What is causing the global surge in ADHD diagnoses?

What is causing the global surge in ADHD diagnoses? This article believes it has to do more with marketing than medicine.

You can't catch attention deficit hyperactivity disorder (ADHD). Yet the diagnosis and treatment of this behavioral condition is spreading like a contagion -- surging as much as tenfold in some countries.

Call it an economic and cultural plague, but not necessarily a medical one, says Brandeis professor Peter Conrad. In a recent paper in the journal Social Science and Medicine, Conrad and coauthor Meredith Bergey examined the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil.

Until recently, North America tallied by far the most ADHD diagnoses, and the United States consumed 90 percent of all Ritalin, one of the most common ADHD drugs. ADHD diagnoses continue to grow in the U.S., but Americans account for only 75 percent of Ritalin users today.

Conrad and Bergey attribute ADHD's growth to five trends. Drug companies are effective lobbyists, and have spurred some countries to relax marketing restrictions on stimulants. Psychoanalytic treatment with talk therapy is giving way to biological psychiatry -- treating psychological problems with drugs. More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD. Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment. Lastly, the easy availability of ADHD information and self-diagnosis via the Internet empowers consumers to ask for prescription treatment.

Many websites promoting ADHD drugs offer checklists with questions like these:

• Do you fidget a lot?
• Is it hard for you to concentrate?
• Are you disorganized at work and home?
• Do you start projects and then abandon them?

"These checklists turn all kinds of different behaviors into medical problems," Conrad says. "The checklists don't distinguish what is part of the human condition and what is a disease."

According to the study, in the U.K., diagnosis of the disorder in school-age children grew from less than one percent in the 1990s to about five percent today. In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.

Growth in Italy and France has been slower, in part due to those countries' more restrictive pharmaceutical drug laws. However, even those nations are becoming more lax, says Conrad. In Brazil, a rising number of ADHD advocacy groups, many with close ties to the pharmaceutical industry, are raising awareness of the disorder.

"There is no pharmacological magic bullet," says Conrad. No drug can account for nonmedical factors that may contribute to behavior. A fidgety student may be responding to the one-size-fits-all compulsory education system, Conrad says, not a flaw in his brain chemistry.

ADHD continues a long history of medicalizing behaviors, especially in the U.S., Conrad says. A century ago, masturbation was considered a disease. Men and women diagnosed with masturbatory insanity were institutionalized or subjected to surgical treatment.

"I think we may look back on this time in 50 years and ask, what did we do to these kids?" Conrad says.

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Medication to help children with life threatening seizures

Research has shown that an investigational medication can help treat children with potentially life threatening seizures.

In its first clinical application in pediatric patients, an investigational medication developed and manufactured at UC Davis has been found to effectively treat children with life-threatening and difficult-to-control epileptic seizures without side effects, according to a research report by scientists at UC Davis and Northwestern University.

The investigational formulation of allopregnanolone was manufactured by UC Davis Health System's Good Manufacturing Practice Laboratory. Two children were treated with the allopregnanolone formulation, one at UC Davis Children's Hospital, the other at the Ann & Robert Lurie Children's Hospital in Chicago. Both children were weaned from general anesthetics and other seizure treatments and their seizures resolved. In both instances the children are recovering.

The research is published online in Annals of Neurology, an official journal of the American Neurological Association and the Child Neurology Society.

Super-refractory status epilepticus is a condition diagnosed in patients with refractory status epilepticus being treated with infusions of general anesthetics when seizures continue for longer than 24 hours, despite anesthesia, or when seizures recur on reduction or withdrawal of the anesthesia. Super-refractory status epilepticus has high morbidity and mortality. There are no Food and Drug Administration (FDA)-approved treatments for the condition.

Allopregnanolone is a positive allosteric modulator of GABAA receptors in the brain. Research in animals has shown that allopregnanolone protects against seizures and can stop status epilepticus. Although the allopregnanolone used to manufacture the investigational treatment was produced by chemical synthesis according to procedures regulated by the FDA, it is synthesized normally in small quantities in the body from progesterone.

"Our laboratory studies have shown that allopregnanolone is effective in stopping status epilepticus that is refractory to treatment," said Michael Rogawski, professor in the UC Davis Department of Neurology and a co-author of the report.

In both of the clinical cases, the patients continued to have seizures despite weeks of intensive treatment with medications, including infusion of anesthetics. Emergency treatment with the investigational medication was approved by the FDA; the two patients received the medication over a five-day period, during which time both were weaned from anesthetics and other seizure medications. Status epilepticus did not recur after treatment. There were no adverse drug effects, the researchers said.

