Son of Michael Douglas Has Dyslexia, Symptoms...

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US/Britain - Dyslexia independent of IQ… [2011-09-26 Medical Xpress]

http://medicalxpress.com/news/2011-09-dyslexia-independent-iq.html

Psychology & Psychiatry

Dyslexia independent of IQ

September 26, 2011

by Emily Finn

About 5 to 10 percent of American children are diagnosed as dyslexic. Historically, the label has been assigned to kids who are bright, even verbally articulate, but who struggle with reading — in short, whose high IQs mismatch their low reading scores. On the other hand, reading troubles in children with low IQs have traditionally been considered a byproduct of their general cognitive limitations, not a reading disorder in particular.

Now, a new brain-imaging study challenges this understanding of dyslexia. “We found that children who are poor readers have the same brain difficulty in processing the sounds of language whether they have a high or low IQ,” says John D. E. Gabrieli, MIT’s Grover Hermann Professor of Health Sciences and Technology and Cognitive Neuroscience, who performed the study with Fumiko Hoeft and colleagues at the Stanford University School of Medicine; Charles Hulme at York University in the U.K.; and Susan Whitfield-Gabrieli, also at MIT. “Reading difficulty is independent of other cognitive abilities.”

The study, which is forthcoming in the journal Psychological Science, could change how educators diagnose dyslexia, opening up reading support to more children who could benefit from it.


Rhymes and results

The researchers recruited 131 children, from 7 to 17 years old. According to a simple reading test and an IQ measure, each child was assigned to one of three groups: typical readers with typical IQs; poor readers with typical IQs; and poor readers with low IQs. All were shown pairs of words and asked to judge whether the words rhymed. (Rhymes are an effective way to probe dyslexics’ reading performance, since dyslexia is thought to entail difficulty connecting written words to sounds.) For some pairs, the researchers used words that rhyme but don’t share the same final letters — such as “bait” and “gate,” or “night” and “bite” — so that rhyme couldn’t be inferred simply from spelling. Using functional magnetic resonance imaging (fMRI), the researchers observed the activity in six brain regions known to be important for reading.

The results? Neural activity in the two groups of poor readers was indistinguishable. “The brain patterns could not have been more similar, whether the child had a high or low IQ,” Gabrieli says. Poor readers of all IQ levels showed significantly less brain activity in the six observed areas than typical readers, suggesting that reading difficulty is due to the same underlying neural mechanism, regardless of general cognitive ability.


Ditching diagnostic discrimination

The findings could have an important impact on both diagnosis and education for kids who struggle to read. Currently, Gabrieli says, many public school systems still require that a child have an otherwise normal IQ score to receive a diagnosis of dyslexia — essentially, that the label be reserved for children with a “reading difficulty that can’t be explained by anything else,” he says. But the new study suggests that even children with low IQ scores might benefit from treatment specific to dyslexia.

Jack Fletcher, a professor of psychology at the University of Houston Texas Medical Center Annex, says the study “adds to the evidence against” the notion that reading difficulty should be chalked up to general intellectual limitations in children with lower-than-average IQs. “Poor reading is poor reading,” he says. “IQ discrepancy doesn’t make much difference.”

Gabrieli, who says he hopes the new results will encourage educators to offer reading support to more struggling students, stresses the importance of diagnosing dyslexia and other behavioral disorders sooner rather than later. “Now, you basically diagnose dyslexia when a child seems miserable in school,” he says. “Maybe you could intervene before they ever get that way.”

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Provided by Massachusetts Institute of Technology (news http://medicalxpress.com/partners/mit/ : web http://web.mit.edu/ )

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© Medical Xpress 2011

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Sweden - Intensive training helps children with reading and writing difficulties… [2011-10-04 PhysOrg]

http://www.physorg.com/news/2011-10-intensive-children-difficulties.html

Social Sciences

Intensive training helps children with reading and writing difficulties

October 04, 2011

Intensive daily training for a limited period is better for children with reading and writing difficulties than the traditional remedial tuition offered by schools, reveals new research from the University of Gothenburg.

Around 5% of school children in Sweden have problems learning to read and write on account of difficulties with word decoding.


Phonemic building blocks

"Most researchers agree that the underlying problem is a limited phonological ability, in other words limited awareness of the sounds that make up spoken words," says Ulrika Wolff, senior lecturer in education at the University of Gothenburg's Department of Education and Special Education, and the researcher behind the study, the first of its kind in Sweden.


12 weeks' training

The study saw more than 50 nine-year-olds with reading and writing problems being given 40 minutes' training every day for a total of 12 weeks by specially trained educationalists from the University of Gothenburg. They were then compared with an equivalent group that had been given the traditional remedial tuition offered by schools.

The training comprised intensive and structured exercises in understanding the alphabetical code. The children practised linking phonemes and graphemes (sounds and letters), phonetic awareness, guided reading aloud and reading in general, which served to strengthen reading fluency and reading speed. However, the strict, research-based programme also incorporated space for creativity, play and curiosity.


Effective action

The results show that the children who took part in the training programme coped significantly better than the children given traditional remedial tuition, and that they did so in all of the areas tested -- word decoding, spelling, reading speed and reading comprehension.

"Structured and individual teaching meant that these children made significant progress," says Wolff. "Reading and writing difficulties often lead to low self-esteem and poor self-confidence, which can make learning to read even more difficult for children. It's important to take effective action as early as possible to break this vicious circle."

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Provided by University of Gothenburg (news http://www.physorg.com/partners/university-of-gothenburg/ : web http://www.gu.se/english/ )

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© PhysOrg.com™ 2003-2011

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US - Children with certain dopamine system gene variants respond better to ADHD drug… [2011-10-21 Medical Xpress]

http://bit.ly/nRYq34

Psychology & Psychiatry

Children with certain dopamine system gene variants respond better to ADHD drug

October 21, 2011

Children with certain dopamine system gene variants have an improved response to methylphenidate - the most commonly prescribed medication for Attention Deficit Hyperactivity Disorder - in a finding that could help eliminate the guesswork from prescribing effective medications for children with ADHD.

