February 9, 2022

Norwegian nationwide cohort study probes use of ADHD medication by ADHD patients undergoing treatment for opioid addiction

A key aspect of ADHD is greater difficulty controlling urges, so it is no surprise that there is a strong association between ADHD and substance use disorders, and opioid addiction in particular. It's also known that stimulants are effective in reducing ADHD symptoms. That would suggest that ADHD patients being treated for opioid addiction should also be treated for ADHD.

How extensive is such complementary treatment? A Norwegian research team used national register data from the Norwegian Prescription Database to find out. They began by identifying all 9,235 individuals who were dispensed at least one opioid agonist prescription from 2015 through 2017.

Opioid agonists, such as methadone and buprenorphine (Suboxone), while opioids have properties that prevent withdrawal and reduce cravings. They can do this precisely by substituting a less dangerous slow-acting opioid for a more dangerous rapid-acting one. They are also less addictive because they do not generate the intense highs of fast-acting opioids. That greatly reduces the risk of overdose, and risk of relapse to more hazardous opioid use, and promotes connections with the professional healthcare sector.

About 7,500 Norwegians are undergoing opioid agonist therapy at any given time. During the three-year study period, roughly three out of four were dispensed buprenorphine and the remainder methadone.

Although somewhere around one in five patients on opioid agonist therapy have ADHD (estimates range from11 to 33%), the team found that less than one in twenty were also dispensed ADHD medication. In 2015, only 3.5 percent received ADHD medication, rising slightly to 4.6 percent in 2017. In 2017, 62 percent received methylphenidate, 42 percent received various amphetamines, and only five percent received non-stimulant atomoxetine (there was some overlap).

Patients on buprenorphine were 60 percent more likely to be dispensed ADHD medications than those on methadone.

The authors concluded, "Co-prescribing of CAS [centrally acting stimulant] and atomoxetine was low in the OAT [opioid agonist therapy] population in Norway, relative to the expected prevalence of ADHD in this patient group. Considering that up to a third of the OAT population is estimated to have ADHD, only 3.5 to 4.6% of patients received both ADHD medication and OAT opioids in Norway in the period from 2015 to 2017. Randomized-controlled trials evaluating ADHD medication in different doses are needed to improve the treatment of ADHD in the OAT population."

Vold, J.H., Aas, C., Skurtveit, S. et al. Dispensation of attention deficit hyperactivity disorder (ADHD) medications in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017. BMC Psychiatry20, 119 (2020). https://doi.org/10.1186/s12888-020-02526-y.

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Population Study Finds No ADHD- or ASD- Related Benefits From Eating Organic Food During Pregnancy

Norwegian Nationwide Population Study Finds No ADHD- or ASD- Related Benefits From Eating Organic Food During Pregnancy

Background:

Organic farming aims to protect biodiversity, promote animal welfare, and avoid using pesticides and fertilizers made from petrochemicals. Some pesticides are designed to target insects’ nervous systems but can also affect brain development and health in larger animals, including humans.

Many people believe organic food is healthier than conventionally produced food, which might be true for certain foods and health factors. But does eating organic food during pregnancy impact the chances of a child developing ADHD or autism spectrum disorder (ASD)?

In Norway, researchers can use detailed national health records to study these connections on a population-wide level, thanks to the country’s single-payer healthcare system and national registries.

Method:

The Norwegian Mother, Father, and Child Cohort Study (MoBa) invites parents to participate voluntarily and has a 41% participation rate. The study includes:

  • 114,500 children
  • 95,200 mothers
  • 75,200 fathers

For this research, a team tracked 40,707 mother-child pairs from children born between 2002 and 2009. They used questionnaires to measure how much organic food mothers consumed during pregnancy. ADHD and ASD symptoms in children were assessed using validated rating scales.

The final analysis included:

  • 40,586 pairs for ADHD symptoms
  • 40,117 pairs for ASD symptoms

The researchers adjusted for factors like maternal age, education, previous pregnancies, BMI before pregnancy, smoking and alcohol use during pregnancy, birth year and season, and the child’s sex.

Key Findings:
  • There was a weak connection between higher organic food consumption and fewer ADHD symptoms in children. However, this link disappeared when maternal ADHD symptoms were considered (31,411 pairs) or when the analysis was limited to siblings (5,534 pairs).
  • Similarly, weak associations between organic food and fewer ASD symptoms disappeared when focusing on siblings (4,367 pairs).
Conclusion:

The researchers concluded that eating organic food during pregnancy has no meaningful effect on the likelihood of a child developing ADHD or ASD. They stated, “The results do not indicate any clinically significant protective or harmful effects of eating organic food during pregnancy on symptoms of ADHD and ASD in the offspring. Based on these findings, we do not recommend any specific advice regarding intake of organic food during pregnancy.”

