ADHD

The American Academy of Pediatrics came out with new recommendations that suggest doctors screen all of their child patients for hunger. About 16 million children in the US live in food scarcity and poverty that can lead to physical health issues as well as behavioral issues, which can then be misdiagnosed.

Reuters covers a new study in JAMA Psychiatry that suggests that children exposed to physical abuse and emotional abuse suffer from similar psychological and behavioral problems. “Even though doctors and parents often believe physical or sexual abuse is more harmful than emotional mistreatment or neglect, the study found children suffered similar problems regardless of the type of maltreatment endured.”

In the Boston Globe, Sarah Schweitzer tells the story of a young boy brutally abused by his parents then given to his grandparents who struggled with extreme poverty and homelessness. “Researchers now understood that trauma could alter the chemistry of developing brains and disrupt the systems that help a person handle stress, propelling a perpetual state of high alert. The consequences could be lifelong. As an adult, he’d be more likely to suffer anxiety and depression and heart disease and stroke. His ability to hold a job, manage money, and make good decisions could be compromised. And there was evidence, controversial but mounting, that he could pass on these traits to his children.”

New York Times columnist, Nicholas Kristof, relates the story of Andrew Francesco, a boy who began taking Ritalin at age five and died from complications with Seroquel when he was fifteen. His father, a former pharmaceutical industry executive, reveals the industry’s greed in his memoir “Overmedicated and Undertreated.” Now the industry is pushing for a first-amendment right to market its drugs for off-label uses.

Two companies have committed to FDA review for video games that they claim can be used to treat “ADHD,” but many scientists remain skeptical. “At the annual meeting of the American Academy of Child & Adolescent Psychiatry on Wednesday, Akili Interactive Labs presented data from a pilot study of its video game, Project: EVO, that showed some positive results in children with attention-deficit hyperactivity disorder (ADHD).”

At Alternet, Jay Syrmopoulos of The Free Thought Project discusses new research on the use of medical marijuana as a treatment for ADHD within the context of the ongoing debate over the validity of the ADHD diagnosis.

A small study of 30 participants in Germany claims that cannabis can be used to treat “ADHD” because it increases the availability of dopamine. "This then has the same effect but is a different mechanism of action than stimulants like Ritalin and dexedrine amphetamine, which act by binding to the dopamine and interfering with the metabolic breakdown of dopamine." According to the report, 22 of the 30 participants opted to discontinue their prescriptions in favor of medical marijuana.

PsychCentral presents a new study from the Center for Disease Control and Prevention (CDC) that found that foster care children are three times more likely than other children on Medicaid to receive a diagnosis of ADHD. Overall, more than one in four children in foster care receive such a diagnosis. CDC statistician Melissa Danielson interpreted these results as revealing a “substantial need” for more medical and behavioral services for kids in foster care.

A number of news outlets have been reporting on a review of modafinil, labeled the new "smart drug," this week. The review in question summarized the recent literature on the drug but others have claimed that the authors underestimated potential side-effects.

New research is investigating how “poverty reduction promotes cognitive and brain development.”

Writing in The Atlantic, James Hamblin reports that research continues to show that physical exercise is integral to “childhood cognition and brain health,” especially for children who exhibit symptoms associated with ADHD. These findings, Hamblin comments, have been discussed with a “phenomenal degree of reservation compared to the haste with which millions of kids have been introduced to amphetamines and other stimulants to address said ADHD.”

Individuals diagnosed with psychotic disorders have an earlier onset of psychosis if they have previously been exposed to prescription stimulants, according to new research currently in press in the Journal of Psychiatric Research.

Let’s face it, as our kids slowly developing brains wrestle with behavioral and maturity issues while also trying to juggle expectations related to academic and social challenges, some of the behaviors they display can be quite concerning. Understandably, after trying what seems like everything in the books plus the kitchen, bathroom and laundry room sinks, caring and often exhausted parents are actively looking for help, resources and answers. But guess what? Without any need for pharmaceutical intervention or “drug therapy,” for centuries parents have been quite capable of helping challenged children overcome semi-annoying and concerning behaviors that some “experts” want to label today as symptoms of a mental disorder. Behaviors that a billion kids worldwide display every day.