Researchers reporting their results in the Oct. 21 Journal of the American Academy of Child and Adolescent Psychiatry tested 89 children with ADHD between ages 7 and 11. They found that children with specific variants of the dopamine transporter (DAT) and dopamine receptor D4 (DRD4) genes showed greater improvement in hyperactivity and impulsivity after taking methylphenidate compared to children with alternative DAT and DRD4 versions.

"Physicians don't have a good way of predicting who will experience great improvement in ADHD symptoms with a particular medication, so currently we use a trial-and-error approach. Unfortunately, as a result, finding an effective treatment can take a long time," explained Tanya Froehlich M.D., lead investigator on the study and a physician in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's Hospital Medical Center.

"With more information about genes that may be involved in ADHD medication response, we may be able to predict treatment course, tailor our approach to each child, and improve symptom response while decreasing health care costs," she added.

The study is the first-ever placebo-controlled pharmacogenetic drug trial for ADHD in school age children to evaluate the effects of dopamine system genes variants using teacher as well as parent ratings of children's symptoms. Given the importance of academic functioning for children with ADHD, Dr. Froehlich said it is crucial to consider medication impact at school as well as at home. Children in the study were not already taking stimulant medications for their ADHD.

Participants were prescribed one week each of placebo and three different doses of methylphenidate for their ADHD. Parents and teachers assessed and scored the children's behavioral symptoms based on the Vanderbilt ADHD Parent and Teacher Rating Scales.

The researchers analyzed DNA from saliva samples to see which ADHD-related gene types the children carried. They looked initially at four genes frequently implicated in ADHD – DRD4, DAT, COMT and ADRA2A. DRD4 and DAT, the most well studied genes for ADHD, showed the strongest effects on methylphenidate dose-response in study participants, according to the researchers.

The DRD4 gene encodes the dopamine receptor protein, which helps control the synthesis and release of dopamine and the firing rate of neurons. The DAT gene encodes the dopamine transporter protein, which removes dopamine from the brain synapses.

Children who lack what is known as the DAT 10-repeat variant showed greater improvement after taking methylphenidate compared to those carrying the 10-repeat. Children without the DRD4 gene 4-repeat variant showed less symptomatic improvement with methylphenidate compared to 4-repeat carriers. A "repeat" is a short nucleotide coding sequences in a gene that is repeated.

Dr. Froehlich and her colleagues indicate in their study that although findings are promising, additional research is needed in larger patient samples to confirm current study findings and their clinical relevance.

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Provided by Cincinnati Children's Hospital Medical Center (news : web)

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© Medical Xpress 2011

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Denmark - Huge hike in ADHD drugs to Danish adults worrying: doctors… [2011-11-11 Medical Xpress (AFP)]

http://bit.ly/uoOJgV

Psychology & Psychiatry

Huge hike in ADHD drugs to Danish adults worrying: doctors

November 11, 2011

A massive increase in the number of Danish adults prescribed medication for Attention Deficit-Hyperactivity Disorder (ADHD) is deeply worrying, the head of the Danish Medical Association said Friday.

"I am very worried by these numbers," Henrik Dibbern told AFP.

He was sounding the alarm over statistics published earlier this year showing that the number of Danish adults medicated for ADHD, which is most commonly prescribed to children and teens, has soared almost 20-fold over the past decade, from just 800 to 15,000.

Dibbern explained that the huge hike could be due to the fact that "many people diagnosed when they were children our adolescents continue taking these medications as adults."

"There are also people who are ill who take these drugs even though they could benefit from alternative treatments" like psychotherapy or less potent drugs, he added.

He stressed though that the explanation for the steep increase was not clear.

"I cannot say that there is abusive consumption," he said, insisting "it is essential to carry out studies on this."

Denmark's National Board of Health also expressed worry about the rise.

"We take this issue very seriously," Anne Mette Dons, who heads the board's oversight division, told AFP.

"We will gather the various actors and specialised institutions for a meeting on this subject next month," she said.

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©  2011 AFP

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Wales - New ADHD findings… [2011-11-14 Medical Xpress]

http://medicalxpress.com/news/2011-11-adhd.html

Psychology & Psychiatry

New ADHD findings

November 14, 2011

A combination of rare and common genetic variations could play a part in biological pathways linked to Attention Deficit Hyperactivity Disorder (ADHD).

Cardiff University scientists revealed last year that children with the condition, like those with autism, were more likely than unaffected individuals to carry duplicated or omitted small DNA segments known as copy number variants (CNVs). The findings suggested that rare genetic variations contribute to ADHD risk. Similar findings have been found for autism, schizophrenia and intellectual disability.

Now a wider study by the same team and colleagues in Eire and Scotland has replicated the initial findings that these large, rare CNVs are more common in children with ADHD than amongst the general population. Their findings additionally suggest a more common type of genetic variant called Single-Nucleotide Polymorphisms (SNPs) may also be relevant to ADHD risk. It has been difficult to identify specific common genetic variants for disorders like ADHD and autism. However the new study found that both rare and common types of genetic variations appeared to impact on the same biological pathways The findings suggest that different types of genetic variations impact on similar pathways that are linked to the disorder.

Attention Deficit Hyperactivity Disorder is characterised by extreme restlessness, fidgetiness, concentration problems and impulsiveness leading to social and educational difficulties. Many affected children also have autistic spectrum disorder, autistic type symptoms, dyslexia, developmental problems, motor-coordination difficulties and behavioural difficulties. For the study published last year, the Cardiff team analysed data from 366 children with ADHD. For the new research, they studied twice as many – 727 – and still found the rare CNVs were more common than in children without the condition.

The team also examined more common SNP variants and found there was no significant difference between children with or without ADHD. However, 13 biological pathways which linked to CNV variants also linked to the SNP variants. The identified pathways affect the development of the central nervous system and four were related to cholesterol, an important component of the brain.

Professor Anita Thapar, Professor of Child and Adolescent Psychiatry at Cardiff University’s School of Medicine, who led the study, said: "These results replicate our finding last year that large, rare copy number variants are significantly more common in children with ADHD than those unaffected. However, we also show that other genetic variants need to be examined and SNPs cannot be ruled out of playing a part. We have also identified 13 biological pathways for further investigation ADHD is a complex disorder like all neuropsychiatric problems which means multiple types of genetic and non-genetic risk factors will be involved".

