In the News

White children are especially likely to be over diagnosed and overtreated for ADHD, according to a new study

Healthy Eating Goes Smart: App Developer Foogal and Autoimmune Disease Expert Dr. Terry Wahls Form Partnership

Revealing one of the driving forces of Alzheimer's

A Rhythmic Small Intestinal Microbiome Prevents Obesity and Type 2 Diabetes

Inhaled nitric oxide reduces hospital stay and improves oxygenation in pregnant patients with COVID-19 pneumonia

White children are especially likely to be over diagnosed and overtreated for ADHD, according to a new study

White children are especially likely to be over diagnosed and overtreated for attention-deficit/hyperactivity disorder during elementary school. That is the key finding from our recent peer-reviewed study.

We analyzed data from 1,070 U.S. elementary school children who had displayed above-average behavioral, academic or executive functioning the year before their initial ADHD diagnoses. We considered these children as unlikely to have ADHD. Children diagnosed and treated for ADHD should display chronically inattentive, hyperactive or impulsive behaviors that impair their functioning and result in below-average academic or social development.

Among elementary school children who had shown above-average academic achievement, 27% of white children versus 19% of nonwhite children were later diagnosed with ADHD. About 20% of white children versus 14% of nonwhite children were using ADHD medication. Among children who had previously been well-behaved in classrooms, 13% of white children versus 8% of nonwhite children were later diagnosed with ADHD. Families’ socioeconomic status or children’s age did not explain these disparities.

We did find that ADHD diagnosis and treatment is very uncommon among elementary school children displaying above-average behavioral, academic or executive functioning. We observed ADHD diagnosis and treatment to occur in less than 5% of this group. Our findings are consistent with prior work examining racial and ethnic disparities among children unlikely to have ADHD.

Why it matters

Among U.S. children and adolescents, ADHD prevalence has increased significantly, from 6% to 10% over the past 20 years. Overdiagnosis may be contributing to this trend. Increases in ADHD prevalence in children are occurring among those displaying mild impairments.

Overdiagnosis stretches already limited mental health resources and allocates them away from children who need them most. Overdiagnosis may also contribute to stigma and skepticism toward those experiencing significant or moderate impairments.

ADHD diagnosis and treatment has been shown to be beneficial for the larger group of children with significant ADHD symptoms and impairments. However, for the smaller group of children with no or only mild symptoms, ADHD diagnosis may result in lower academic achievement and behavior during elementary school.

Children with mild ADHD may be more likely to compare themselves with children without disabilities, and so adopt negative ability beliefs that interfere with their learning and behavior. Overtreatment also unnecessarily exposes children to medication’s negative side effects, such as sleep problems or depressed appetites.

What still isn’t known

We don’t know why white children in elementary school are especially likely to be overdiagnosed and overtreated for ADHD. One possibility is that white parents are more likely to seek diagnoses and treatments because they are more accepting of ADHD as a health condition. Limited research suggests that some parents may be attempting to obtain ADHD diagnoses and medications as a way to increase their children’s academic achievement.

We couldn’t investigate whether white children are more likely to be overdiagnosed and overtreated for ADHD during middle or high school because our study’s data collection ended at the end of elementary school.

What’s next

Researchers are repeatedly calling for investigations of ADHD overdiagnosis and overtreatment. We are extending our research by examining whether disparities in ADHD diagnosis and treatment vary for boys and girls by race and ethnicity.

Paul L. Morgan receives funding from the U.S. Department of Education's Institute of Education Sciences.

This article is republished from The Conversation under a Creative Commons license. Read the original article here: https://theconversation.com/white-children-are-especially-likely-to-be-overdiagnosed-and-overtreated-for-adhd-according-to-a-new-study-185102.

Healthy Eating Goes Smart: App Developer Foogal and Autoimmune Disease Expert Dr. Terry Wahls Form Partnership

Author and leading medical expert in autoimmune disease, Dr. Terry Wahls, has joined forces with Foogal, a digital health software company, to help people take control of their health through proper nutrition and healthy eating.

The partnership comes at a crucial time in history, as researchers with the National Institutes of Health are tracking a rise in autoimmune disorders, particularly among adolescents. Evidence suggests the changes in lifestyle and environment, such as the Western diet, may be to blame for the increase.

Dr. Terry Wahls, Professor of Medicine at the University of Iowa, is best known for her miraculous recovery from Secondary Progressive Multiple Sclerosis. Using a research-backed food-as-medicine method centered around a Paleo-inspired diet, she reversed the progression of her disease and regained the ability to enjoy life. The strategy allowed her to escape the confines of a tilt-recline wheelchair and rebuild the strength to bike to work daily.