Mortality rates in super-refractory status epilepticus can be as high as 50 percent, and those who survive experience high rates of subsequent neurological impairment. The authors note that progesterone and ganaxolone, a chemical analog of allopregnanolone, have been studied in clinical trials for epilepsy and have shown benefit. Researchers at UC Davis, led by Rogawski, currently are investigating the use of allopregnanolone as a treatment for traumatic brain injury.

"Neurosteroids, including allopregnanolone, are a promising treatment for epilepsy and refractory status epilepticus that may overcome resistance to benzodiazepines and barbiturates and facilitate the withdrawal of these agents by preventing rebound seizures, a key problem in treatment of super-refractory status epilepticus," Rogawski said.

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Pharmacists help reduce errors in anti-epileptic drug prescriptions

Pharmacists can help reduce errors in anti-epileptic drug prescriptions.

Clinical pharmacists can reduce anti-epileptic drug (AED) prescription errors that commonly result from incomplete or poor documentation, according to a literature review published in Seizure, The European Journal of Epilepsy. 

Researchers from the Alder Hey Children’s NHS Foundation Trust in the United Kingdom conducted a 12-month retrospective review of all pediatric outpatient prescriptions of anti-epileptic drugs (AEDs) at a large children’s hospital. In the study, the authors acknowledged that pediatric AEDs are particularly difficult to prescribe, given the wide variety of available choices and potential interactions among AEDs and other medications. 

The investigators monitored all new prescriptions for AEDs issued from the hospital’s general pediatric and pediatric neurology departments in 2012. Data was collected regarding patient demographics, diagnosis/indication for the AED, clarity of dosage instructions, prescriber details, and whether a pharmacist intervention was required prior to dispensing the medication. 

Over the course of the year, a total of 262 new AED prescriptions were written, with 19 patients receiving more than 1 AED prescription. Of those prescriptions, an astounding 72.1% were deemed incomplete with at least 1 piece of missing information, the study authors noted. 

Furthermore, 164 (62.6%) of the prescriptions did not document any diagnosis or reason for prescribing the AED. Of the remaining 98 prescriptions, 50 documented only the word “epilepsy,” while 48 described a non-epileptic diagnosis, such as “migraine,” “behavioral problems,” and “chronic pain.” 

AED prescribers recorded their designation and immediate contact details in just 41.6% of all AED prescriptions. Of those detailed prescriptions, 65.1% were written by a senior doctor, 17.4% were prescribed by a specialist trainee or junior doctor, and another 17.4% were illegible or not recorded. 

Among all epilepsy diagnoses, the most commonly prescribed AED was sodium valproate, followed by a tie between carbamezapine and levetiracetam. For prescriptions with a designated non-epileptic diagnosis, the most commonly prescribed medication was gabapentin. 

Pharmacists contacted physicians concerning 44 prescriptions (16.8%), 15 (34%) of which were due to errors in dosage or frequency of administration. Such dosing errors were identified by pharmacists for carbamazepine, gabapentin, lamotrigine, and topiramate, among other AEDs. According to the researchers, all AED prescriptions with dosing errors were amended prior to being dispensed. 

“Although there were high numbers of incomplete or inadequate prescriptions in the current study, no patients had their medication incorrectly dispensed, (which) reflects the pharmacists’ review of each prescription prior to the drug being dispensed,” the study authors concluded. “Clearly, it is the clinician’s responsibility to prescribe the most appropriate AED, but it might be reasonable to have the choice of drug confirmed by a clinical pharmacist.”

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Complementary medicine is commonly used to treat children with autism

Treatment for autistic children is often seen using alternative medicine in complement to medicine treatments.

In a study of the range of treatments being employed for young children with autism and other developmental delays, UC Davis MIND Institute researchers have found that families often use complementary and alternative medicine (CAM) treatments and that the most frequent users of both conventional and complementary approaches are those with higher levels of parental education and income.

There is no Food and Drug Administration-approved medical treatment for the core symptoms of autism spectrum disorder, a lifelong neurodevelopmental condition whose hallmarks are deficits in social relatedness, repetitive thoughts and behaviors and, often, intellectual disability.

In the search for treatments to help their children, families may turn to unconventional approaches such as mind-body medicine (e.g. meditation or prayer), homeopathic remedies, probiotics, alternative diets or more invasive therapies such as vitamin B-12 injections, intravenous immunoglobulin or chelation therapy -- some of which carry significant risks.