The full paper Investigating the Contribution of Common Genetic Variants to the Risk and Pathogenesis of ADHD has just been published in the American Journal of Psychiatry.

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Provided by Cardiff University (news http://medicalxpress.com/partners/cardiff-university/ : web http://www.cardiff.ac.uk )

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© Medical Xpress 2011

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Australia - ADHD kids need individualized treatment… [2011-11-18 Medical Xpress]

http://bit.ly/rtJBds

Psychology & Psychiatry

ADHD kids need individualized treatment

November 18, 2011

New research from The Australian National University is providing strong support for individualised assessment and treatment for children with Attention Deficit/Hyperactivity Disorder (ADHD).

A study conducted by postgraduate researcher Lisa Gomes looked at the nature of and differences in attention and memory between boys with the two most common subtypes of ADHD and a control group.

“The two most common subtypes, ADHD-Predominantly Inattentive (ADHD-PI) and ADHD-Combined (ADHD-C), share clinically significant problems of inattention, but differ in their clinically significant levels of hyperactivity and impulsivity,” she said.

“Important differences have emerged in the literature about demographic and family characteristics, and psychosocial functioning between ADHD subtypes. Some researchers have therefore theorized that these subtypes are distinct and unrelated disorders.

“Studies that have investigated the nature of the fundamental building blocks of learning – attention and memory – in ADHD have found mixed results pertaining to differences between the subtypes.”

Ms. Gomes said the results of her study suggested that whilst both ADHD groups showed significant impairment on the measures of attention and memory, the nature of these was more similar than dissimilar between the ADHD groups.

“On attention tests, the two subtypes performed comparably with some additional selective attention impairments for the ADHD-C group and almost no differences on study measures of memory found between groups,” she said.

“However, examining the individualised attention and memory profiles across participants suggested a high degree of heterogeneity within both ADHD subtypes.”
Ms Gomes said ADHD was a common disorder in childhood which could have a significant impact on many facets of a child’s life.

“In the school context, children with both ADHD subtypes have been found to display marked problems with their learning,” she said.

“The heterogeneous nature of attention and memory, which are the fundamental building blocks of learning within each ADHD subtype, has clear clinical implications. It reinforces the need for there to be individualised assessment and treatment for children with ADHD in order to properly understand their learning difficulties.”

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Provided by Australian National University

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© Medical Xpress 2011

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US - Dyslexic adults have more trouble if background noise levels are high… [2011-11-23 Medical Xpress]

http://bit.ly/rCV21K
Diseases

Dyslexic adults have more trouble if background noise levels are high

November 23, 2011

Dyslexia affects up to 17.5% of the population, but its cause remains somewhat unknown. A report published in the Nov. 23 issue of the online journal PLoS ONE supports the hypothesis that the symptoms of dyslexia, including difficulties in reading, are at least partly due to difficulty excluding excess background information like noise.

In the study of 37 undergraduate students, the researchers, led by Rachel Beattie of the University of Southern California, found that the poor readers performed significantly worse than the control group only when there were high levels of background noise.

The two groups performed comparably at the prescribed task when there was no background noise and when the stimulus set size was varied, either a large or a small set size.

According to Dr. Beattie, "these findings support a relatively new theory, namely that dyslexic individuals do not completely filter out irrelevant information when attending to letters and sounds. This external noise exclusion deficit could lead to the creation of inaccurate representations of words and phonemes and ultimately, to the characteristic reading and phonological awareness impairments observed in dyslexia."

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More information: Beattie RL, Lu Z-L, Manis FR (2011) Dyslexic Adults Can Learn from Repeated Stimulus Presentation but Have Difficulties in Excluding External Noise. PLoS ONE 6(11): e27893. doi:10.1371/journal.pone.0027893

Provided by Public Library of Science (news http://medicalxpress.com/partners/public-library-of-science/ : web http://www.plos.org/ )

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© Medical Xpress 2011

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US - New gene study of ADHD points to defects in brain signaling pathways… [2011-12-04 Medical Xpress]

http://bit.ly/u98G4b

Psychology & Psychiatry

New gene study of ADHD points to defects in brain signaling pathways

December 04, 2011

Pediatric researchers analyzing genetic influences in attention-deficit/hyperactivity disorder (ADHD) have found alterations in specific genes involved in important brain signaling pathways. The study raises the possibility that drugs acting on those pathways might offer a new treatment option for patients with ADHD who have those gene variants—potentially, half a million U.S. children.

"At least 10 percent of the ADHD patients in our sample have these particular genetic variants," said study leader Hakon Hakonarson, M.D., Ph.D., director of the Center for Applied Genomics at The Children's Hospital of Philadelphia. "The genes involved affect neurotransmitter systems in the brain that have been implicated in ADHD, and we now have a genetic explanation for this link that applies to a subset of children with the disorder."

The study appears online in Nature Genetics.

ADHD is a common but complex neuropsychiatric disorder, estimated to occur in as many as 7 percent of school-age children and in a smaller percentage of adults. There are different subtypes of ADHD, with symptoms such as short attention span, impulsive behavior and excessive activity. Its causes are unknown, but it tends to run in families and is thought to be influenced by many interacting genes. Drug treatment is not always effective, particularly in severe cases.

The study team did whole-genome analyses of 1,000 children with ADHD recruited at The Children's Hospital of Philadelphia, compared to 4,100 children without ADHD. The researchers searched for copy number variations (CNVs), which are deletions or duplications of DNA sequences. They then evaluated these initial findings in multiple independent cohorts that included nearly 2,500 cases with ADHD and 9,200 control subjects. All the study subjects were children of European ancestry.

Among those cohorts, the research team identified four genes with a significantly higher number of CNVs in children with ADHD. All the genes were members of the glutamate receptor gene family, with the strongest result in the gene GMR5. Glutamate is a neurotransmitter, a protein that transmits signals between neurons in the brain. "Members of the GMR gene family, along with genes they interact with, affect nerve transmission, the formation of neurons, and interconnections in the brain, so the fact that children with ADHD are more likely to have alterations in these genes reinforces previous evidence that the GRM pathway is important in ADHD," said Hakonarson. "Our findings get to the cause of the ADHD symptoms in a subset of children with the disease."

