Premature birth tied
to increased risk of
By Kerry Grens
Apr 19, 2011
The earlier babies are born,
the more likely they are to later
get a prescription for ADHD
medication, according to a new
study from Sweden.
Researchers found that babies
born as little as three weeks
before their due dates had an
elevated risk for attention
deficit hyperactivity disorder
The findings suggest that
mothers considering scheduling
cesarean births a few weeks
early reconsider and deliver as
close to term as possible, the
People with ADHD have trouble
paying attention or controlling
impulsive behaviors, and can
be treated with behavioral
therapy or medication.
The condition is diagnosed in
about three to five percent of
school-aged children in the
In the new study, the
researchers analyzed a
Swedish database of more than
a million children aged 6 to 19
years; 7,506 of them had
received a prescription for
The children born extremely
prematurely -- between 23 and
28 weeks of pregnancy -- were
most at risk of later developing
ADHD, with their chances being
two and a half times greater
than a baby born at full term
(after 39 weeks).
Fifteen out of every 1,000
babies born at this extremely
premature age later received a
prescription for ADHD
medication, compared to six out
of every 1,000 babies born
between 39 and 41 weeks of
Low birth-weight and severe
prematurity were already known
to be risk factors for developing
This study confirms those
findings and reveals that even
babies born very close to full
term - between 37 and 38
weeks of pregnancy - are still
20 percent more likely to
develop ADHD, said Dr. Anders
Hjern, the lead author.
Seven out of every 1,000
children born moderately
premature (37-38 weeks) were
prescribed ADHD drugs.
"The finding that early term
birth carries an increased risk
for ADHD has important
implications for planned
cesarean births, which are
often performed during these
very weeks," Hjern told Reuters
Health in an email.
"To minimize the risk for ADHD
these births should be planned
as close to the full term date
(that is week 40) as possible."
Other factors, such as the
mother's smoking habits and
genetics, also play a role in a
child's risk of developing ADHD.
The researchers accounted for
these potential influences by
comparing siblings, and found
that extremely premature
babies remained twice as likely
to develop ADHD as their
full-term brothers or sisters.
Revisiting ADHD and Ritalin
The doctor who in his 1996 book suggested that the hyperactivity disorder was being over-
diagnosed has released a new book on the progress of some of his patients over the years.
By Melissa Healy
Los Angeles Times
May 15, 2011
Fifteen years ago, Dr. Lawrence H. Diller, a pediatrician from Walnut Creek,
ignited a national debate over the steep rise in children being diagnosed with
attention-deficit hyperactivity disorder and treated with stimulant medication.
Diller's 1996 book, "Running on Ritalin," suggested that ADHD was being over-
diagnosed, and that Ritalin, and the many formulations of amphetamine-like
drugs that would follow, was being prescribed in many cases to children who
would respond well to family therapy and tailored programs and routines at
home and at school.
Diller warned that as harried parents, teachers and physicians attached the
ADHD label to more and more children who were dreamy, unmotivated,
forgetful, restless, impulsive or distractible, the nation's tolerance for children's
natural temperamental variance would narrow. Instead of helping children work
around weaknesses and choose strategies and paths that played to their
strengths, society's growing inclination to medicate them, Diller cautioned, could
turn many into lifelong patients.
Today, nearly 5% of American children between ages 6 and 17 — about 4.5
million children — have been diagnosed with ADHD, and two-thirds of those
take medicine to control their symptoms. The drugs have helped define a
generation of young adults widely known as "Generation Rx."
In a new book, "Remembering Ritalin," released this month by Perigee Books,
Diller revisited 10 of his patients, now in their 20s and 30s, to ask how the ADHD
diagnosis, and the medication that often came with it, had affected their lives.
Those you treated as youngsters are now young adults, and studies suggest
that as many as two-thirds of them will continue to have ADHD into adulthood. Is
this what you saw?
The outcomes from the kids I've been seeing were not as bad as that suggested
by the limited formal research. Of the 10 former patients who talked to me,
maybe only two still seemed to be significantly bothered by problems of ADHD.
Only about 400 children (out of millions who have been diagnosed with ADHD
and treated with Ritalin-type drugs) have been followed from childhood into
young adulthood by formal research studies, and some of the most respected of
those studies have been done by Russell Barkley of the State University of New
York's Upstate Medical University. For reasons that I think have a lot to do with
economics, the kids that I treated, now in their mid-20s to mid-30s, are doing
much better than Barkley and other researchers would have suggested.
For instance, only 5% of Barkley's group graduated from college, while half of
my patients did — although it took one kid until age 27 to do it. Half of Barkley's
patients had been fired from jobs. My group had only two. Up to half of Barkley's
patients had substance-abuse problems. Again in my group of 10, only two,
perhaps three, were problem users.
What did your patients remember about being on medication? How do they feel
about it now?
Nine of the 10 kids I revisited had taken Ritalin. Of the eight who took it for
years, seven said they were glad they had taken it, though there were side
effects (mostly loss of appetite and trouble falling asleep). They said they would
have gotten in far worse trouble or failed even more school if they hadn't taken
Some hated taking it when they were kids because they felt different. But most
felt it wasn't that big a deal. This was all before the full-day formulations of
ADHD drugs became available, so all these kids had to go to the office at
lunchtime for their pill. That's no longer necessary.
When I do prescribe Ritalin, I've always described it as an aid to making better
decisions, which these kids nevertheless have to make on their own. I can't tell
you how pleased it made me to hear from those I revisited how important that
was to them — that I told them they were making decisions.
What do they say about the nondrug treatments you emphasize?
Many told me they thought the family therapy was useful in tuning down family
tensions. But a few said, even though it helped, they hated hearing their
parents tell me about the bad things they had done since the last visit. I've really
taken their remarks to heart. I always tried to have parents talk to their kids
instead of me when telling me about the good and the bad. But now, I really
insist that the parents talk to their kids, not me. The alternative is to have the
kids feel like pieces of furniture while the parents describe their defects to the
You write about "middle-class ADHD" as a less impairing form of the disorder.
Can you explain?
I work in a private practice in a pretty affluent community. A child who comes to
see me is coming from a family where someone has a job with health insurance,
or can pay out-of-pocket. The four or five big studies that have tracked those
with ADHD over time drew from lower-middle class and Medicaid populations. I
think that accounts for the better outcomes I see in my small sample.
Kids from middle- and upper-middle-class families have some key advantages:
The parents have the means and the wherewithal to cocoon them from the
worst aspects of their personality, especially in school and with peers. They do
this by securing special education services, counseling and tutoring for their
If they can get their kid to 18 or 20 without a lot of time in the juvenile system,
and managed to keep him or her from major substance abuse, the future looks
much brighter. By that point, the impulsivity and the hyperactivity begin to abate,
and these kids are beginning to choose, after getting through high school, what
they want to pursue. The choices open up and they do better.
On pressing for nondrug treatments before Ritalin, are you still swimming
against the tide?
I've never been against medicine; have prescribed it for 32 years.
Pills represent efficiency, and effective nondrug interventions like special
education or behavior-modification value engagement with the child. The
medical and educational systems value efficiency. Parents, when offered a
choice initially between efficiency and engagement, almost always choose
engagement. However, when offered the choice of only a pill or nothing, they'll
take the pill. And that's often the only choice they're given.
So I remain a relatively lonely professional voice pointing out this moral
dilemma. But it is greatly edifying that when people hear the full message, they
invariably say, "You know, he's right."
ADD and ADHD
Attention-Deficit Disorder and Attention-Deficit Hyperactivity Disorder