Saturday, September 19, 2020

Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

 Is there a relationship between medication use and a LOWER risk of accidents? 

Yes. 

Short term? Yes.

Long-term? Yes.

Men? Yes.

Women? Yes. 

Please take your medicines. 


Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes


Question

Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings

In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning

Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

ADHD & Accidents Crashes Violations Suspensions in Motor Vehicles - New Data

 Do teens with ADHD have more accidents? More Moving Violations?

Yes. For Years,


Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD

Accidents and Moving Violations in ADHD (purple) vs Control (orange)Allison E. Curry, PhD, MPH,corresponding authora,b Benjamin E. Yerys, PhD,c,d Kristina B. Metzger, PhD, MPH,a Meghan E. Carey, MS,a and Thomas J. Power, PhDb,d

Abstract

Methods: We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license (N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression.

Objectives: To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD).

Results: Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD.

Conclusions: Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed.





https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564068/figure/fig2/?report=objectonly


Tuesday, August 04, 2020

Central Auditory Processing Disorder - CAPD Teaching Suggestions

Parents can use these at home too.

"Suggestions for Successful Management of Students with Central Auditory Processing Disorder (CAPD): Tips for the Teacher"

The student with a central auditory processing disorder (CAPD) will respond in a variety of ways to changes within their environment and instructional program. Management suggestions identified for a student with a CAPD should be based on the student’s individual profile of auditory processing strengths and weaknesses. Suggestions in this listing are in the areas of attention, preferential seating, instructions, preview and review, time, classroom adaptations, self-advocacy, and organizational strategies. The audiologist will select those strategies most appropriate for the student’s CAP profile."

Full PDF here 

http://www.iag-online.org/resources/New-Items-2e/CAPD-TipsForTeachers.pdf


CAPD - Central Auditory Processing Disorder   - Strategies

Attention

 Gain bi-sensory attention. Auditory processing is maximized when the same information is received simultaneously through different modalities. Therefore, it is important to gain the student’s visual as well as auditory attention before speaking with him or her.

 Speak at eye level. Whenever possible, speak at the student’s eye level, get close to the student, and face the student to provide clear visual and auditory information.

 Use cueing. It may be beneficial to work out a cueing system to help students become aware of times when they are not paying attention. These “pretuning” techniques help to focus the student’s attention on the subject coming up. Use words such as “listen,” “ready,” and “remember this one.”

 Assign peer partners. Assign a peer partner to the student with a CAPD. The peer partner can assist the student with a CAPD in activities such as paying attention, getting assignments listed, participating in small group projects, and tuning in for key information. Peer tutoring may also be a part of the buddy system if appropriate.

 Mark transitions between activities. Students with auditory processing difficulties often need more time to make transitions. Therefore, it is helpful and important to mark transitions between activities by clearly identifying the new activity by naming and explaining the sequence of steps needed to accomplish the task.

 Review and transition. Clearly closing an activity may be accomplished by briefly summarizing what the student should have learned and/or completed before transitioning to the next activity.

 Provide notetaking assistance. Because it is difficult to watch the teacher and take notes simultaneously, it may be helpful for the student to be able to get a copy of another student’s notes, to get a copy of the teacher’s notes, to have a study guide, and/or be able to record the lesson for future reference and study.

Flexible Preferential Seating

 Provide preferential seating distance. Seat the student near the primary sound source (e.g., teacher, television, computer, center activity area). A distance of three-four feet is the best, but a distance up to six-eight feet should be adequate. This allows the student to derive maximum benefit from both auditory and visual information cues.

 Avoid seating near noise sources. Seat the student away from competing or distracting noise sources (e.g., external noise sources, bathroom area, telecommunications equipment, aquarium). Seating away from windows and doorways also will reduce possible sources of distraction.

 Provide better ear option. Seat the student so that the better ear, if indicated, is directed toward the primary sound source. (The audiologist will provide this recommendation if appropriate.)

 Allow flexible preferential seating options. Allow flexibility in seating to continuously achieve the preferential seating advantage. This enables the student to attend and actively participate as the classroom activities and the teacher or other primary sound source change location.