"ADHD is a highly heterogeneous disorder, and separating out the different subgroups of genetic mutations that these children have is very important," said co-first author Josephine Elia, M.D., a child psychiatrist at Children's Hospital and an ADHD expert. She added that thousands of genes may contribute to the risk of ADHD, but that identifying a gene family responsible for 10 percent of cases is a robust finding in a common neuropsychiatric disorder such as ADHD. Overall, according to the CDC, 5.2 million U.S. children aged 3 to 17 have been diagnosed with ADHD.

Elia said the fact that their study identified gene variants involved in glutamate signaling is consistent with studies in animal models, pharmacology and brain imaging showing that these pathways are crucial in a subset of ADHD cases. She added, "This research will allow new therapies to be developed that are tailored to treating underlying causes of ADHD. This is another step toward individualizing treatment to a child's genetic profile."

Hakonarson expects this study will set the stage for further discoveries of ADHD-related genes along GMR signaling pathways. Moreover, the current research strongly suggests that selective GRM agonists could be tested in clinical trials as a potential therapy for ADHD in patients harboring particular CNVs. He added that further preclinical studies must first be done to evaluate candidate drugs.

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Provided by Children's Hospital of Philadelphia (news http://medicalxpress.com/partners/children-s-hospital-of-philadelphia/ : web http://www.chop.edu/consumer/index.jsp )

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© Medical Xpress 2011

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US - No increased risk of serious cardiovascular events among adults who use ADHD medications: study… [2011-12-12 Medical Xpress]

http://bit.ly/tn1WTP

Medications

No increased risk of serious cardiovascular events among adults who use ADHD medications: study

December 12, 2011

Although there have been cardiovascular safety concerns about attention-deficit/hyperactivity disorder (ADHD) medications because of their ability to increase heart rate and blood pressure levels, an analysis that included more than 150,000 ADHD users found no evidence of an increased risk of heart attack, stroke or sudden cardiac death associated with current use compared with nonuse or rare use among young and middle-aged adults, according to a study appearing in JAMA. The study is being released early online because of its public health importance.

"Between 2001 and 2010, use of medications labeled for treatment of ADHD increased even more rapidly in adults than in children. According to a 2006 U.S. Food and Drug Administration (FDA) advisory committee briefing on the safety of ADHD medications, more than 1.5 million U.S. adults were taking stimulants in 2005, and adults received approximately 32 percent of all issued prescriptions," according to background information in the article. "Placebo-controlled studies in children and adults indicate that stimulants and atomoxetine [a medication used to treat ADHD] elevate systolic blood pressure levels by approximately 2 to 5 mm Hg and diastolic blood pressure levels by 1 to 3 mm Hg and also lead to increases in heart rate. Although these effects would be expected to slightly increase risk for myocardial infarction [MI; heart attack], sudden cardiac death (SCD), and stroke, clinical trials have not been large enough to assess risk of these events."

Laurel A. Habel, Ph.D., of Kaiser Permanente Northern California, Oakland, and colleagues examined whether medications used primarily to treat ADHD are associated with an increased risk of heart attack, SCD, or stroke in adults. The researchers used computerized health records from 4 study sites, starting in 1986 at 1 site and ending in 2005 at all sites, with an additional assessment using 2007 survey data. Participants were adults 25 through 64 years of age with dispensed prescriptions for methylphenidate, amphetamine, or atomoxetine. Each medication user (n = 150,359) was matched to two nonusers on study site, birth year, sex, and calendar year (total users and nonusers = 443,198).

During follow-up, there were 1,357 cases of heart attacks, 296 cases of sudden cardiac death, and 575 cases of stroke. After analyses of the data, the researchers found that current or new use of ADHD medications, compared with nonuse or remote use, was not associated with an increased risk of serious cardiovascular events, such as heart attack, sudden cardiac death, or stroke. "We also found little support for an increased risk for any specific medication or with longer duration of current use. Results were similar when users were restricted to new users. Rate ratios did not appear to be influenced by prior cardiovascular disease or by prior non-ADHD psychiatric conditions. They also were similar across age groups. As expected, event rates were substantially higher in the Medicaid population; however, the rate ratio for current use was similar to that in other sites," the authors write.

The researchers also found that among ever users of ADHD medications, the adjusted rate ratio of serious cardiovascular events was nearly the same during periods of current use as during follow-up periods more than 1 year after use ended. Cardiovascular diseases were similar or slightly more prevalent in new users than nonusers.

The authors note that a modestly elevated risk of serious cardiovascular events cannot be ruled out, given limited power of the study and a lack of complete information on some potentially important risk factors and other factors related to use of these medications.

In an accompanying editorial, Philip Shaw, M.D., Ph.D., formerly of the National Institute of Mental Health (currently with the Human Genome Research Institute), Bethesda, Md., writes that the findings of this study raise several clinically important issues.

"First, the findings support the final decision by the FDA in 2006 not to place a black box warning of serious cardiovascular events on ADHD medications for all children and adults but to pursue further research. The findings, however, do not directly inform the current black box warning for psychostimulants, which is confined to patients with structural heart lesions. The study focused on very rare events, which prevented examination of specific subgroups such as individuals with cardiac disease. Joint care by cardiologists and other physicians remains necessary for these individuals. In addition, the study provides no evidence to support routine obtaining of electrocardiograms before starting treatment, certainly insofar as this recommendation was driven by concerns about serious cardiovascular events."

