ADHD ‘Inextricably’ Linked to Substance Abuse

New study says parents beware

Abstract: http://pediatrics.aappublications.org/content/134/1/e293.abstract

The journal Pediatrics published a study (June 30) which found that children with ADHD are 2 times more likely to meet diagnostic criteria for alcohol abuse or dependence and more than 2.5 times more likely to develop a substance use disorder (SUD). Additionally, ADHD children are twice as likely to develop cocaine abuse or dependence.

Is there any good news? The researchers noted that stimulant medication may reduce the risk for trying drugs and developing an SUD. Prior studies both contradict and confirm this.

The study’s authors warn, “Individuals with co-occurring ADHD and active SUDs require a careful, individual risk/benefit assessment regarding the safety of prescribing a stimulant medication. Longer acting preparations of stimulant medication, the prodrug formulation of dextroamphetamine, and nonstimulant medications for ADHD all have lower abuse potential than short-acting preparations of stimulant medication and, thus, their use should be strongly considered if there is a high risk of misuse, diversion, or abuse of stimulant medications.”

“Misuse and diversion of stimulant medications are more widespread problems than abuse or addiction,” the report states. What is diversion? Diversion is your child not using the medication as prescribed, but rather selling it to someone else.

The report indicates that prior research suggests that between 16% and 23% of school-aged children are approached to sell, buy, or trade their stimulant medication.

Toddlers Being Prescribed ADHD Meds

Toddlers Being Prescribed ADHD Meds

Read more: http://www.inquisitr.com/1259397/cdc-finds-shocking-number-of-toddlers-medicated-for-adhd-medicaid-recipients-especially-vulnerable/

The Centers for Disease Control reports that Medicaid claims in Georgia reveal 1 in 225 toddlers are medicated for ADHD – that’s 760 cases in the state alone. The CDC estimates that more than 10,000 toddlers may be taking ADHD medications.

Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif. and author of The Last Normal Child said, “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Dr. Ed Hallowell, a noted child psychiatrist and ADHD expert appeared on Fox and Friends. He said it’s “crazy” that toddlers are being given drugs like Adderall and Ritalin.

“People are looking for a quick solution to the age-old problem of rambunctious little toddlers,” he said. “The solution is not to give them medication. The solution is to play with them, to be with them, to take care of them. Not to give them a pill in the hopes
that’ll quiet them down.”

Prescriptions for toddlers are being granted despite the fact that ADHD medication has not been studied for this group. Indeed the American Academy of Pediatrics does not even broach the subject of ADHD medication in toddlers (children under 4 years old).

Two year olds are notably rambunctious. Most experts agree that it’s far too early to diagnose ADHD at age 2. Your opinions are welcome.

Study Says Most Doctors Don’t Follow ADHD Treatment Guidelines for Preschoolers

Does yours?

Published in the American Academy of Pediatrics (AAP)

Study presented Saturday at the Pediatric Academic Societies’ annual meeting in Washington, D.C.
author Dr. Andrew Adesman

Read full article: http://www.webmd.com/add-adhd/childhood-adhd/news/20130504/most-docs-dont-follow-adhd-treatment-guidelines-for-preschoolers-study

New treatment guidelines were published recently by the American Academy of Pediatrics (AAP). These guidelines now allow for an ADHD diagnosis in children as young as 4-years old. The new guidelines are somewhat controversial because three out of the four common medications used to treat ADHD patients are not FDA approved for use among children that young.

Much like the guidelines in the United Kingdom, the new AAP guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD. Treatment with medication is a last resort option used when behavior-management is unsuccessful.

A study presented Saturday at the Pediatric Academic Societies’ annual meeting in Washington, D.C. reports that about 90% of the pediatric specialists who diagnose and treat preschool children do not follow those treatment guidelines. According to study author Dr. Andrew Adesman, chief of behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park, NY, some pediatric specialists prescribe medication too soon and some do not offer them as a second line treatment.

In a medical center news release, Adesman noted, “It is unclear why so many physicians who specialize in the management of ADHD — child neurologists, psychiatrists and developmental pediatricians — fail to comply with recently published treatment guidelines.”

Can I Talk to My Baby and Prevent ADHD?