 Provide quiet study/work area. Provide the student with a “private” or isolated area, such as a study carrel, for individual seatwork, testing, or tutoring. This helps to minimize the student’s problems in foreground/ background discrimination.

 Use daily routines. Use daily routines or schedules to help keep the student focused and organized.

 Use earplugs. If their use is recommended, allow the student to use earplugs or earmuffs during individual seatwork time to help tune out distractions.

  FM amplification. Use a personal or sound field FM system to improve access to auditory information, if this is indicated by the student’s CAP profile. Students with difficulty hearing in noise, integrating information, or organizing information may benefit from FM amplification. An audiologist should make the recommendation for an FM system. The teacher(s) will receive an in-service on the use of the FM system. 66 Instructions

 Speak in a clear, well-modulated voice. Speak distinctly, at a comfortably loud level, and at a rate the student can follow easily. Vary loudness to increase the student’s attention. Remember not to overexaggerate your speech. Emphasize important information using intonation and stress. Repeat important words when necessary.

 Use natural gestures. Use natural gestures that enhance the message. Avoid extraneous gestures and excessive movement while delivering the message if this appears to distract the student.

 Reduce distractions. Avoid extraneous noises and visual distractions, especially when giving instructions and teaching new concepts.

 Alert the student. Before giving instructions, stand close to the student, call the student’s name, and gently tap the student’s shoulder, or use another cue to make sure you have the student’s attention. Using the student’s name during teaching time also will help to maintain attention.

 Reduce motor activities during instruction time. Reducing motor activities during verbal presentations is helpful for some students with a CAPD, especially if the student has an integration deficit.

 Define purpose. State the purpose of each activity clearly and directly before introducing the specific instructions for task completion.

 Give age and ability-appropriate directions. Give direct and uncomplicated directions. Use age-appropriate vocabulary that clarifies the logical, time-ordered sequence (e.g., first, second, last).

 Repeat direction and allow ample response time. It may be necessary to repeat each step of the instruction and allow time between each step for the student to process the information.

 Provide examples. Work on an example together and leave the example on display.

 Use modeling. Use modeling to provide a clear demonstration of student performance expectations.

 Identify key words. Emphasize key words when speaking or writing, especially when presenting new information.

 Give written and verbal instructions. Provide both written and verbal instructions to aid the student in following directions and completing tasks.

 List the steps. To help the student learn multi-step sequences, list the steps on a reference card. As the student becomes more familiar with the sequence, steps in the written directions may be omitted gradually and systematically until the student is able to complete the sequence automatically without referring to the written cues.

 Encourage the student to ask for clarification. Encourage the student to ask questions for clarification of information. It may be necessary to rephrase the information to ensure that the student with a CAPD is able to comprehend. Also, some students with a CAPD have a language deficit and may not be familiar with key words. By substituting words and simplifying the grammar, the intended meaning may be conveyed and understood more easily.

 Repeat or paraphrase. Have the student repeat the content of the instructions to provide the comprehension feedback. This technique allows the teacher to see which parts of the instruction need to be corrected or repeated. Ask for verbal accounts rather than a “yes” or “no” response. Reinforce listening for meaning rather than exact repetition.

 Give positive feedback. It is important that students receive positive feedback to ensure understanding of the message or instruction correctly. Feedback is important even if the student understood only a portion of the message.

 Boost self-confidence. Many students with a CAPD lack of self-confidence due to comparisons made by themselves or others about their performance. Reinforcing all work performed successfully will help to alleviate this problem.

 Check instruction comprehension. Check the student’s work after the first few items to ensure that the student understood and retained the instructions. The teacher should watch for signs of inattention, decreased concentration, or understanding. Periodic comprehension checks (e.g., paraphrasing instructions, main idea, key points) are helpful to keep the student on task.

 Allow subvocalization. To help with reading comprehension, the student could be allowed to subvocalize while reading until such time as this is unnecessary.

 Allow reauditorization. Some students have a need to reauditorize information as they formulate their response. This strategy also strengthens the memory trace. 67 Preview and Review

 Review, preview, and summarize class lessons. For all class lessons, review previous material, preview material to be presented, and help students summarize the material presented. Discuss new and previously introduced vocabulary words and concepts. Whenever possible, relate new information to the student’s previous experiences and environment.