The research is published online today in the Journal of Behavioral and Developmental Pediatrics. It was led by Robin Hansen, director of the Center for Excellence in Developmental Disabilities at the MIND Institute and chief of the Division of Developmental Behavioral Pediatrics in the UC Davis School of Medicine.

"In our Northern California study population, it does not appear that families use complementary and alternative treatments due to the lack of availability of conventional services, as has been suggested by other research," Hansen said. "Rather, they use the treatments in addition to conventional approaches."

The cause or causes of most neurodevelopmental disorders are not known, and the conditions have no cure. Many children suffer from a wide array of associated symptoms that may not be directly associated with their condition and that make their daily lives and those of their families stressful. Such symptoms include irritability, hyperactivity, gastrointestinal problems and sleep disorders.

The study included nearly 600 diverse children between 2 and 5 years with autism and developmental delay who were enrolled in the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. Of the participants, 453 were diagnosed with autism and 125 were diagnosed with developmental delay.

CAM use was more common among children with autism than children diagnosed with other types of developmental delay, 40 percent versus 30 percent respectively. Nearly 7 percent of children with autism were on the gluten-free/casein-free diet, particularly children with frequent gastrointestinal problems.

"We were pleased to find that most families utilizing CAM therapies were choosing ones that were low risk," said Kathleen Angkustsiri, assistant professor of developmental and behavioral pediatrics and a study co-author.

However, a small but statistically significant number -- about 4 percent -- were found to use alternative treatments classified by the study as potentially unsafe, invasive or unproven, such as antifungal medications, chelation therapy and vitamin B-12 injections.

"Our study suggests that pediatricians and other providers need to ask about CAM use in the context of providing care for children with autism and other developmental disorders, and take a more active role in helping families make decisions about treatment options based on available information related to potential benefits and risks," said Roger Scott Akins, lead author and a former postdoctoral fellow at the MIND Institute, who now is chairman of the Division of Neurodevelopmental Pediatrics at Naval Medical Center Portsmouth, Va.

Irva Hertz-Picciotto, professor of public health sciences and principal investigator for the CHARGE study, said the research supports the emergent need for identifying validated treatments for neurodevelopmental conditions.

"These findings emphasize the enormous and urgent need for effective treatments and for rigorous research that can identify them and verify their effectiveness and safety," Hertz-Picciotto said. "Of course it is reasonable for parents to keep searching for ways to help their children, when there are few effective treatments and none that can help every child."

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Epilepsy drug may help adults learn pitch

Results from a study shows that an epilepsy drug can help adults learn the rare skill of having perfect pitch.

Perfect pitch, also called absolute pitch, is the ability to accurately name any pitch you hear. People with perfect pitch can sing any note of the chromatic scale without hearing reference pitches first.

Until recently, perfect pitch was thought to be an innate ability that very few children possessed. The American Psychological Association estimates that only one in 10,000 Americans have the gift.

But according to a research report published last week, scientists have discovered that Valproate, a drug used to treat epilepsy, can help adults develop perfect pitch.

Research had shown that the drug enabled adult mice to learn habits that were previously only possible for mice to learn during youth.

Harvard researcher Takao Hensch and an international team of scientists, then, decided to give Valproate to a group of adult men who had no prior musical training. They asked the group to complete an online ear-training course that lasted for two weeks.

At the end of the trial, those who took Valproate were significantly better at identifying pitches than those taking a placebo.

Hensch, who is a professor of molecular and cellular biology at Harvard, recently discussed the research team's findings with Linda Wertheimer of NPR. "It's a mood-stabilizing drug, but we found that it also restores the plasticity of the brain to a juvenile state," Hensch said.

In other words, the drug seems to restore the ability to learn certain tasks that were once thought impossible to learn outside of childhood.

Of course, the implications of such a drug are enormous. It could help adults learn a new language and speak that language without an accent, abilities which are thought to peak in early childhood.

For a long time, perfect pitch was thought to be a result of nature, not nurture.

In the NPR interview, Hensch acknowledges that there is a genetic component. But he and many other researchers believe that perfect pitch can be acquired, through early musical training before age seven.

Other researchers disagree, saying that the ability to develop perfect pitch is genetic and can't be taught.

However, there is one point on which researchers tend to agree: It is impossible for adults to develop perfect pitch.

Many musicians regard perfect pitch as the holy grail, the ultimate musical gift. Mozart had perfect pitch, and many experts think Beethoven had it also.

The ability to instantly identify whether any pitch is sharp or flat can help string players play in tune. The ability to sing any pitch can help singers navigate densely chromatic music.