The answer may surprise you.
Full article in healthychildren.org

A Scottish study being being published in the journal Research In Developmental Disabilities, analyzed hundreds of videos of mothers interacting with their year-old babies. The researchers found that less vocal communication (talking, singing, cooing, making sounds, etc.) by the parent was associated with an increase in the likelihood the child would develop conditions such as ADHD.

Most parents experience a little guilt when using the TV or computer as an electronic babysitter, and this guilt may be warranted.

The researcher’s data were quite profound: For every reduction of five vocalizations per minute by the mother, the odds of an infant going on to develop mental health issues such as ADHD by the age of seven increased by 44%.

Study co-author Philip Wilson, professor of primary care and rural health at the University of Aberdeen, said “We have got the possibility that active parenting and active communication by the parents may have a protective effect against the development of problems with attention and conduct.”

The American Academy of Pediatrics suggests no TV or electronic stimulation before the age of 2. After that age, one half hour or less is recommended.

For a full article on brain development and TV watching, see http://www.healthychildren.org/English/family-life/Media/Pages/Why-to-Avoid-TV-Before-Age-2.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A+No+local+token

Why to Avoid TV Before Age 2
www.healthychildren.org
The problem lies not only with what toddlers are doing while they’re watching TV; it’s what they aren’t doing. Specifically, children are programmed to learn from interacting with other people.

Does ADHD Last My Whole Life?

A new study sheds light
Reported in US News & World Report, published health.usnews.com

US News& World Report cites a study that shows ADHD persists as one ages and produces more problems in adulthood.

The researchers also shed light on our current process of diagnosis, stating:

“We should use caution in describing this constellation of behaviors as a ‘disease,'” he said.

The American Academy of Pediatrics says doctors should do an evaluation for ADHD for any child aged 4 to 18 who has behavioral problems or is falling behind at school. But that should also include a thorough assessment for learning disabilities, emotional issues or physical conditions that could be causing their symptoms — such as sleep apnea.

Barbaresi’s advice to parents: “Don’t accept a cursory evaluation and a prescription.”

Read the entire article: http://health.usnews.com/health-news/news/articles/2013/03/04/adhd-can-often-persist-into-adulthood?page=2

New research on attention and video games

Research published in the July issue of Pediatrics reveals that too much time spent watching television and playing video games can cause attention problems.

A graduate student at Iowa State University, Edward Swing, found that excessive screen time, whether in front of a computer or TV, could double the risk of attention problems in children and young adults.

Swing’s research confirms previous findings from Dr. Dimitri Christakis, the George Adkins Professor of Pediatrics at the University of Washington in Seattle.  Christakis’ research found that faster-paced shows increased the risk of attention problems.  "You prime the mind to accept that pace. Real life doesn’t happen fast enough to keep your attention,” says Christakis.

The  American Academy of Pediatrics (AAP) has long recommended that children over the age of 2 view less than two hours of TV or computer per day. Prior to that age, they suggest no TV viewing or computer.

Swing compared data of 1300 children in grades three, four, and five who watched TV or played video games less than two hours a day to children who watched more.  He found that more video time could nearly double the risk of attention problems in children and young adults

"The children were reporting their TV and video game use and the parents were also reporting TV and video game use," Swing said. "The teachers were reporting attention problems," he said of the middle school students.

While both Swing’s and Christakis’ studies do merit attention, they are quite limited.  For example, Swing used teacher rating reports to assess whether children had problems paying attention, if they interrupted classmate’s work, if they had trouble staying on task, or showed problems in other areas related to inattention. Teacher reports typically vary over time and from teacher to teacher. They are also highly subjective. To account for this, Swing had more than one teacher rate the children and that the ratings tended to be in agreement.

The greatest flaw in this research is that Swing did not account for content, i.e. what were the students watching or playing? Were the students watching educational TV or playing educational games? Were they playing race car games? Shooting games? Were they playing problem solving games?  Were the games fast paced? Slow? Did they require reasoning skills? We’ll never know and that’s problematic because it leaves so many questions unanswered. As we are what we eat, we are what we stimulate ourselves with.

"These media aren’t going away," Christakis said. "We do have to find ways to manage them appropriately."  On this I can agree. Limiting time to the AAP recommendations is prudent parenting.