More information: DOI:10.1001/JAMA.2001.1830 , DOI:10.1001/JAMA.2011.1866

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Provided by JAMA and Archives Journals (news http://medicalxpress.com/partners/jama-and-archives-journals/ : web http://pubs.ama-assn.org/ )

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© Medical Xpress 2011

[brendalana]

Greetings, all…

Maybe this e-mail exchange will humorously shed a little light on my interest vis-a-vis learning different folk:

   Re: Christmas wishes
   Date: 2011-12-31 10.58.29 GMT
   To: Karen XXXXX

   Happy new year, Karen…

   Here am I… more attention deficit disordered than ever… having to urinate every hour-and-a-half or so… three iMacs through my own fault in continuous operational disarray—two on Mac OS Lion… t'other on OS Leopard… their nice-to-have but rarely used clutter of complicated to install peripherals increasingly joined by more… likewise third party software like Scrivener, MacFamily Tree, bought, installed, regularly updated but yet to be utilised… and… if so… subject to my can't-leave-well-enough-alone unwittingly deleted content and backup—as happened much to my chagrin 2011-12-24 with iFinance while unnecessarily tweeting and CleanApp'ing this iMac 3.60GHz Intel… an album full of my maternal birth family photographs inherited three years ago, started but far from ever being digitally scanned… over four hundred pages of over a quarter of a century's stream-of-conscious musings in need of editing… books bought or gifted but never read… DVDs often not viewed… given to sleeping at odd hours, often midst watching television… meals to be prepared and taken… distracted by Facebook… addicted to surfing for matters to update or relative to my already extensive archives… which your 2011-12-24 appreciated newsy e-mail—now retrieved from my pending file—kindly refers to as a news service… okay… enough… this done and dusting off is by way of this old fart's apology for e-tardiness… i? U... next...

   Brenda…


On 2011-12-24, at 06.36.19, Karen XXXXX wrote:

   Dear Brenda

   (SNIP)

   UNQUOTE...

Meanwhile, all… may you and those closest and dearest to you enjoy a healthy, happy and prosperous 2012 and many a year to come…

B+...

[brendalana]

US - F.D.A. Is Finding Attention Drugs in Short Supply… [2012-01-01 NY Times]

http://nyti.ms/sgNty7

F.D.A. Is Finding Attention Drugs in Short Supply

Christopher Capozziello for The New York Times
Lynn Whitton of Westport, Conn., said she was “flabbergasted” by the Drug Enforcement Administration's claim that there were no shortages of drugs for attention deficit hyperactivity disorder.

By GARDINER HARRIS

Published: December 31, 2011

Medicines to treat attention deficit hyperactivity disorder are in such short supply that hundreds of patients complain daily to the Food and Drug Administration that they are unable to find a pharmacy with enough pills to fill their prescriptions.

The shortages are a result of a troubled partnership between drug manufacturers and the Drug Enforcement Administration, with companies trying to maximize their profits and drug enforcement agents trying to minimize abuse by people, many of them college students, who use the medications to get high or to stay up all night.

Caught in between are millions of children and adults who rely on the pills to help them stay focused and calm. Shortages, particularly of cheaper generics, have become so endemic that some patients say they worry almost constantly about availability.

While the Food and Drug Administration monitors the safety and supply of the drugs, which are sold both as generics and under brand names like Ritalin and Adderall, the Drug Enforcement Administration sets manufacturing quotas that are designed to control supplies and thwart abuse. Every year, the D.E.A. accepts applications from manufacturers to make the drugs, analyzes how much was sold the previous year and then allots portions of the expected demand to various companies.

How each manufacturer divides its quota among its own A.D.H.D. medicines — preparing some as high-priced brands and others as cheaper generics — is left up to the company.

Now, multiple manufacturers have announced that their medicines are in short supply. The F.D.A. has included these pills on its official shortages list, as has the American Society of Health-System Pharmacists, which tracks the problem for hospitals. And the American Academy of Child and Adolescent Psychiatry has told the more than 8,000 doctors in its membership that shortages seem to be “widespread across a number of states” and are “devastating” for children.

Officials at the Food and Drug Administration say the shortages are a result of overly strict quotas set by the Drug Enforcement Administration, which, for its part, questions whether there really are shortages or whether manufacturers are simply choosing to make more of the expensive pills than the generics, creating supply and demand imbalances.

The situation has made for a rare open disagreement between two federal agencies.

“We have reached out to the D.E.A. and told them that there are shortage issues,” said Valerie Jensen, associate director of the F.D.A.’s drug shortage program. “But the quota issues are outside of our area of responsibility.”

Still, Special Agent Gary Boggs of the Drug Enforcement Administration’s Office of Diversion Control, said in an interview, “We believe there is plenty of supply.”

Some high-priced pills are indeed readily available, and D.E.A. officials said that so long as that is the case, they believe that A.D.H.D. drug supplies are adequate. Agent Boggs attributed any supply disruptions to decisions made by manufacturers.

Novartis, for instance, makes both branded and generic versions of Ritalin; Shire Pharmaceuticals does the same for Adderall XR. In both cases, the companies have ensured that supplies of branded drugs are adequate while allowing generic versions to go wanting.

“We are working diligently to ensure our supply of these products meets demand, including discussions with D.E.A. regarding our quota levels for these controlled substances,” said Kathy Bloomgarden, a spokeswoman for Novartis.

But those who rely on the drugs can react very differently to apparently similar medicines, so an adequate supply of one drug does them no good when their preferred medicine is unavailable, patients and their doctors say. And prices can vary so much that some patients say they cannot afford to switch.

Lynn Whitton of Westport, Conn., who has an attention deficit hyperactivity disorder, expressed disbelief when told that the Drug Enforcement Administration said there were no shortages of A.D.H.D. medicines. “What?” she said. “I’m just flabbergasted!”

Ms. Whitton said she had recently gone to more than a dozen pharmacies in Westport and New York City before finding one that would partially fill Ritalin prescriptions for her and her 18-year-old son, who also has the disorder.

Erin Fox, manager of the drug information service at the University of Utah, said problems arise when there is a mismatch between what manufacturers choose to make and what patients are prescribed.

And, Dr. Fox said, while manufacturers sometimes use their limited quotas to ensure adequate supplies of high-priced branded drugs at the expense of low-profit generics, all of the issues would be resolved if the Drug Enforcement Administration were simply more generous with its quotas, particularly since sales of A.D.H.D. medicines have risen so rapidly.

Doctors wrote 51.5 million prescriptions for A.D.H.D. drugs in 2010, with a total sales value of $7.42 billion — an increase of 83 percent from the $4.05 billion sold in 2006, according to IMS Health, a drug information company.

