Updated guidelines issued for attention deficit...
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Updated guidelines issued for attention deficit hyperactivity disorder (ADHD) T heAmerican Academy of Pediatrics (AAP) has up- such as inattention and hyperactive behavior should be dated its guidelines for the diagnosis and manage- observed in more than one setting. This means that a cli- ment of attention deficit hyperactivity disorder (ADHD). nician should obtain information from parents, teachers, Although much of the advice remains the same, the and other caregivers before making a diagnosis. new guidelines offer several significant changes worth Treatment. For preschoolchildren (ages 4 or 5), the noting: AAP recommends that the first-line treatment offered Screening. The AAP now recommends that any child for ADHD be in the form of behavioral therapy, with or teenager, ages 4 to 18,be screened for ADHD ifhe or medication held in reserve for use only when behavior she develops academic or behavior problems in addi- modification doesnot produce significant improvement. tion to symptoms suggesting ADHD, such as inattention, For older children and teenagers, the AAP recommends hyperactivity, or impulsive behavior. This represents either medicationor behavioral therapy for ADHD-but an expansion of the previous recommendations, which concludes that the combination of both is probably best. w.e.re_r.estrkte_d tQshildren ag~~ 6~ 12. < -------Am~l'ican-Acad(lm¥__of Pediatrics. ''ADHD;-Clinical Practice Guide_- _~ __ . Diagnostic criteria. The AAP recommends that di- line for theDiagnosis, Evaluation, and Treatment of Attention- agnosis of ADHD be made on the basis of criteria pub- Deficit/Hyperactivity Disorder in Children and Adolescents;' lished in the Diagnostic and Statistical Manual of Mental Pediatrics (Nov. 20ll): VoL 128, No.5,electronic publication ahead ofpnnt. Disorders, Fourth Edition (DSM-IV). A key element of this recommendation is the reminder that symptoms covered behavior modification, stressreduction tech- niques, and tipson howto avoidrelapse. The remain- ing participants were assigned to mindfulness training, which focused on building awareness and acceptance of key components of addiction and withdrawal, such as intense cravings and fluctuations in mood. Participants in both arms of the study met for group therapy twice a week for four weeks. Both immediately after the intervention ended and at a17-week follow-up assessment, individuals assigned to mindfulness training were more likely to have quit smok- ing completely, with abstinence confirmed by breath tests measunng levelSOf Clgarette l5yproducts. m-tne ~fo~u~r~----- week mark, 36% of the people assigned to mindfulness training were abstinent from cigarettes, compared with 15% of those assigned to the Freedom From Smoking group. At the 17-week mark, the differences were even more pronounced: 31% of the peopleassigned to mind- fulness training remained abstinent, comparedwith 6% of those assigned to Freedom From Smoking. This is a small study, however, with relatively short- term results. That being said, the study is areminder that mindfulness training-already usedin conjunction with other stop-smoking techniques-might alsobe worth trying on its own. Mindfulness training helps people quit smoking M ultiple options exist to help people stop smoking, from nicotine replacement therapy to psychother- apy and self-help programs. But for the most part, the success rates of these programs are discouraging. Most people addicted to cigarettes have to make several quit attempts before they can finally kick the habit. Even then, they may have trouble staying abstinent. Environmental cues and triggers-such as the smell of a cigarette or the pressures of a stressful day-can induce powerful cravings, including recollections of the plea- sures of smoking, that a person may find hard to resist. That's why most tobacco cessation programs encourage . people 1:0 avoid trfgge.r~reaucestress, anannaalterna- tives to cigarettes. A new study suggests that a different approach-which involves learning to accept and tolerate the challenges of withdrawal from addiction, rather than finding ways to avoid these unpleasant experiences-might be a better way toquit cigarettes. The study is believed to be the first randomized controlled trial of mindfulness training as a stand-alone treatment for nicotine addiction. The results are promising. Researchersatthe Yale University School of Medi- cine recruited 88 smokers to participate in the trial. On average, participants were smoking 20 cigarettes a day and had made five previous attempts to quit. Half of the participants were assigned to the American Lung Asso- ciation's Freedom From Smoking program. The program www.health.harvard.edu Brewster JA,et al. "Mindfulness Training for Smoking Cessation: Results from a Randomized Controlled Trial;' Drug and Alcohol Dependence (June 30, 2011): electronic publication ahead of print. January 2012 I Harvard Mental Health Letter I 7
Transcript of Updated guidelines issued for attention deficit...