And perfect pitch can help any musician sight-read a difficult score. A drug that could aid adults in developing this ability would probably prove extremely popular among musicians.

But Hensch warns that scientists are only beginning to understand how Valproate affects the brain's ability to learn new things. And the drug is known to have side effects.

So, it may be a long time before Valproate is available to consumers for this purpose. And those who take such a medication may find that perfect pitch has its downside.

Those who have it might not enjoy listening to an orchestra that tunes to a concert "A" that is a little sharp or flat, as some orchestras do. And hearing the out-of-tune pitches of electric appliances, train whistles and other background noises in our environment could become annoying for a whole new reason.

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Study: Complementary & Alternative Medicine Use In Youth With Recurrent Headaches

A new study published in Pediatrics claims that children with chronic recurring headaches, especially those with another chronic condition, are more likely to use complementary and alternative medicine.

OBJECTIVE: To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care.

METHODS: Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used.

RESULTS: Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care.

CONCLUSIONS: CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

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Link between sleep apnea and mental illness

This article discusses the interesting link that exists between sleep apnea and mental illnesses such as depression and bipolar disorder.

With bipolar disorder cropping up from celebrities to politicians, you may be wondering what truly affects these individuals. Yes, a mental illness is typically a misfire of chemical and electrical  waves within the brain. Nevertheless, is there another, underlying cause? One cause can point to a varying disorder called sleep anpea, a condition that can create a mental abnormality. Does the lack of oxygen to the brain due to lack of sleep cause a mental illness?

If you snore, the two greater factors of blame are pointed to either, obstructive sleep apnea or obesity. The lack of oxygen to the brain can cause one to be tired during the day, inciting drastic mood swings. In most cases, individuals suffer from depression and inconsistent sleep schedules, resulting in lying awake at night. Sleep is imperative to the overall general health of an individual. Finding the serenity of slumber should be natural, without one becoming dependent on sleep aids.

If you are prescribed a muscle relaxant, your lack of sleep can actually become worse; especially, sufferers of obstructive sleep apnea. It’s not advised to have certain muscle relaxants including medications, such as: Valium, Ativan and Klonopin. These prescriptions can cause the surrounding airway muscles to collapse- causing sleep depravity, resulting in mood changes and chemical imbalances.

Medication for many, is imperative to live a functionally, normal life, but many contemplate what can be done to lesson the side-effects they feel? The first suggestion is moderate exercise and changing your diet. For some, it is not that simple and many should look into acquiring a prescribed CPAP. This machine produces the air that individuals need when the body is having complications during sleeping. This machine has been used on individuals who have undergone a sleep study and suffer from conditions that require its use. Speak to your doctor who will determine the machine type, they will also determine the air pressure that you need to stay consistently asleep. Once sleep is obtained normally, the mental balance can once again become stabilized.

Sleep deprivation is a condition millions of Americans suffer from. Psych Central advises individuals can suffer from memory loss, a disorientation of rationalization, resulting in severe mood swings. When your body is tired, it becomes dehydrated and this combination can be a deadly mix to your mental stability. Some individuals with a deeper severity of sleep loss had reported hallucinations and slurred speech. Dr. Yasinski of Yasinski Psychiatry states,

“Without adequate oxygen to your brain, the ability of psychiatric medications, exercise and healthy living to improve depression or bipolar disorder is decreased and thus many patients present as ‘treatment resistant’ when in reality they are resistant only due to a co-morbid sleep apnea disorder that has gone unrecognized.”

A sleep study is highly recommended for individuals who suffer from sleep disruption and mental disorders like bipolar. This painless test can gauge the level of severity from children to adults. If sleep apnea is the cause of the mental illness, treatment can be recommended and prescribed by a doctor, leading to stability of sleep, mind and life.

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Risks of taking epilepsy drugs while pregnant

Keep in mind ...What does the WHO recommend

Recommendation(s)

• Women with epilepsy should have seizures controlled as well as possible with the minimum dose of antiepileptic drug taken in monotherapy, wherever possible. Antiepileptic drug polytherapy should be avoided. Valproic acid should be avoided if possible.  Strength of recommendation: STRONG
• Folic acid should routinely be taken by women with epilepsy of child bearing age who are on antiepileptic drugs.  Strength of recommendation: STRONG
• Standard breast feeding recommendations remain appropriate for women with epilepsy on the antiepileptic drugs included in this review (phenobarbital, phenytoin, carbamazepine and valproic acid). Strength of recommendation: STRONG
• JR

Risks of taking epilepsy drugs while pregnant

This article discusses the various risks associated with pregnant women taking drugs for epilepsy, such as having a child with developmental delays or showing signs of autism.