Agent Boggs of the Drug Enforcement Administration said his agency was concerned that A.D.H.D. drug abuse was on the rise. “We see people abuse it in college and then continue to abuse it nonmedically once they leave,” he said.

Since the drugs have been shown to improve concentration, and not just in people with A.D.H.D., they have become popular among students who are seeking a study aid. And since they can impart a euphoria that users have likened to a cocaine high, the pills are sometimes ground up by people who snort them for a thrill.

On the other hand, there are people like Sheryl Greenfield of Bryn Mawr, Pa., an A.D.H.D. patient who spent days calling dozens of pharmacies to find a generic substitute for Adderall XR. She finally gave up and bought the brand, and her co-pay went to $200 from $10. “I can afford the difference, but I know some people who can’t,” she said.

Shortages of amphetamine-based drugs like Adderall became so endemic that many doctors switched patients to methylphenidate-based drugs like Ritalin, creating shortages among those medicines as well, according to the F.D.A.

Ruth Hughes, chief executive of Children and Adults with Attention Deficit Hyperactivity Disorder, a patient advocacy organization, said the drug shortages had become so acute that many patients were going untreated, increasing their risks of deadly traffic accidents and job dismissals. “The consequences of not getting treatment can be devastating,” Ms. Hughes said.

Dr. Alexander Lerman, a psychiatrist from Chappaqua, N.Y., said his patients could not simply switch from one medicine or dosage to another without consequences. And some of his patients, he said, cannot afford the branded version of the drugs.

“For the first time in my career,” Dr. Lerman said, “there is this enormous and mysterious scarcity of the basic product that is proven to work.”


A version of this article appeared in print on January 1, 2012, on page A1 of the New York edition with the headline: F.D.A. Is Finding Attention Drugs in Short Supply.

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Join the discussion of this article.
Go to Well http://well.blogs.nytimes.com/?p=68377
[2012-01-01 BLS: POSTED BELOW…]

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US - A.D.H.D. Drug Shortage Has Patients Scrambling… [2012-01-01 NY Times]

http://well.blogs.nytimes.com/?p=68377

December 31, 2011, 6:17 PM

A.D.H.D. Drug Shortage Has Patients Scrambling

By ANAHAD O'CONNOR

A shortage of medication for attention-deficit hyperactivity disorder has left many patients struggling to fill their prescriptions.

As Gardiner Harris reports, the shortages are the result of a troubled partnership between drug manufacturers, which want to maximize their profits, and the Drug Enforcement Administration, which wants to curtail abuse of the drugs.

   Caught in between are millions of children and adults who rely on the medicines to help them stay focused and calm. Shortages have become so endemic — particularly of cheaper generics — that some patients say that they suffer almost constant worry that they will not get enough.

   The disconnect between the D.E.A. and just about everyone else involved in the sales of the medicines is so profound that they even disagree over whether there are shortages. “We believe there is plenty of supply,” Special Agent Gary Boggs of the D.E.A.’s office of diversion control said in an interview.

   But multiple drug manufacturers have announced that their medicines are in short supply. The Food and Drug Administration lists the drugs as being in short supply on its official drug shortages list. The American Society of Health-System Pharmacists, which tracks drug shortages for hospitals, lists the medicines as being in short supply. Many doctors and patients complain about shortages.

   Officials at the F.D.A. blame the shortages on overly strict quotas set by the D.E.A. — making for a rare open disagreement between two federal agencies.

   “We have reached out to the D.E.A. and told them that there are shortage issues,” said Valerie Jensen, associate director of the F.D.A.’s drug shortage program. “But the quota issues are outside of our area of responsibility.”

To learn more about the medication shortage and the reasons behind it, read the full report, “F.D.A. Is Finding Attention Drugs in Short Supply< http://nyti.ms/sgNty7 >,” and then please join the discussion below.

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Related Posts:

FROM WELL

Attention Problems, Except for Screens
http://well.blogs.nytimes.com/?p=52229

The Reality of Attention Deficit Disorder
http://well.blogs.nytimes.com/?p=42331

Extra Time for College Admissions Tests
http://well.blogs.nytimes.com/?p=39385

An Objective Test for Attention Problems
http://well.blogs.nytimes.com/?p=29843

Testing a Child for Learning Disabilities
http://well.blogs.nytimes.com/?p=24467

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Comments:

EmilyWA

I take methylphenidate (generic ritalin) for hypersomnia, a condition related to narcolepsy, that causes me to be unable to work (much less drive to work!) safely without medication.

In the last four months, I've had to go to multiple pharmacies, have my prescription changed (ex: take 2 10mg pills instead of 1 20ml pill), and made dozens of calls to local pharmacies searching for my medication.

I recognize that people do abuse this drug, but there are many more people like myself who cannot function without it.
Jan. 1, 2012 at 1:04 a.m.

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LNLos Angeles, CA

I take methylphenidate (generic ritalin), which I need in order to function. I just checked with my mail-order pharmacy, which is out of stock until late January. This completely artificial shortage is deeply troubling and scary.
Jan. 1, 2012 at 12:21 a.m.

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© 2012 The New York Times Company

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US - Healthy eating may help ADHD kids: US study… [2012-01-09 Medical Xpress (AFP)]

http://medicalxpress.com/news/2012-01-healthy-adhd-kids.html

Psychology & Psychiatry

Healthy eating may help ADHD kids: US study

January 09, 2012

by Kerry Sheridan

Simply eating healthier may improve the behavior of children with attention deficit hyperactivity disorder if therapy and medication fail, said a study published Monday in the journal Pediatrics.

Researchers, however, said that their review of recent controlled scientific studies had shown conflicting evidence on the impact of supplements and restricted diets -- in some cases they were no better than the placebo effect.

Nutritional interventions should therefore be considered an alternative or secondary approach to treating ADHD, not a first-line attack, said the review by doctors at Northwestern University Medical School in Chicago.

"Supplemental diet therapy is simple, relatively inexpensive, and more acceptable to patient and parent," than strict additive-free diets that have been popular in the past, said the study.

"Public education regarding a healthy diet pattern and lifestyle to prevent or control ADHD may have greater long-term success."