 Provide pre-teaching materials and assignments. Provide preassigned readings and home assignments to help introduce new concepts and topics.

 Avoid divided attention. Avoid asking students with a CAPD to divide their attention between listening and taking notes at the same time. Allow students to tape record lessons or provide students with a detailed outline of the information presented in the class lesson.

 Review and orient. Provide a short review statement about the topic(s) to be discussed to orient the student. Write a brief outline and list key vocabulary on the board or an overhead projector. Provide the student with a copy of the outline and key vocabulary to use in following the discussion and for review.

 Frequently summarize key points. Repeat and summarize key points frequently. Emphasize key vocabulary words during the discussion.

 Give salient clues. Give salient clues to identify and emphasize important information (e.g., “This is important,” “The main points are…,” “This could be a test question.”).

 Use verbal review strategies. Use verbal review strategies to ask questions periodically about the material being presented. This is a helpful topic maintenance strategy. Verbal review questions should include language required for description, explanation, exemplification, comparison, and relating real events to abstract principles.

 Give individual attention. Students with a CAPD often need individual attention. Inform resource personnel and parents of planned vocabulary and curriculum topics to be covered in the classroom to allow opportunity for pre-teaching as a supplement to classroom activities.

 Reference important pages. Refer students to important textbook pages for less review and preview.

 Encourage class participation. Encourage participation in expressive language activities related to each lesson. Reading is especially important since information and knowledge gained through reading help compensate for what may be missed because of auditory difficulties. Time

 Avoid fatigue. Students with a CAPD often become fatigued more easily than their peers. It is often difficult for the student to attend because of the effort required to keep up and compete in classroom activities. To minimize fatigue, consider the following suggestions. - Give several short classroom activities instead of one long activity. - Provide short periods of instruction with breaks so the student can move around if needed. - Alternate activities requiring greater auditory processing requirements with those that are less demanding. - Avoid higher-level auditory tasks when the student is already fatigued. (Consider presenting high-auditory content information during the morning.)

 Allow extended time. Students with a CAPD should be given adequate time to comprehend and complete tasks. Avoid giving penalties for not completing assignments in the prescribed classroom time. Whenever possible, give students fewer items to complete in the amount of classroom time available or give them additional time in the resource room to complete the assignment.

 Give adequate response time. It may be necessary to allow students with a CAPD more time to formulate responses to verbal questions, especially questions that include comparisons, generalizations, and explanations requiring lengthier and more complex language organization. Classroom Adaptations

 Record instructions. Class lessons or instructions can be recorded so that the student can listen to and review the material later.

  Sound tune the classroom. Acoustical modifications may be implemented to create a positive acoustical listening and learning environment (e.g., carpeting, drapes, sound absorbing materials).

 Arrange classroom. Structure the classroom to reduce background noise, reverberation, and distractions. Noise interferes with the reception of auditory information and distracts the listener from the complex task of processing (e.g., organizing and interpreting) information. Special areas for small group instruction that are relatively quiet and distraction-free are helpful for many students.  

 Avoid open classrooms. Avoid open classroom settings for students with a CAPD. In these settings, reduce distractions by using sound barriers (e.g., bookshelves, flannel boards) and other modifications to improve the listening environment.

 Close windows and doors. Keep doors and windows closed to reduce external noise entering the classroom.

Self Advocacy

 Encourage self-monitoring. Encourage the student to self-monitor the listening environment and identify any problems that may be interfering with the learning process.

 Encourage self-advocacy. Encourage the student to self-regulate by using strategies to modify conditions and situations that may compromise effective learning. This will assist the student in learning self-regulation strategies and becoming an effective manager of his listening and learning environment.

 Suggest counseling. If necessary, the student should be referred for counseling for social/emotional concerns as part of the management plan. The student (and parents) needs to understand the nature of the CAPD and why it is essential to develop compensatory strategies.

Organizational Strategies

 Encourage the use of agenda book or other organizers. Encourage the student to consistently use an agenda book (or other organizer or calendar) to ensure that assignments, upcoming events, and other important class information are recorded.

 Clearly present organizational expectations. Ensure that the student understands specific organizational expectations for the classroom (e.g., where to place homework, use of folders, required classroom tools). Use cue cards as reminders.

