attention-deficit hyperactivity disorder

Less-frequent dosing may help kids continue treatment.

* THE QUESTION Children who exhibit impulsive, inattentive and overly active behavior often must take several pills a day -- at precise intervals, for years on end -- to help control their conduct. However, the vast majority of these children soon stop taking the medication, negating their benefits. Might pills that need to be taken less frequently make discontinuation of treatment less likely?

* THIS STUDY analyzed records of 11,537 youths, ages 6 to 17, who were prescribed various brands and formulations of methylphenidate hydrochloride (MPH), the most commonly used drug for attention-deficit hyperactivity disorder (ADHD). Those who were given a longer-lasting, extended-release pill continued taking it for an average of 140 days, compared with 103 days for those who took an immediate-release version that required more-frequent doses. Within the extended-release group, those using Concerta took it longer (147 days) than those on Ritalin LA (113 days) or Metadate CD (101 days).

* WHO MAY BE AFFECTED BY THESE FINDINGS? Youths with ADHD, which may affect as many as 5 percent of children in the United States, boys more often than girls.

* CAVEATS The findings were based on prescription refill data. As a result, the study could not definitively establish whether the participants actually took the medication or took the prescribed amount nor identify reasons for discontinuation. The study did not determine such characteristics as a participant's ability to follow directions or motivation to receive treatment -- factors that could affect the results. The study was funded by McNeil Consumer & Specialty Pharmaceuticals, which makes Concerta; two of the four authors were McNeil employees.

* FIND THIS STUDY June issue of the Archives of Pediatrics & Adolescent Medicine; abstract available online at www.archpediatrics.com.

* LEARN MORE ABOUT ADHD at www.help4adhd.org and www.nimh.nih.gov.

aphasia

Intensive speech therapy may help stroke survivors.

* THE QUESTION A stroke that damages the language center of the brain can rob a person of the ability to speak and comprehend verbal communication, a condition known as aphasia. If language skills have not returned in six months to a year, it's generally thought that little more improvement can be expected. Might short-term intensive therapy alter that perception?

* THIS STUDY involved 27 people who had had aphasia for about four years. In groups of two or three, they were given language retraining for three hours a day for 10 days. Treatment included playing language card games, restricting use of gestures to communicate and, for 15 participants, additional exercises to be done with a family member -- such as going to a bakery and asking for bread. Language functions -- including the ability to effectively communicate, comprehension and the amount of everyday communication -- increased in 85 percent of the participants. Improvements were about the same regardless of the person's age or how severe or long-lasting their aphasia had been. Improvements were more pronounced in those whose families participated in their treatment.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with chronic aphasia, which afflicts as many as 60 percent of those who lose language ability from a stroke.

* CAVEATS The authors suggest that the intensity of the treatment was crucial to participants' success, but the study did not determine which aspects of treatment were responsible for the results. Some of the findings stemmed from reports made by family members, who may have been biased by expectations of improvement. The study was small, and it did not compare intensive short-term treatment with other treatments or with no treatment.

* FIND THIS STUDY June 9 online edition of Stroke; abstract available at www.strokeaha.org (at "Stroke ASAP").

* LEARN MORE ABOUT aphasia at www.aphasia.org and www.nidcd.nih.gov/health.

gestational diabetes

Treatment seems to reduce newborn complications.

* THE QUESTION Women who develop diabetes while pregnant face a number of uncertainties. Their babies may be unusually large and prone to complications, and they're more apt to give birth by Caesarean section. Does treating the diabetes change these risks?

* THIS STUDY randomly assigned 1,000 pregnant women with gestational diabetes to continue routine pregnancy care or to receive individualized dietary advice, have their blood glucose levels monitored and take insulin if needed. Of the women's 1,030 babies, 4 percent of those born to the normal-care group had serious complications, compared with 1 percent of those whose mothers had gotten treatment. Caesarean delivery rates were about the same in both groups, but more women in the treatment group than in the normal-care group had induced labor (39 percent vs. 29). Babies in the treatment group generally weighed less than the others, and fewer were considered large for their gestational age at birth.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Pregnant women. About 5 percent of those who do not have diabetes develop it while pregnant. People born large for their gestational age are more likely to develop diabetes.

* CAVEATS Physicians' knowledge of women's diabetes may have influenced decisions to induce labor; this, in turn, may have led to fewer complications at birth. Long-term follow-up would be needed to learn the rate of diabetes among the lower-birth-weight children as they become adults.

* FIND THIS STUDY June 16 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.

* LEARN MORE ABOUT gestational diabetes at http://diabetes.niddk.nih.gov and www.mayoclinic.com.

-- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.