The study reviewed research published on the sugar-restricted, additive-free Feingold Diet, megavitamin therapies, omega-3 fatty acid supplementation and the suspected link between ADHD and a "Western-style" high-fat, low-fiber diet.

Three to five percent of US schoolchildren, or nearly five million youths, are diagnosed with ADHD, which involves hyperactive behavior, inability to pay attention, and impulsivity. It is often treated with stimulant medications such as the controversial Ritalin drug.

The precise causes of ADHD are unknown, although studies have pointed to hereditary factors as well as social and environmental influences. Eating high-sugar and high-fat foods may exacerbate symptoms, some research has shown.

But while proposed interventions such as giving iron supplements or cutting out additives and food dyes have soared in popularity in recent years, the Pediatrics article said there is little solid science to back up those claims.

For instance, the much-hyped Feingold Diet which advocates no red or orange color dyes in food as well as no apples, grapes, deli, sausage or hot dogs, was highly touted in the 1970s and 80s for improving symptoms in more than half of ADHD children.

"Controlled studies failed to confirm the effectiveness of the diet to the extent claimed," said the Pediatrics review, also noting that the regimen was very difficult for many parents to follow.

Similarly, studies focused on getting rid of potential allergens in the diet such as wheat, eggs, chocolate, cheese and nuts, have shown limited success with some ADHD kids "but a placebo effect could not be excluded," said the study.

Even when it comes to sugar and diet soda, two elements which many parents believe can trigger hyperactivity in children, scientific studies have been unable to prove a definitive link.

"The majority of controlled studies fail to demonstrate a significant adverse effect of sucrose or aspartame," said the study.

The authors noted that avoiding high sugar foods in young children "may prevent diet-related exacerbations of ADHD."

But when parents restrict a child's sugar intake in order to ward off bad behavior, their inherent belief that it will work is likely to blur any objective assessment of whether it works or not.

"In practice, the link between sugar and hyperactive behavior is so universal in the opinion of parents of children with ADHD that no controlled study or physician counsel is likely to change this perception."

The suspected role of zinc and iron-deficiency deserves further study, while megavitamin therapy has not been proven to work and may even be dangerous in the long term, it said.

For many parents, simply paying more attention to feeding their kids a healthy diet, rich in fish, vegetables, fruit, legumes, and whole-grains, is likely to help.

"A greater attention to the education of parents and children in a healthy dietary pattern, omitting items shown to predispose to ADHD, is perhaps the most promising and practical complementary or alternative treatment of ADHD," said the study.

Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York, who was not part of the study, said more research is needed into dietary treatments for ADHD.

"We have more questions than answers," he said. "It is unfortunate that more research is not being done to examine the role of dietary interventions for the treatment of ADHD.

"Since some of these nutritional interventions cannot be patented, drug companies are not willing to underwrite the costs of the needed research."

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©  2012 AFP

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Canada - Physical activity program leads to better behavior for children with ADHD… [2012-01-17 Medical Xpress]

http://bit.ly/wuVZN6

Psychology & Psychiatry

Physical activity program leads to better behavior for children with ADHD

January 17, 2012

While children who suffer from attention-deficit hyperactivity disorder (ADHD) struggle with hyperactive-impulses and have trouble maintaining attention, a recent study found that a structured physical activity program may help to improve their muscular capacities, motor skills, behavior assessments, and the ability to process information. This new exploratory study was released in the recent issue of the Journal of Attention Disorders (published by SAGE).

Authors Claudia Verret, Marie-Claude Guay, Claude Berthiaume, Phillip Gardiner, and Louise Béliveau enrolled ten children in a physical activity program that included a warm-up, aerobic activity, muscular and motor-skill exercises, and a cool-down. The objective of each session was to maintain moderate to high-intensity activity throughout each session as observed by a heart-rate monitor.

"A main finding of this study is that both parents and teachers observed better behavioral scores in the physical activity group," wrote the authors. "This could mean that positive effects of physical activity may occur in different settings of the children's life."

The authors monitored ten children with ADHD who were participating in the physical activity program three times a week and eleven different children with ADHD as part of a control group.

The authors wrote, "Considering the beneficial effect of physical activity participation on some important ADHD-related variables, schools and parents of children with ADHD should look to maximize opportunities for structured group physical activity in their children's life."

More information: The article entitled "A Physical Activity Program Improves Behavior and Cognitive Functions in Children with ADHD: An Exploratory Study" from the Journal of Attention Disorders is available free for a limited time at: http://jad.sagepub.com/content/16/1/71.full.pdf+html

Provided by SAGE Publications
http://jad.sagepub.com/

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© Medical Xpress 2011-2012

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US - New Definition of Autism Will Exclude Many, Study Suggests… [2012-01-20 NY Times]

http://nyti.ms/yFPAea

Health

New Definition of Autism Will Exclude Many, Study Suggests

By BENEDICT CAREY

Published: January 19, 2012

Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply.

The results of the new analysis are preliminary, but they offer the most drastic estimate of how tightening the criteria for autism could affect the rate of diagnosis. For years, many experts have privately contended that the vagueness of the current criteria for autism and related disorders like Asperger syndrome was contributing to the increase in the rate of diagnoses — which has ballooned to one child in 100, according to some estimates.

The psychiatrists’ association is wrestling with one of the most agonizing questions in mental health — where to draw the line between unusual and abnormal — and its decisions are sure to be wrenching for some families. At a time when school budgets for special education are stretched, the new diagnosis could herald more pitched battles. Tens of thousands of people receive state-backed services to help offset the disorders’ disabling effects, which include sometimes severe learning and social problems, and the diagnosis is in many ways central to their lives. Close networks of parents have bonded over common experiences with children; and the children, too, may grow to find a sense of their own identity in their struggle with the disorder.

The proposed changes would probably exclude people with a diagnosis who were higher functioning. “I’m very concerned about the change in diagnosis, because I wonder if my daughter would even qualify,” said Mary Meyer of Ramsey, N.J. A diagnosis of Asperger syndrome was crucial to helping her daughter, who is 37, gain access to services that have helped tremendously. “She’s on disability, which is partly based on the Asperger’s; and I’m hoping to get her into supportive housing, which also depends on her diagnosis.”