January 27, 2025

Meta-analysis Finds Little or No Link Between Assisted Reproductive Technologies and ADHD

Background:

Infertility affects about one in six couples worldwide. To address this, medical experts have developed Assisted Reproductive Technologies (ART), including In Vitro Fertilization (IVF) with or without Intra-Cytoplasmic Sperm Injection (ICSI).

Some research suggests that children conceived through ART might have higher rates of intellectual disabilities, cerebral palsy, cancer, and neurological issues compared to children conceived naturally. However, studies looking at a possible link between ART and ADHD have produced mixed and conflicting results.

Until now, there hasn’t been a meta-analysis examining the connection between ART and ADHD. A South Korean research team has conducted the first systematic review and meta-analysis on this topic. Their final analysis included eight studies with a total of over ten million participants, comprising six cohort studies and two cross-sectional studies.

Method:

The research focused on two types of studies:

  1. Cohort Studies: These follow two groups (one exposed to ART and one not exposed) over time to see if a specific outcome, like ADHD, occurs.
  2. Cross-Sectional Studies: These compare the prevalence of ADHD at a single point in time between those exposed to ART and those who weren’t.

Both types of studies are observational, meaning they don’t involve controlled experiments and can be influenced by confounding factors.  So they can document interesting associations, not causality.  The studie were mostly large-scale national studies and used clinical ADHD diagnoses.

Key Findings:
  • Cohort Studies: Meta-analysis of six cohort studies, involving nearly 8 million participants, found no link between ART and ADHD. However, there was high variability (heterogeneity) in the results from individual studies.
  • Cross-Sectional Studies: Meta-analysis of two cross-sectional studies, covering over 2.3 million participants, also found no link between ART and ADHD. Heterogeneity was moderate.
  • Adjustment for Confounding: A separate analysis of three studies that adjusted for confounding factors (like socioeconomic status or parental health) involved more than 7.5 million participants. It found a very small association, with ART-conceived children being 8% more likely to develop ADHD. There was no variability among these studies.
Conclusion:

The researchers concluded that while there may be a small association between ART and ADHD, the effect is minimal, and the results are influenced by differences in study designs. They advised interpreting these findings with caution, noting, “The limited effect size and inherent heterogeneity underscore the need for cautious interpretation.”

January 24, 2025

Taiwan nationwide population study documents link between ADHD and periodontitis in adolescents

Background:

Periodontitis, commonly known as gum disease, is a condition where the gums become inflamed. If untreated, it can cause the gums to pull back from the teeth, exposing their base, which may eventually lead to loose teeth or tooth loss. While this condition mostly affects adults, it’s also common among teens who don’t floss or brush their teeth properly.

Until now, only a few small studies have looked at a possible link between ADHD and gum disease. A team in Taiwan recently conducted a nationwide study to explore this connection.

Taiwan has a universal health insurance program, introduced in 1995, that provides medical care to nearly all (99.7%) residents. The Taiwan National Health Research Database collects and oversees all insurance claims, making it an excellent resource for large-scale studies.

Methods:

The researchers used the database to identify teens aged 12 to 19 with ADHD (diagnosed by a psychiatrist) who had no history of gum disease between 2001 and 2011. These teens made up the ADHD group. They matched each ADHD participant with four teens who didn’t have ADHD or gum disease, creating a control group. The groups were matched by age, gender, enrollment date, family income, place of residence, and other health conditions (like obesity, diabetes, smoking, depression, and substance use).

All diagnoses of gum disease were confirmed by board-certified dentists.

The study included:

  • 16,211 teens with ADHD
  • 162,110 matched controls
Key Findings:
  • Teens with ADHD were 2.3 times more likely to develop gum disease than those in the control group without ADHD.
  • There were no significant differences between boys and girls or among teens from different income levels (low, medium, or high).
  • ADHD medications, mainly methylphenidate, didn’t affect the likelihood of developing gum disease. This was true for both short-term and long-term users compared to non-users.
Conclusion:

The researchers concluded that teens with ADHD have a higher risk of developing gum disease later on, even after accounting for other risk factors like smoking, diabetes, and depression. They stated, “ADHD is an independent risk factor for developing periodontitis.”

January 23, 2025