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Dr. Robert Quillin presents on ADHD at TAPA 2014, La Cantera Resort, San Antonio, TX - February 22, 2014
Citation preview
ADHD
Rethinking an old diagnosis
Robert L Quillin MD FAAP
Disclosures
Speaker and consultant for VayaPharma makers of Vayarin
Previous research support provided by PernixTherapeutics
Will discuss off label use of medications medical foods and supplements
Presentation Outline
morbidity of the attention disorders
current diagnostic approach to attention
disorders
the neurobiochemistry of attention
approach to stimulant use in attention disorders
paradigm shift in the treatment of attention disorders
Faces not easy to forget
STATE OF THE UNION
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Disclosures
Speaker and consultant for VayaPharma makers of Vayarin
Previous research support provided by PernixTherapeutics
Will discuss off label use of medications medical foods and supplements
Presentation Outline
morbidity of the attention disorders
current diagnostic approach to attention
disorders
the neurobiochemistry of attention
approach to stimulant use in attention disorders
paradigm shift in the treatment of attention disorders
Faces not easy to forget
STATE OF THE UNION
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Presentation Outline
morbidity of the attention disorders
current diagnostic approach to attention
disorders
the neurobiochemistry of attention
approach to stimulant use in attention disorders
paradigm shift in the treatment of attention disorders
Faces not easy to forget
STATE OF THE UNION
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Faces not easy to forget
STATE OF THE UNION
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
STATE OF THE UNION
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
ADHD Timeline
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Impact of ADHD Approximately 11 of children 4-17 years of age (64 million) have been
diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis continues to
increase from 78 in 2003 to 95 in 2007 and to 110 in 2011
Rates of ADHD diagnosis increased an average of 3 per year from 1997
to 2006 and an average of approximately 5 per year from 2003 to 2011
Boys (132) were more likely than girls (56) to have ever been
diagnosed with ADHD
The average age of ADHD diagnosis was 7 years of age
Prevalence of ADHD diagnosis varied substantially by state from a low of
56 in Nevada to a high of 187 in Kentucky
httpwwwcdcgovncbdddadhddatahtmlus
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Financial Impact of ADHD
Using a prevalence rate of 5 the annual societal lsquolsquocost of illnessrsquorsquo for
ADHD is estimated to be between $36 and $52 billion in 2005 dollars It is
estimated to be between $12005 and $17458 annually per individual
There were an estimated 7 million ambulatory care visits for ADHD in
2006
The total excess cost of ADHD in the US in 2000 was $316 billion
The annual average direct cost for each per ADHD patient was $1574
compared to $541 among matched controls
ADHD creates a significant financial burden regarding the cost of medical
care and work loss for patients and family members
httpwwwcdcgovncbdddadhddatahtmlcost
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
ldquoI CAN CALCULATE THE MOTION
OF HEAVENLY BODIES BUT NOT
THE MADNESS OF PEOPLErdquo
Sir Isaac Newton
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
What exactly is ADHD
ADHD is one of the most common neurodevelopmental disorders of
childhood
Initial diagnosis in childhood and often lasts into adulthood
Children with ADHD may have
trouble paying attention
controlling impulsive behaviors (may act without thinking about what
the result will be)
or be overly active
The ADHD Molecular Genetics Network Report from the third international meeting ofthe attention-deficit hyperactivity disorder molecular genetics networkAmerican Journal of Medical Genetics 2002 114272-277
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
ADHD defined by DSM-5INATTENTION Six or more symptoms of inattention for children up to age 16 or
five or more for adolescents 17 and older and adults symptoms of inattention
have been present for at least 6 months and they are inappropriate for
developmental level
Often fails to give close attention to details or makes careless mistakes in
schoolwork at work or with other activities
Often has trouble holding attention on tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish schoolwork chores
or duties in the workplace (eg loses focus side-tracked)
Often loses things necessary for tasks and activities (eg school materials pencils
books tools wallets keys paperwork eyeglasses mobile telephones)
Often avoids dislikes or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework)
Often has trouble organizing tasks and activities
Is often easily distracted
Is often forgetful in daily activities
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
ADHD defined by DSM-5HYPERACTIVITY AND IMPULSIVITY Six or more symptoms of hyperactivity-
impulsivity for children up to age 16 or five or more for adolescents 17 and
older and adults symptoms of hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive and inappropriate for the
personrsquos developmental level
Often fidgets with or taps hands or feet or squirms in seat
Often leaves seat in situations when remaining seated is expected
Often runs about or climbs in situations where it is not appropriate (adolescents or
adults may be limited to feeling restless)
Often unable to play or take part in leisure activities quietly
Often blurts out an answer before a question has been completed
Often has trouble waiting hisher turn
Often interrupts or intrudes on others (eg butts into conversations or games)
Is often on the go acting as if driven by a motorldquo
Often talks excessively
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Basic types
1) ADHD predominantly inattentive type
2) ADHD predominantly hyperactive-impulsive type
3) ADHD combined type
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Comorbidity the rule not the exception
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (female)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