The new analysis, presented Thursday at a meeting of the Icelandic Medical Association, opens a debate about just how many people the proposed diagnosis would affect.

The changes would narrow the diagnosis so much that it could effectively end the autism surge, said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and an author of the new analysis of the proposal. “We would nip it in the bud.”

Experts working for the Psychiatric Association on the manual’s new definition — a group from which Dr. Volkmar resigned early on — strongly disagree about the proposed changes’ impact. “I don’t know how they’re getting those numbers,” Catherine Lord, a member of the task force working on the diagnosis, said about Dr. Volkmar’s report.

Previous projections have concluded that far fewer people would be excluded under the change, said Dr. Lord, director of the Institute for Brain Development, a joint project of NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, Columbia University Medical Center and the New York Center for Autism.

Disagreement about the effect of the new definition will almost certainly increase scrutiny of the finer points of the psychiatric association’s changes to the manual. The revisions are about 90 percent complete and will be final by December, according to Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force making the revisions.

At least a million children and adults have a diagnosis of autism or a related disorder, like Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. People with Asperger’s or P.D.D.-N.O.S. endure some of the same social struggles as those with autism but do not meet the definition for the full-blown version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder, eliminating Asperger syndrome and P.D.D.-N.O.S. from the manual. Under the current criteria, a person can qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under the proposed definition, the person would have to exhibit 3 deficits in social interaction and communication and at least 2 repetitive behaviors, a much narrower menu.

Dr. Kupfer said the changes were an attempt to clarify these variations and put them under one name. Some advocates have been concerned about the proposed changes.

“Our fear is that we are going to take a big step backward,” said Lori Shery, president of the Asperger Syndrome Education Network. “If clinicians say, ‘These kids don’t fit the criteria for an autism spectrum diagnosis,’ they are not going to get the supports and services they need, and they’re going to experience failure.”

Mark Roithmayr, president of the advocacy organization Autism Speaks, said that the proposed diagnosis should bring needed clarity but that the effect it would have on services was not yet clear. “We need to carefully monitor the impact of these diagnostic changes on access to services and ensure that no one is being denied the services they need,” Mr. Roithmayr said by e-mail. “Some treatments and services are driven solely by a person’s diagnosis, while other services may depend on other criteria such as age, I.Q. level or medical history.”

In the new analysis, Dr. Volkmar, along with Brian Reichow and James McPartland, both at Yale, used data from a large 1993 study that served as the basis for the current criteria. They focused on 372 children and adults who were among the highest functioning and found that overall, only 45 percent of them would qualify for the proposed autism spectrum diagnosis now under review.

The focus on a high-functioning group may have slightly exaggerated that percentage, the authors acknowledge. The likelihood of being left out under the new definition depended on the original diagnosis: about a quarter of those identified with classic autism in 1993 would not be so identified under the proposed criteria; about three-quarters of those with Asperger syndrome would not qualify; and 85 percent of those with P.D.D.-N.O.S. would not.

Dr. Volkmar presented the preliminary findings on Thursday. The researchers will publish a broader analysis, based on a larger and more representative sample of 1,000 cases, later this year. Dr. Volkmar said that although the proposed diagnosis would be for disorders on a spectrum and implies a broader net, it focuses tightly on “classically autistic” children on the more severe end of the scale. “The major impact here is on the more cognitively able,” he said.

Dr. Lord said that the study numbers are probably exaggerated because the research team relied on old data, collected by doctors who were not aware of what kinds of behaviors the proposed definition requires. “It’s not that the behaviors didn’t exist, but that they weren’t even asking about them — they wouldn’t show up at all in the data,” Dr. Lord said.

Dr. Volkmar acknowledged as much but said that problems transferring the data could not account for the large differences in rates.

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Amy Harmon contributed reporting.

A version of this article appeared in print on January 20, 2012, on page A1 of the New York edition with the headline: New Autism Rule Will Trim Many, A Study Suggests.

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Readers’ Questions: Redefining Autism
http://consults.blogs.nytimes.com/?p=11823
James C. McPartland, an assistant professor in the Child Study Center at Yale University, is answering your questions about this possible new definition of autism.

Multimedia
DOCUMENT: How the Definition of Autism May Change

Graphic
Redefining Autism
http://nyti.ms/w4bEaj

Interactive Feature
Patient Voices: Autism
http://nyti.ms/AEbhUS

Related

Health Guide: Autism
Autism, Grown Up: Navigating Love and Autism (December 26, 2011)
http://nyti.ms/z608WJ

Autism, Grown Up: Autistic and Seeking a Place in an Adult World (September 18, 2011)
http://nyti.ms/zROryy

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COMMENTS (281)
http://nyti.ms/xFdPGm

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© 2012 The New York Times Company

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US - DSM-5 proposed criteria for autism spectrum disorder diagnosis… [2012-01-23 Medical Xpress]

http://bit.ly/xIooQD

Psychology & Psychiatry

DSM-5 proposed criteria for autism spectrum disorder diagnosis

January 23, 2012

(Medical Xpress) -- The American Psychiatric Association (APA) has proposed new diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism. While final decisions are still months away, the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis. The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status--in social communication and other relevant cognitive and motor behaviors.

Dr. James Scully, Medical Director of the American Psychiatric Association said, “The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions for children who suffer from autism spectrum disorder.”

The draft DSM-5 criteria will provide a more useful dimensional assessment to improve the sensitivity and specificity of the criteria. This change will help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, rather than providing general labels that tend not to be consistently applied across different clinics and centers.

Proposed DSM-5 criteria are being tested in real-life clinical settings known as field trials. Field testing of the proposed criteria for autism spectrum disorder does not indicate that there will be any change in the number of patients receiving care for autism spectrum disorders in treatment centers--just more accurate diagnoses that can lead to more focused treatment.

Criteria proposed for DSM-5 are posted on the DSM-5 website and will be open for additional public comment this spring. More information on the process for developing DSM-5 is also available on the website. Final publication of DSM-5 is planned for May 2013.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to http://www.dsm5.org .

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Provided by American Psychiatric Association

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