 


Monday, May 11, 2020

Vitamin D and Covid-19

Covid-19 Prevention with Vitamin D

Vitamin D levels appear to play role in COVID-19 mortality rates

Patients with severe deficiency are twice as likely to experience major complications

Date:
May 7, 2020
Source:
Northwestern University
Summary:
Researchers analyzed patient data from 10 countries. The team found a correlation between low vitamin D levels and hyperactive immune systems. Vitamin D strengths innate immunity and prevents overactive immune responses. The finding could explain several mysteries, including why children are unlikely to die from COVID-19.

Thursday, April 23, 2020

Tuesday, April 21, 2020

Autism, CBD-Low THC Presentation

Thank you to Compassionate Cultivation for coordinating the early AM Zoom meeting.  FYI ...Im tired. JR


Autism and CBD 
 Overview
  • I am discussing a complementary treatment
  • The Low THC CBD program (TCUP) is NOT recreational cannabis.
  • I am treating a diverse population of neurologically complex individuals. 
  • People with autism have significant problems that impact their lives AND the lives of others
  • Cannabinoids have a biologic basis for efficacy
  • Clinical data for indication, risks is emerging but exists.
  • Link to a selection of PEER-REVIEWED articles (pro and con)


What is a Complementary Treatment?  Added therapy BEYOND Standard treatment.

AUTISM and the ENDO Cannabinoid System - see below
 Caveats -  Complementary therapies will:

(1)  provide a reasonable potential for therapeutic gain and (2) do not unreasonably place the patient's medical condition at risk. 

(2)  ... there is a professional obligation on physicians to:
 (a) investigate, understand and assess whether the underlying therapeutic basis is designed to improve a patient's overall quality of life (even anecdotally and for limited a duration) and to 
 (b) ensure that the therapy is not medically contraindicated



BACKGROUND

Incidence of Autism in Children  

In March 2014, the Center for Disease Control released a new estimate for children with an autism spectrum disorder. According to the CDC, one in 68 children have ASD, which is a 30 percent increase over the previous estimate of one in 88.  

Assuming there are approximately 7 million children in Texas (2016): 
  • 102,941 have autism 
  • 14,700 have mild cognitive impairment 
  • 9,100 have moderate and severe cognitive impairment 
  • In comparison, about 70,000 children have epilepsy in Texas and about 14,000 have refractory epilepsy. 
  • Theoretically, about 77,000 Texas children have autism and insomnia.  

Incidence of Insomnia in Children with autism, cognitive impairment 
  • Insomnia in children with ASD occurs across all cognitive levels, and the prevalence may be as high as 60–86%, which is two to three times greater than typically developing (TD) children [3, 7, 22–27]. 
  • 20% agitation. 

Outcomes for insomnia in Children  
  • Accidents 
  • Elopement 
  • Medicine side effects 
  • Poor daytime functioning / adverse developmental outcome 

What medicines are FDA-approved for insomnia in childrenNone. 
  • Medications such as benzodiazepines (e.g.valium) and diphenhydramine (e.g Benadryl) were shown to have paradoxical, excitatory or even SEIZURE-provoking response. 

What medicines are used? What are the side effects? 
  • Melatonin followed by α-agonists (e.g clonidine) 
  • Anti-Depressants (e.g.trazodone)
  • Anti-Psychotics
  • Anti-Convulsants
  • "In general pediatric insomnia, antihistamines are prescribed most commonly (n = 8367 [88.6%]), followed by antipsychotic agents (n = 465 [4.9%]), α-adrenergic receptor agonists (n = 399 [4.2%]), and selective serotonin reuptake inhibitors (n = 159 [0.1%]).” 
What about Commercial CBD Products?
  • Safety
  • Reliability
  • Watch for pesticides, lead – other health problems

Texas MCD – estimate of expenditures 
Costs:  ASD costs a family $60,000/year on average 
What number of physician visits for insomnia?  
  • The prevalence of sleep problems among typically developing children is as high as 25%. 
  • In one study of outpatient general pediatric visits “potentially sleep-related medications were prescribed for 6.1% of children (n = 9441)”.  



  • The Endocannabanoid System in Autism Click For the article