Tag Archives: ADHD

ADHD patients– not at increased risk for Celiac disease

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It seems that so many conditions have been linked to Celiac disease; perhaps, Celiac disease is to health problems as Kevin Bacon is to actors (Six Degrees of Kevin Bacon – Wikipedia, the free encyclopedia).  A notable exception may be ADHD (JPGN 2013; 56: 211-14).

In a prospective study from Turkey, a total 362 children between 5 and 15 years who were diagnosed with ADHD at a child psychiatry clinic (2007-2010) were evaluated.  Serum levels of tissue transglutaminase (TTG) IgA and IgG antibodies were obtained; serum IgA levels were determined in those with isolated TTG IgG positivity.  In addition, the authors identified a matched control group of 390 children.

Results:

  • TTG IgA seropositivity was noted in 4 patients with ADHD (1.1%) compared with 3 controls (0.8%).  Only one of the four ADHD patients had histologic evidence of celiac disease (0.27%).
  • There was a higher incidence of TTG IgG in the ADHD group, 3.9% compared with 0.5% in controls. However, serum IgA was normal in all of these patients (indicating that TTG IgA was likely reliable).  Followup TTG IgG testing was negative consistent with false positivity.

Perhaps this result is not surprising to those who have seen a ‘classic’ celiac disease presentation.  In these children who often had physical signs of malnutrition including a bloated abdomen, the effect of a gluten-free diet changed a “perfectly-behaved” (=listless) child into a very active toddler.  So, in these children, a gluten-free diet but not celiac disease triggered hyperactivity.

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Stopping criminality in ADHD

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While not much related to pediatric gastroenterology, I nevertheless found an article on the relationship between medication adherence for attention deficit-hyperactivity disorder (ADHD) and criminality to be provocative (NEJM 2012; 2006-14).

In this Swedish study with 25,656 patients, there was a significant reduction in the crime rate during periods of receiving the medication compared with nonmedication periods: 32% reduction for men and 41% for women.

Approximately 50% of the patients were between ages 15-24, 30% between 25-39, and the remainder >40 years.  Overall, 37% of the men had been convicted of any crime and 15% of the women.

To avoid possible bias from reverse causation, the investigators looked at whether the order of the change in medication status was important.  The criminality associations were significant regardless of the order, suggesting that this type of bias was unlikely.  The authors state that “it is possible that pharmacologic ADHD treatment helps patients to better organize their lives,” thereby decreasing their likelihood of crime.

There are many other concerns raised regarding ADHD medications, including adverse effects (eg. cardiovascular), overprescription, and side effects.  However, this inverse association with criminality should be added to other potential benefits.