Dr. Wahls will work with Foogal to help the 23.5 million Americans suffering from autoimmune conditions follow her lead and take control of their health. The smartphone app will offer research-backed, chef-created recipes created explicitly for managing autoimmune disorders.

"I am very excited to be collaborating with Foogal in the shared vision of improving health through the foods we consume," said Dr. Wahls. "This shared vision for improving health is through delicious health-affirming meals you and your family will love."

Foogal and Dr. Wahls' collaboration will blend technology and medical expertise to provide a stress-free, easy-to-use roadmap for optimal wellness.

"The combination of Dr. Wahls' pioneering work in the food-as-medicine field and Foogal's software development expertise is powerful," said Todd Knobel, founder of Foogal. "Together, working as one team, we will develop a tool that will help Dr. Wahls' patients and followers embrace health and live their best lives."

About the Global Autoimmune Crisis: The National Institute of Allergy and Infectious Diseases reports that scientists have discovered more than 80 diseases occur due to the immune system attacking the body's organs, tissues and cells. Researchers believe genetics, infections, and environmental exposures play a role in developing these diseases.

About Foogal: Foogal develops digital health apps that allow users to quickly find suitable meals for their health conditions, such as prediabetes and diabetes. Recipes go beyond the ordinary, crafted by some of America's finest chefs, scientists, nutrition pioneers and academics. The company has created three diet protocols: Insulin Resistance Protocol, Autoimmune Protocol, and Wellness Protocol.

About Dr. Terry Wahls: A pioneer in testing and understanding the effect of therapeutic diet and lifestyle to treat multiple sclerosis-related symptoms, Dr. Wahls is the author of "The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine." She currently travels the world, providing lectures and education about the importance of diet and lifestyle for those with chronic diseases.

Revealing one of the driving forces of Alzheimer's

Alzheimer's disease, the most common form of dementia, currently has no cure or effective therapy, in part due to gaps in our understanding of how the progressive neurodegenerative disorder arises in the brain.

Now, a Flinders University study has shown how a protein called tau, a critical factor in the development of Alzheimer's disease, turns from normal to a disease state -- and demonstrates how this discovery could deliver a therapeutic target.

Published in the journal Science Advances, the team's findings provide hope for preventing the tau transformation process from happening, thereby keeping tau in a healthy state and avoiding toxic effects on brain cells.

"Alongside a small peptide called amyloid-beta, the tau protein is a central factor in Alzheimer's disease. Tau is necessary for the toxic effects on brain cells that then result in impaired memory function," says senior study author Dr Arne Ittner, Senior Research Fellow in Neuroscience in the Flinders Health and Medical Research Institute.

In the course of Alzheimer's disease development, tau accumulates in deposits inside brain cells. During this process, tau gets heavily modified, with various deposits made up of tau carrying multiple small changes at many different positions within the tau molecule.

While such changes to tau have been known to neuropathologists for decades, it remained unclear how tau arrives at this multi-modified stage. The new study has solved part of this mystery and provides a new mechanism to explain how tau gets progressively modified.

The study set out to answer whether one change at one specific spot in tau would make it easier for another spot to be modified. The team focussed on the relationship between tau and protein kinases, which are enzymes that introduce changes in tau.

"Usually, protein kinases target specific spots, called phosphorylation sites, in tau and other proteins, and introduce changes only at these specific spots," says study lead author Dr Kristie Stefanoska, Research Fellow in Dementia at Flinders University.

"However, we suspected that some of these enzymes are able to target several spots in tau and would do so even more efficiently if tau were already modified at one spot to begin with."

The researchers conducted a large experiment that included up to 20 different changes in tau and 12 enzymes, focussing on the most abundant type of change seen in tau from the brains of Alzheimer's patients.

While the study did discover that one change in tau does makes it easier for another change to be introduced, it was also able to identify "master sites" in tau, being specific spots that govern subsequent modifications at most of the other sites.

"By modifying these master sites, we were able to drive modification at multiple other spots within tau, leading to a similar state seen in the brains of Alzheimer's patients," says Dr Ittner.

The next step for the team was to see whether master sites could be targeted to reduce the toxic properties of tau in Alzheimer's, in a bid to improve memory function.

