ChildsWork News, June 1, 2012: ADHD & Autism Research Update
As we head into the weekend, I wanted to share a couple interesting research pieces with you all that concern ADHD and autism research and treatment. The first of these article comes from research out of Stanford University and will appear in the June issue of Biological Psychology. According to study author, Antonio Hardan, an antioxidant (N-Acetylcysteine or NAC) may be an effective new treatment for autistic children’s irritability and repetitive behaviors. This is a really promising treatment which, though only tested under a pilot study, could mean great things for autism in the future. The next article concerns ADHD treatment. Rather than offer new possibilities, however, this study from the APA publication Developmental Psychology suggests that one treatment used for ADHD, called working memory training, may not be as effective as initially thought. Lead author, Monica Melby-Lervåg, PhD, of the University of Oslo suggests that the differences between studies about this treatment lead to questions regarding its effectiveness. Has anyone tried working memory training with ADHD students or others with reading and language disorders? Do you agree with this study’s findings? Certain Features of Autism May Be Improved by Antioxidant From a Medical News Today press release A specific antioxidant supplement may be an effective therapy for some features of autism, according to a pilot trial from the Stanford University School of Medicine and Lucile Packard Children's Hospital that involved 31 children with the disorder. The antioxidant, called N-Acetylcysteine, or NAC, lowered irritability in children with autism as well as reducing the children's repetitive behaviors. The researchers emphasized that the findings must be confirmed in a larger trial before NAC can be recommended for children with autism. Irritability affects 60 to 70 percent of children with autism. "We're not talking about mild things: This is throwing, kicking, hitting, the child needing to be restrained," said Antonio Hardan, MD, the primary author of the new study. "It can affect learning, vocational activities and the child's ability to participate in autism therapies." The study appears in the June 1 issue of Biological Psychiatry. Hardan is an associate professor of psychiatry and behavioral sciences at Stanford and director of the Autism and Developmental Disabilities Clinic at Packard Children's. Stanford is filing a patent for the use of NAC in autism, and one of the study authors has a financial stake in a company that makes and sells the NAC used in the trial. Finding new medications to treat autism and its symptoms is a high priority for researchers. Currently, irritability, mood swings and aggression, all of which are considered associated features of autism, are treated with second-generation antipsychotics. But these drugs cause significant side effects, including weight gain, involuntary motor movements and metabolic syndrome, which increases diabetes risk. By contrast, side effects of NAC are generally mild, with gastrointestinal problems such as constipation, nausea, diarrhea and decreased appetite being the most common. The state of drug treatments for autism's core features, such as social deficits, language impairment and repetitive behaviors, is also a major problem. "Today, in 2012, we have no effective medication to treat repetitive behavior such as hand flapping or any other core features of autism," Hardan said. NAC could be the first medication available to treat repetitive behavior in autism - if the findings hold up when scrutinized further. The study tested children with autism ages 3 to 12. They were physically healthy and were not planning any changes in their established autism treatments during the trial. In a double-blind study design, children received NAC or a placebo for 12 weeks. The NAC used was a pharmaceutical-grade preparation donated by the neutraceutical manufacturer BioAdvantex Pharma. Subjects were evaluated before the trial began and every four weeks during the study using several standardized surveys that measure problem behaviors, social behaviors, autistic preoccupations and drug side effects. During the 12-week trial, NAC treatment decreased irritability scores from 13.1 to 7.2 on the Aberrant Behavior Checklist, a widely used clinical scale for assessing irritability. The change is not as large as that seen in children taking antipsychotics. "But this is still a potentially valuable tool to have before jumping on these big guns," Hardan said. In addition, according to two standardized measures of autism mannerisms and stereotypic behavior, children taking NAC showed a decrease in repetitive and stereotyped behaviors. "One of the reasons I wanted to do this trial was that NAC is being used by community practitioners who focus on alternative, non-traditional therapies," Hardan said. "But there is no strong scientific evidence to support these interventions. Somebody needs to look at them." Hardan cautioned that the NAC for sale as a dietary supplement at drugstores and grocery stores differs in some important respects from the individually packaged doses of pharmaceutical-grade NAC used in the study, and that the over-the-counter version may not produce the same results. "When you open the bottle from the drugstore and expose the pills to air and sunlight, it gets oxidized and becomes less effective," he said. Although the study did not test how NAC works, the researchers speculated on two possible mechanisms of action. NAC increases the capacity of the body's main antioxidant network, which some previous studies have suggested is deficient in autism. In addition, other research has suggested that autism is related to an imbalance in excitatory and inhibitory neurotransmitters in the brain. NAC can modulate the glutamatergic family of excitatory neurotransmitters, which might be useful in autism. The scientists are now applying for funding to conduct a large, multicenter trial in which they hope to replicate their findings. "This was a pilot study," Hardan said. "Final conclusions cannot be made before we do a larger trial." Memory Training Unlikely to Help Treating ADHD, Boosting IQ From a Science Daily press release Working memory training is unlikely to be an effective treatment for children suffering from disorders such as attention-deficit/hyperactivity or dyslexia, according to a research analysis published by the American Psychological Association. In addition, memory training tasks appear to have limited effect on healthy adults and children looking to do better in school or improve their cognitive skills. “The success of working memory training programs is often based on the idea that you can train your brain to perform better, using repetitive memory trials, much like lifting weights builds muscle mass," said the study's lead author, Monica Melby-Lervåg, PhD, of the University of Oslo. "However, this analysis shows that simply loading up the brain with training exercises will not lead to better performance outside of the tasks presented within these tests." The article was published online in Developmental Psychology. Working memory enables people to complete tasks at hand by allowing the brain to retain pertinent information temporarily. Working memory enhancing tasks usually involve trying to get people to remember information presented to them while they are performing distracting activities. For example, participants may be presented with a series of numbers one at a time on a computer screen. The computer presents a new digit and then prompts participants to recall the number immediately preceding. More difficult versions might ask participants to recall what number appeared two, three or four digits ago. In this meta-analysis, researchers from the University of Oslo and University College London examined 23 peer-reviewed studies with 30 different comparisons of groups that met their criteria. The studies were randomized controlled trials or experiments, had some sort of working memory treatment and a control group. The studies comprised a wide range of participants, including young children, children with cognitive impairments, such as ADHD, and healthy adults. Most of the studies had been published within the last 10 years. Overall, working memory training improved performance on tasks related to the training itself but did not have an impact on more general cognitive performance such as verbal skills, attention, reading or arithmetic. "In other words, the training may help you improve your short-term memory when it's related to the task implemented in training but it won't improve reading difficulties or help you pay more attention in school," said Melby-Lervåg. In recent years, several commercial, computer-based working memory training programs have been developed and purport to benefit students suffering from ADHD, dyslexia, language disorders, poor academic performance or other issues. Some even claim to boost people's IQs. These programs are widely used around the world in schools and clinics, and most involve tasks in which participants are given many memory tests that are designed to be challenging, the study said. "In the light of such evidence, it seems very difficult to justify the use of working memory training programs in relation to the treatment of reading and language disorders," said Melby-Lervåg. "Our findings also cast strong doubt on claims that working memory training is effective in improving cognitive ability and scholastic attainment."