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Child psychiatric problems treated (4/29/97)

Information now available through brain imaging equipment provides new insight into attention deficit disorder (ADD). One major focus of the child psychiatry division at The University of Texas Health Science Center is ADD, which presents a delimma to teachers and parents alike. Steven R. Pliszka, MD, who specializes in ADD, was appointed director of the Health Science Center's recently formed division of child and adolescent psychiatry.

"The division has two major thrusts," stated Dr. Pliszka. "The first is to develop clinical services, the second to develop a research program.

"We now have five child and adolescent psychiatrists doing outpatient treatment, and we specialize in attention deficit disorder," Dr. Pliszka said. "We treat mood disorders, depression and bipolar disorder, focusing primarily on medical biological treatment. We don't have a large psychotherapy component at this time, so we focus on treatment with medication. If psychotherapy is also needed we do a limited amount, but most patients are referred to clinical faculty in the community."

Attention deficit disorder is a disease of infancy and childhood characterized by developmentally inappropriate inattention and hyperactivity, although the disease may appear without the hyperactivity component. These children act impulsively, and they are unable to persist when given a task or problem to do. They have difficulty in organizing and completing schoolwork, which is frequently done in a haphazard manner. Children with ADD are not goal-oriented, and they appear not to listen, or to ignore instructions. The disease is six to nine times more likely to appear in boys than girls.

Dr. Pliszka is currently working with Mario Liotti, MD, PhD, and Martin Woldorff, PhD, both from the Research Imaging Center at the Health Science Center, on a project of special interest to him.

"We continually measure brain waves while the child does a particular task, to study the child's attention deficit," Dr. Pliszka explained. "These kids have trouble controlling their impulses - they can't stay in their seats, can't stay focused, and they talk and think too rapidly. So we have them do a task that requires them to be able to stop themselves every time a letter appears on the screen.

"About 20 percent of the time after the letter has appeared they get a signal that they should *not* press the button - they have to think with their finger in midair," Dr. Pliszka said. "Naturally the children with ADD don't do as well at this task. We are interested in the period of time it takes for them to either stop or to continue, once the letter has appeared on the screen. When the child can successfully stop himself, the brain produces a particular electrical signal in the frontal lobe. The purpose of this experiment is to see if that particular signal is missing in kids with attention deficit disorder, and this gives us insight into what is actually going on in the brain.

"Most children with ADD respond well to medication," according to Dr. Pliszka. "Medication increases the child's focus, allowing him to complete a task, such as schoolwork.

"We are also working on other research projects," Dr. Pliszka stated. "Dr. Rene Olvera is studying depression and the differences in rates between Hispanic and non-Hispanic teenagers, looking at the cultural effects."

In the future, Dr. Pliszka hopes to do a drug study of Addercell in the treatment of ADD. This is a new form of stimulant medication which is longer acting, and may have fewer side effects than the commonly prescribed Ritalin.

"We also hope to do other kinds of studies, such as drug treatment for depression, possibly more biological studies, and some functional MRI studies," he concluded.

Contact: Jan Elkins (210) 567-2570