The current study employed mice that have both amyloid and tau and developed Alzheimer's-like symptoms, including memory deficits. The researchers found that mice did not develop memory deficits when they had a version of tau that lacked one of the identified master sites, compared with mice that had the usual version of tau.

The team will now investigate how its findings can be translated into a treatment.

"We have shown that this new concept has therapeutic potential, but future work is needed to understand the role of these master sites in health and disease," says Dr Stefanoska.

"Tau modification in Alzheimer's disease is a complicated process. Ours is the first study to link an initial change in tau with multi-site modification along the entire protein."

The authors say the new mechanism and the master sites at its centre could apply to a range of neurological disorders in which tau is involved, including Parkinson's disease, concussion-induced chronic brain injury and stroke.

"Slowing down the changes at master sites of tau in these diseases may put the brakes on tau toxicity and dementia," says Dr Ittner.

"This new mechanism helps us understand why there is extensive tau modification in Alzheimer's disease in the first place. This will assist researchers and clinicians in designing means for better and earlier diagnosis."

The paper -- Alzheimer's disease: Ablating single master site abolishes tau hyperphosphorylation by Kristie Stefanoska, Mehul Gajwani, Amanda R. P. Tan, Holly I. Ahel, Prita Riana Asih, Alexander Volkerling, Anne Poljak and Arne Ittner -- is published in Science Advances.

A Rhythmic Small Intestinal Microbiome Prevents Obesity and Type 2 Diabetes

An estimated 500 to 1,000 bacterial species reside in each person’s gut, perhaps numbering 100,000 trillion microorganisms. In a new paper, published July 5, 2022 in Cell Reports, researchers at University of California San Diego School of Medicine used mouse models to explore how diet and feeding patterns affect these intestinal microbes — and the health of the hosts, particularly with obesity and type 2 diabetes.

In both mice and men, the ileum is the final stretch of the small intestine, connecting to the cecum, the first part of the large intestine. In the ileum, nutrients are drawn out of liquefied food; in the cecum, which also marks the beginning of the colon, the process of extracting water begins.

Both processes are complex, dynamic and profoundly influenced by factors ranging from the types of foods consumed and when, to the microbial residents of the gut, whose presence and behaviors help dictate digestion, absorption of nutrients, vitamin synthesis and development of the immune system.

“It’s important to realize that the gut microbiome is constantly changing, not only based on what we’re eating, but also based on the time of day,” said senior study author Amir Zarrinpar, MD, PhD, assistant professor of medicine at UC San Diego School of Medicine and a gastroenterologist at UC San Diego Health.

“Most researchers are getting snapshots of this constantly shifting environment, which makes it hard to understand what is going on in the gut. With this study, we are trying to get multiple snapshots throughout the day, almost like a movie, to better understand how food and the microbiome interact to affect weight gain and diabetes.

“And what we’ve learned is that cyclical changes in the gut microbiome are quite important for health since they help with the circadian clock, and with that the regulation and control of glucose, cholesterol and fatty acids — and overall metabolic health.”

In their latest work, Zarrinpar and colleagues further elucidate the impact and interplay of these factors, particularly in terms of the ileum and its unique functions related to digestion and absorption. Specifically, they looked at how diet-induced obesity (DIO) and time-restricted feeding (TRF) alter ileal microbiome composition and transcriptome (the protein-coding part of an organism’s genome) in mouse models.

The researchers found that in mouse models, DIO and the absence of TRF (mice could eat as much as they wanted whenever they wanted) resulted in disruptions to gut microbiome rhythms and the signaling pathways that help modulate intestinal clocks. In other words, the mice became fat and unhealthy.

“It is interesting that restricting food access with TRF acts not only through restoration of patterns affected under the unhealthy state, but also through new pathways,” said first author Ana Carolina Dantas Machado, PhD, a postdoctoral scholar in Zarrinpar’s lab.

“These findings underscore the influence of diet and time restricted feeding patterns in maintaining a healthy gut microbiome, which in turn modulates circadian rhythms that govern metabolic health,” said Zarrinpar. “It’s a very complicated relationship between the microbiome and the host, with the former helping determine the latter’s gastrointestinal functioning and health.”

Their work, said the authors, can inform future studies, in particular investigations of how the gut works or how drugs act upon the gut function depending upon the state of the microbiome at a particular time or time of day.

Co-authors include: Steven D. Brown, Amulya Lingaraju, Vignesh Sivaganesh, Cameron Martino, Peng Zhao, Antonio F.M. Pinto, Max W. Chang, R. Alexander Richter Alan R. Saltiel, Rob Knight and Satchidananda Panda, all at UC San Diego; Amandine Chaix, University of Utah; and Alan Saghatelian, Salk Institute for Biological Studies.