From Comorbid Psychiatric Disorders in Youth in Juvenile Detention (male)
Arch Gen Psychiatry 200360(11)1097-1108 doi101001archpsyc60111097
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
httpstudentacademichelpblogspotcom200910
baseball-players-with-adhdhtmlixzz2bFzBnnv0
Tuesday October 6 2009
Baseball Players with ADHD
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Whatrsquos missing
Learning disorders
Dyslexia dysphasia dysgraphia
Autism spectrum disorders including PDD and
Aspergerrsquos syndrome
Tic disorders
Tourettersquos syndrome
Congenital genetic disorders ndash Down syndrome
DiGeorge syndrome and others
Cancers ndash leukemia brain tumors
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Donrsquot forget your fundamentals
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
NEURO-developmental disorder
I History and Physical ndash with interview covering emotional and psychosocial concerns particularly early development
II Hearing and vision screen particularly hearing
III Labs
Complete blood count ndash anemia due to low iron low B12
Lead level ndash consider your patientrsquos exposures
Thyroid ndash too much or too little
IV EEG ndash is it a seizure
V Behavior Checklists
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Tools of the trade
Behavior Rating Scales
subjective evaluations by teachers and parents self report
Vanderbilt Assessment Scale 6-12 years
Conners 3rd edition 6-18 years
More ADHD specific vs Conners CBRS
SNAP-IV R 6-18 years
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
The big players
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Is that all to ADHD
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Where they act
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Arenrsquot you glad thatrsquos over
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
To treat or not to treat
Gold standard ndash The stimulantRitalin Adderall Focalin
Daytrana Vyvanse Quillivant XR
Other choicesNonstimulants ndash Intuniv Kapvay Straterra
Medical foods ndash VayarinVitamins ndash Brsquos Drsquos Mg Zinc
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
COMPARE
4-5 years old lt50
pounds
Short acting better
Hyperactive
Family history
Side effects
Parental ambivalence
5 years old 50+
pounds
Long acting best
Inattentive
New diagnosis
Comorbidities
Parental Fear
CONTRAST
Where to start
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Prescription Medical Foods
Defined as
ldquoa food which is formulated to be consumed or administered enterallyunder the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluationrdquo
Section 5(b) of the Orphan Drug Act (21 USC 360ee (b) (3))
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
FDA Regulation of Prescription
Medical Foods
Foods
FDA GRAS for
Safety
Dietary Supplements
No Pre-Market FDA Approval for pre-1994 ingredients
-OR-
FDA review for new dietary ingredients
Prescription Medical Foods
FDA GRAS for Safety of Ingredients
FDA Required Clinical Evidence for Efficacy
Prescription Drugs
FDA Approval for Safety amp Efficacy
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Time is right for a change
Omega3 + Phosphatidylserine - Vayarin
B-vitamins folate B6 B12 choline ndashDeplin Cerefolin
Vitamin D
Magnesium
Zinc
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
PS-Omega-3 showed an endpoint that no
longer qualified as ADHD in the TOVA
Vaisman N et al Correlation between changes in blood fatty acid composition and visual sustained attention performance in children
with inattention effect of dietary n-3 fatty acids containing phospholipids Am J Clin Nutr 2008 87(5) p 1170-80
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Folate
J Pediatr 2008 Jan152(1)101-5
Folate pathway genetic polymorphisms are related to attention
disorders in childhood leukemia survivors
Krull KR Brouwers P Jain N Zhang L Bomgaars L Dreyer Z Mahoney D
Bottomley S Okcu MF
Learning Support Center for Child Psychology Texas Childrens Hospital
Houston TX USA
CONCLUSION Preliminary data imply a strong relationship
between MTHFR polymorphisms and the inattentive symptoms of
ADHD in survivors of childhood ALL
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
MagnesiumVitamin B6Magnes Res 2006 Mar19(1)46-52
Improvement of neurobehavioral disorders in children
supplemented with magnesium-vitamin B6 I Attention deficit
hyperactivity disorders
Mousain-Bosc M1 Roche M Polge A Pradal-Prat D Rapin J Bali JP 1Explorations Fonctionnelles du Systegraveme Nerveux Centre Hospitalier
Universitaire Careacutemeau Nicircmes France
CONCLUSION In almost all cases of ADHD Mg-B6 regimen for at
least two months significantly modified the clinical symptoms of the
disease hyperemotivityaggressiveness were reduced school
attention was improved When the Mg-B6 treatment was stopped
clinical symptoms of the disease reappeared
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
ZincActa Med Croatica 2009 Oct63(4)307-13
[The role of zinc in the treatment of hyperactivity disorder in
children]
Dodig-Curković K1 Dovhanj J Curković M Dodig-Radić J Degmecić D1University Department of Child and Adolescent Psychiatry University
Department of Psychiatry Osijek University Hospital Osijek Croatia
kdodigyahoomail
CONCLUSION The dose of zinc sulfate used was 55 mgday which is
equivalent to 15 mg zinc The improvement achieved in ADHD children
with the use of zinc sulfate appears to confirm the role of zinc
deficiency in the etiopathogenesis of ADHD Additional studies are
needed to identify the real and efficient dose of zinc
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
Vitamin D
Pediatr Int 2014 Jan 13 doi 101111ped12286 [Epub ahead of print]
Vitamin D Status in Children with Attention Deficit Hyperactivity
Disorder
Goksugur SB1 Tufan AE Semiz M Gunes C Bekdas M Tosun M Demircioglu F1Department of Pediatrics Medical Faculty Abant Izzet Baysal University Bolu
Turkey
CONCLUSION 25-OH-vitamin D level in ADHD group and control
group was respectively 209plusmn194 ngmL and 349plusmn154 ngmL
(p=0001) Our results suggest that there is an association between
lower 25-OH-vitamin D concentrations and ADHD in childhood and
adolescence
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
C
O
N
C
L
U
S
I
O
N
THANK YOU TAPA
THANK YOU TAPA