoms are more impaired than children with uncomplicated ADHD, and may be at risk of developing bipolar disorder and other mood disorders.

Treating children with ADHD and impaired mood (AIM) can be complicated because their symptoms straddle two mental disorders that are usually treated with very different medications. It is unclear whether typical ADHD medications are safe for children with impaired mood. Some studies suggest that stimulants, the type of medication normally used to treat ADHD, can start a manic episode in children who have bipolar disorder.^3,4,5 It is unclear how children with AIM will respond to treatment with stimulants. It is also unclear whether medications typically used to treat bipolar disorder are appropriate as an initial treatment for children with AIM.

In their study, the researchers plan to test a new psychosocial treatment that uses aspects of ADHD behavioral programs in combination with cognitive-behavioral and psychoeducational therapies for pediatric mood disorders. Seventy-two children with AIM ages 7 to 11 will be randomly assigned to receive either the psychosocial treatment combined with ADHD medication treatment or medication alone. This study will 1) develop and evaluate psychosocial therapies specifically for children with ADHD and impairments in mood; 2) examine the preferred initial treatment for children with ADHD and impairments in mood; and 3) assess the safety of stimulant medications in this population.

Reference

¹Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. 2007 Sep;161(9):857-64.

²Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.

³Faedda GL, Baldessarini RJ, Glovinsky IP, Austin NB. Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review. J Affect Disord. 2004 Oct 1;82(1):149-58.

⁴Soutullo CA, DelBello MP, Ochsner JE, McElroy SL, Taylor SA, Strakowski SM, Keck PE Jr. Severity of bipolarity in hospitalized manic adolescents with history of stimulant or antidepressant treatment. J Affect Disord. 2002 Aug;70(3):323-7.

⁵DelBello MP, Soutullo CA, Hendricks W, Niemeier RT, McElroy SL, Strakowski SM. Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset. Bipolar Disord.c 2001 Apr;3(2):53-7.