Inhaled nitric oxide reduces hospital stay and improves oxygenation in pregnant patients with COVID-19 pneumonia

High dose inhaled nitric oxide gas (iNO) is a safe and effective respiratory therapy for pregnant women hospitalized with severe COVID-19 pneumonia, resulting in a more rapid weaning from supplemental oxygen and reduced length of hospital stay, according to a research team led by Massachusetts General Hospital (MGH). In a study published in Obstetrics & Gynecology, researchers from four Boston hospitals reported that the addition of twice-daily nitric oxide to standard of care oxygen therapy decreased the respiratory rate of pregnant women with low oxygenation levels of the blood without causing any side effects.

“To date, very few respiratory treatments to complement supplemental oxygenation in COVID-19 pregnant patients have been tested,” says senior author Lorenzo Berra, MD, with the Department of Anesthesia, Critical Care and Pain Medicine, MGH. “Investigators from all four medical centers that participated in our study agreed that administration of high dose nitric oxide through a snug-fitting mask has enormous potential as a new therapeutic strategy for pregnant patients with COVID-19.”

Pneumonia triggered by COVID-19 is particularly threatening to pregnant women since it may quickly progress to oxygen insufficiency in the blood and bodily tissues, a condition known as hypoxemia, requiring hospitalization and cardiopulmonary support. “Compared to non-pregnant female patients with COVID-19, pregnant women are three times more likely to need intensive care unit admission, mechanical ventilation, or advanced life support, and four times more likely to die,” notes Carlo Valsecchi, MD, lead author in the Department of Anesthesia, Critical Care and Pain Medicine, MGH. “They also face a greater risk of obstetric complications such as preeclampsia, preterm delivery, and stillbirth.”

Nitric oxide is a therapeutic gas that was initially approved by the U.S. Food and Drug Administration in 1999 for inhalation treatment of intubated and mechanically ventilated newborns with hypoxic respiratory failure. With MGH driving many early studies, iNO in high concentrations was also shown to be effective as an antimicrobial in reducing viral replication of SARS-CoV-1 and, more recently, SARS Co-V-2, the virus that causes COVID-19. During the first wave of COVID-19, MGH treated six non-intubated pregnant patients with iNO at high doses of up to 200 parts per million (ppm). Findings of a more favorable outcome with iNO led MGH clinicians to offer this treatment to other pregnant patients, and to design the current study to determine the safety and efficacy of iNO200 for COVID-19 pneumonia in pregnancy.

To that end, a collaborative network of four medical centers in the Boston area was formed. In addition to MGH, it included Tufts Medical Center, Beth Israel Deaconess Medical Center, and Boston Medical Center. Researchers and clinicians from multiple departments -- including critical care medicine, respiratory care, and maternal fetal medicine -- studied 71 pregnant patients with severe COVID-19 pneumonia admitted to these hospitals, 20 of whom received iNO200 twice daily. The study found that iNO therapy at this dosage, when compared to standard of care alone, resulted in reductions in the need for supplemental oxygen and in hospital and ICU lengths of stay. No adverse events related to the intervention were reported in either mothers or their babies.

“Being able to wean patients from respiratory support quicker could have other profound implications, including reducing stress on women and their families, lowering the risk of hospital-acquired infections, and relieving the burden on the health care system,” notes Berra. “Above all, our study supports the safety of high dose nitric oxide in the pregnant population, and we hope more physicians will consider incorporating it into carefully monitored treatment regimens.”

Berra is an associate professor of Anesthesia, Harvard Medical School (HMS), and medical director of Respiratory Care, MGH. Valsecchi is a post-doctoral fellow and investigator in the Department of Anesthesia, MGH. Co-authors include William Barth, Jr., MD, vice chair of Obstetrics, MGH, and an associate professor of Obstetrics, Gynecology, and Reproductive Biology, HMS; Ai-ris Collier, MD, investigator and instructor in Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center; Ala Nozari, professor of Anesthesiology at Boston Medical Center; Jamel Ortoleva, MD, assistant professor of Anesthesiology at Tufts Medical School, and cardiothoracic anesthesiologist and critical care physician at Tufts Medical Center; and Anjail Kaimal, MD, chief of the Division of Maternal-Fetal Medicine, MGH, and an associate professor of Obstetrics, Gynecology, and Reproductive Biology, HMS.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.