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ADHD: New Findings

Two new studies add to our understanding of attention deficit hyperactivity disorder (ADHD). The first study indicates that maternal smoking is a risk factor for ADHD, and the second study suggests that desipramine is effective for treating ADHD in adults.

Researchers compared 140 boys aged 6 to 17 with ADHD and 120 normal controls. Children with ADHD were more likely than controls to have mothers or fathers with ADHD and lower IQ scores. Mothers of ADHD children were also nearly three times as likely to have smoked during pregnancy (22% vs. 8%), although rates of maternal alcohol and illicit drug use were similar in both groups. While none of the ADHD children whose mothers smoked had birth weights below 5 pounds, the authors posit that both smoking-related fetal hypoxia and the direct impact of nicotine on the developing brain contribute to ADHD. They hypothesize that nicotine exposure influences the ultimate number of nicotine receptors and, indirectly, the dopaminergic system. These findings are consistent with rat models of hyperactivity linked to nicotine exposure.

Researchers in the second study randomized 41 adults with ADHD to receive either desipramine (200 mg daily) or placebo for six weeks. Desipramine significantly reduced ADHD symptoms in 68% of the adults. This efficacy rate is similar to those reported in studies of desipramine in children and adolescents with ADHD. Reductions in inattention, impulsivity, and hyperactivity were similar to those achieved using robust doses of methylphenidate in adults with ADHD.

Comment: While additional data regarding other possible environmental factors and the nature and extent of other substances used during pregnancy are necessary to fully evaluate the first study, the results suggest that prevention of ADHD may be enhanced by reducing maternal smoking during pregnancy and possibly by reducing fetal exposure to second-hand smoke. The second study offers clinicians a new and powerful use for a familiar and highly effective psychopharmacological tool.

— J Yager

Published in Journal Watch Psychiatry November 1, 1996

Citation(s):

Milberger S et al. Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children? Am J Psychiatry 1996 Sep 153 1138-1142.

• Medline abstract (Free)

Wilens T et al. Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. Am J Psychiatry 1996 Sep 153 1147-1153.

• Medline abstract (Free)