April 29, 2024
Guanfacine is a non-stimulant medication for ADHD. It is an Alpha-2 agonist that targets and excites receptors in the prefrontal cortex of the brain, the region that governs executive functions such as judgment, decision making, planning, and response suppression. These functions tend to be sub-optimal in ADHD.
Most treatment guidelines recommend stimulants as the preferred treatment for ADHD, because they respond faster, and studies show they have higher efficacy in reducing symptoms. But for individuals for whom treatment with stimulants is subpar, guidelines recommend non-stimulants as second-line treatment.
Previous meta-analyses have focused on efficacy among children and adolescents with ADHD. This meta-analysis, by a Chinese study team, expanded its reach to not only update the former, but also include studies of adults.
The team’s systematic search of the medical literature for double-blind randomized controlled trials (RCTs) identified eleven that could be combined for meta-analysis. With only a single study of efficacy for adults, however, no meta-analysis could be performed specific to persons 18 and older.
Meta-analysis of all eleven studies with a combined total of 2,623 participants found guanfacine to be roughly 75% more effective than placebo for reducing ADHD symptoms. Variation between studies (heterogeneity) was low. There was no sign of publication bias.
Breaking that down by length of time on guanfacine found no evidence of a dose-response effect, however. In fact, participants with less than ten weeks of treatment (seven RCTs, 1,771 participants) outperformed those with longer periods of treatment (four RCTs, 852 participants) with a narrow overlap in the 95% confidence limits.
The outcomes were also sensitive to the ADHD symptom scale used. Meta-analysis of RCTs using the Clinical Global Impression of Improvement treatment response score (four studies, 850 participants) reported no significant improvement, while RCTs relying on ADHD-Rating-Scale-IV (six studies, 1,128 participants) reported a significant improvement, but without providing a standardized effect size.
Finally, a meta-analysis of ten RCTs with a combined total of 2,273 persons found a 23% increase in treatment-emergent adverse events for guanfacine relative to placebo. The three most common such events in the guanfacine group were somnolence (38.6%), headache (20.5%), and fatigue (15.2%).
Sijie Yu, Sihao Shen, and Ming Tao, “Guanfacine for the Treatment of Attention-Deficit Hyperactivity Disorder: An Updated Systematic Review and Meta-Analysis,” Journal of Child and Adolescent Psychopharmacology (2023), https://doi.org/10.1089/cap.2022.0038.
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.
The Norwegian Mother, Father, and Child Cohort Study (MoBa) invites parents to participate voluntarily and has a 41% participation rate. The study includes:
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:
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.
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.”
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.
The research focused on two types of studies:
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.
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.”
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.
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:
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.”
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