Updated guidelines issued for attention deficit hyperactivity disorder (ADHD)
The American Academy of Pediatrics (AAP) has up- such as inattention and hyperactive behavior should bedated its guidelines for the diagnosis and manage- observed in more than one setting. This means that a cli-
ment of attention deficit hyperactivity disorder (ADHD). nician should obtain information from parents, teachers,Although much of the advice remains the same, the and other caregivers before making a diagnosis.new guidelines offer several significant changes worth Treatment. For preschool children (ages 4 or 5), thenoting: AAP recommends that the first-line treatment offered
Screening. The AAP now recommends that any child for ADHD be in the form of behavioral therapy, withor teenager, ages 4 to 18,be screened for ADHD ifhe or medication held in reserve for use only when behaviorshe develops academic or behavior problems in addi- modification does not produce significant improvement.tion to symptoms suggesting ADHD, such as inattention, For older children and teenagers, the AAP recommendshyperactivity, or impulsive behavior. This represents either medication or behavioral therapy for ADHD-butan expansion of the previous recommendations, which concludes that the combination of both is probably best.w.e.re_r.estrkte_dtQshildren ag~~6~ 12. < -------Am~l'ican-Acad(lm¥__of Pediatrics. ''ADHD;-Clinical Practice Guide_- _~ __ .
Diagnostic criteria. The AAP recommends that di- line for the Diagnosis, Evaluation, and Treatment of Attention-agnosis of ADHD be made on the basis of criteria pub- Deficit/Hyperactivity Disorder in Children and Adolescents;'lished in the Diagnostic and Statistical Manual of Mental Pediatrics (Nov. 20ll): VoL 128, No.5, electronic publication ahead
ofpnnt.Disorders, Fourth Edition (DSM-IV). A key element ofthis recommendation is the reminder that symptoms
covered behavior modification, stress reduction tech-niques, and tips on how to avoid relapse. The remain-ing participants were assigned to mindfulness training,which focused on building awareness and acceptance ofkey components of addiction and withdrawal, such asintense cravings and fluctuations in mood. Participantsin both arms of the study met for group therapy twice aweek for four weeks.
Both immediately after the intervention ended and ata 17-week follow-up assessment, individuals assigned tomindfulness training were more likely to have quit smok-ing completely, with abstinence confirmed by breath testsmeasunng levelSOf Clgarette l5yproducts. m-tne ~fo~u~r~-----week mark, 36% of the people assigned to mindfulnesstraining were abstinent from cigarettes, compared with15% of those assigned to the Freedom From Smokinggroup. At the 17-week mark, the differences were evenmore pronounced: 31%of the people assigned to mind-fulness training remained abstinent, compared with 6%of those assigned to Freedom From Smoking.This is a small study, however, with relatively short-
term results. That being said, the study is a reminder thatmindfulness training-already used in conjunction withother stop-smoking techniques-might also be worthtrying on its own.
Mindfulness training helps people quit smoking
Multiple options exist to help people stop smoking,from nicotine replacement therapy to psychother-
apy and self-help programs. But for the most part, thesuccess rates of these programs are discouraging. Mostpeople addicted to cigarettes have to make several quitattempts before they can finally kick the habit.
Even then, they may have trouble staying abstinent.Environmental cues and triggers-such as the smell of acigarette or the pressures of a stressful day-can inducepowerful cravings, including recollections of the plea-sures of smoking, that a person may find hard to resist.That's why most tobacco cessation programs encourage. people 1:0 avoid trfgge.r~reaucestress, anannaalterna-tives to cigarettes.A new study suggests that a different approach-which
involves learning to accept and tolerate the challenges ofwithdrawal from addiction, rather than finding ways toavoid these unpleasant experiences-might be a betterway to quit cigarettes. The study is believed to be the firstrandomized controlled trial of mindfulness training as astand-alone treatment for nicotine addiction. The resultsare promising.
Researchers at the Yale University School of Medi-cine recruited 88 smokers to participate in the trial. Onaverage, participants were smoking 20 cigarettes a dayand had made five previous attempts to quit. Half of theparticipants were assigned to the American Lung Asso-ciation's Freedom From Smoking program. The program
www.health.harvard.edu
Brewster JA, et al. "Mindfulness Training for Smoking Cessation:Results from a Randomized Controlled Trial;' Drug and AlcoholDependence (June 30, 2011): electronic publication ahead of print.
January 2012 I Harvard Mental Health Letter I 7