Chile’s Skills for Life (SFL) program, the largest school-based psychosocial intervention program in the world, has demonstrated improved behavioral and academic outcomes for elementary students identified as “at risk.” A team of Chilean and U.S. researchers assessed the SFL program and will publish their results in the October issue of the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP).

On Sunday, the front page of the UK’s Independent ran a story entitled, “Thousands of children are being medicated for ADHD – when the condition may not even exist.” Fiction novelist and author of the upcoming “Concentr8,” William Sutcliffe, writes, “The pharmaceutical/medical industry teaches us that whatever the problem, a pill is the answer.” “This notion is becoming so all-powerful, and so locked together with a pressurised, exam-centred, conformist educational system, that every parent who has a misbehaving or inattentive child may now find themselves pushed towards a diagnosis of ADHD.”

I imagine that everybody on this side of the issue knows by now that the eminent psychiatrist Jeffrey Lieberman, MD, Chief Psychiatrist at Columbia, and past President of the APA, called Robert Whitaker "a menace to society." The grounds for Dr. Lieberman's vituperation were that Robert had dared to challenge some of psychiatry's most sacred tenets! But in all the furor, it was largely ignored that in the same interview Dr. Lieberman had said something else that warrants additional discussion.

Amid growing criticism about the over-prescription of psychotropic medication in foster care, Pennsylvania commissioned PolicyLab to conduct an analysis of the use of psychiatric drugs among all of the state’s Medicaid-enrolled children. The report, released in June, found that the rate of psychotropic prescriptions among youth in Medicaid and foster care was higher than previously reported.

This month’s issue of JAMA Psychiatry ran an editorial commenting on recent research revealing that the majority of youth prescribed antipsychotics have not been diagnosed with a mental disorder.

On Tuesday, NPR told the story of DeAngelo Cortijo. DeAngelo became a foster kid at age 3 after his mother attempted suicide. He was “diagnosed with bipolar and anxiety disorders, attachment disorder, intermittent explosive disorder or posttraumatic stress disorder,” and was prescribed “a combination of antipsychotics, antidepressants and stimulants, and was told that taking them was his only hope of being normal.” Through equine therapy, DeAngelo was eventually able to get off all of his medication. Now, California is hoping to pass reforms that would prevent foster kids, like DeAngelo, from being “prescribed antipsychotic drugs at double to quadruple the rate of that not in foster care.”

“We are consistently seeing sensory, motor, and cognitive issues pop up more and more in later childhood, partly because of inadequate opportunities to move and play at an early age,” writes Angela Hanscom in The Washington Post.

Healthline reports that as five second-generation antipsychotics (SGAs) lose patent protection, Medicaid expenditures for antipsychotics are projected to be cut in half over the next five years. But some worry that the decrease in spending may lead policymakers to lift existing restrictions on antipsychotics at a time when most SGAs are prescribed to children for off-label reasons.

What would happen if the mental health system fully recognized the pervasive and profound impacts of trauma on their clients? How might a deeper appreciation of the multi-faceted sequelae of childhood maltreatment and toxic stressors reshape mental health services? While the implementation of trauma-informed care in mental health programs has made significant inroads, the dominant bio-reductionist model continues to constrain and undermine progress.

Former DSM-IV task force chair Allen Frances takes aim at the “massive overuse of psychotropic medication in children” in an article for the Psychiatric Times. He shares a checklist of questions for doctors to consider before prescribing medication to children. Frances warns: “We simply don’t know what will be the long-term impact of bathing a child’s immature brain with powerful chemicals.”

The majority of children, adolescents and young adults prescribed antipsychotic medications have not been diagnosed with a mental disorder, according to a recent study published in JAMA Psychiatry.

-Psychiatrists Ilina Singh and Simon Wessely ask if it would be ethically right to treat a child for ADHD, even if it were possible to definitively identify a biomarker for ADHD.