Women with epilepsy who take anti-seizure medication while they are pregnant are more likely to later report delays in their child's development and autism symptoms, according to a new study from Norway.

The findings probably won't change the conversation too much between women and their doctors in terms of managing epilepsy during pregnancy, because it's already understood that the medications carry some risks, said Dr. Lewis Holmes, director of the Antiepilepsy Drug Registry at Massachusetts General Hospital, who was not involved in the research.

However, studies like this are badly needed, he added, because women are often asking about risks to their children's development, and "it hasn't really been mapped out."

The researchers could not prove that the anti-epileptic drugs are to blame, but the findings add to other evidence linking the medications to effects on children's development.

Seizure medication taken during pregnancy is already tied to a higher risk of physical malformations in the baby, and the drugs are linked with a greater chance of complications during pregnancy and childbirth.

One study from Denmark earlier this year also found that women who took the epilepsy drug valproate during pregnancy were three times more likely to have a child with an autism spectrum disorder.

"The risk of other effects on fetal development, that is, development and behavior, is less clear," said Dr. Gyri Veiby, lead author of the new study and a researcher at the University of Bergen in Norway.

She said that among all pregnancies, about three to five women out of every 1,000 use anti-epileptic drugs during pregnancy.

"It is reasonable to assume that most (anti-epileptic drugs) have the potential to harm the developing fetus. On the other hand, seizures should also be avoided during pregnancy," Veiby wrote in an email.

"In order to assess whether antiepileptic drug treatment during pregnancy is justified, we need to know as much as possible about the potential risks for the fetus," she said.

Veiby and her colleagues examined data from a large survey of mothers across Norway.

More than 108,000 women filled out a questionnaire asking about the behavior and development of their children at 18 and 36 months of age.

The survey included questions about social, physical and verbal skills, mannerisms, aggression and other traits.

Among the women in the study, 634 had epilepsy and 333 of them took epilepsy medication while they were pregnant - that translated to about 46 percent of the children of epileptic mothers having been exposed to one or more of the medications.

Children whose mothers took epilepsy drugs while pregnant were more likely to score outside the normal range on several developmental measurements, the researchers report in the journal Epilepsia.

For instance, 3.3 percent of three-year-olds whose mothers did not have epilepsy did not meet milestones for physical skills, whereas 7.5 percent of kids exposed to epilepsy drugs in utero failed to meet these milestones.

In addition, 4.8 percent of three-year-olds whose mothers did not have epilepsy scored abnormally on their ability to form sentences, while 11.2 percent of the children whose mothers took anti-seizure medication were delayed in their sentence skills.

The kids whose mothers took epilepsy medication while pregnant were also more likely to have autistic traits - 6 percent - compared to just 1.8 percent of the kids who mothers did not have epilepsy.

A mother's epilepsy itself did not appear to contribute to the heightened risk. Mothers with the condition who did not take any medication were no more likely to have a child with delays than mothers without epilepsy.

Dr. Cynthia Harden, a neurology professor at Hofstra-North Shore LIJ School of Medicine in Hempstead, New York, said it's possible the findings could be explained in part by something called "selection bias."

Mothers who take epilepsy medication while pregnant, for example, might be more concerned and therefore looking out for developmental delays, so they could be more likely to report them.

But Harden also said it's possible the drugs themselves have a negative effect on babies' development.

"There might be something real going on here, but it's possible that the magnitude of the effect is exaggerated by selection bias," said Harden, who is also the director of the Comprehensive Epilepsy Care Center at North Shore-LIJ Medical Group in Great Neck, NY.

Holmes said the findings support parents taking action on cues that their child might have a delay.

"Because there are concerns about subtle effects, I think it's smart to go ahead and think about obtaining some formal testing...as a way of making sure that everything is OK before first grade," Holmes said.

Harden agreed that the study doesn't change the discussion about epilepsy management during pregnancy too much.

Already, patients and physicians are aware of the potential hazards of the drugs, yet "seizures are dangerous, and we cannot permit our patients to have seizures during pregnancy," she said.

Physicians try to reduce the dose of the medication, trim back the treatment to one type of drug if possible, and avoid the use of valproate.

Veiby added that another way to minimize the risks during pregnancy is to plan ahead to figure out the safest treatment strategy, and to avoid unplanned pregnancies.

"Unfortunately, many women on (anti-epileptic drugs) do not receive the appropriate pre-pregnancy counseling," she said.

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How to tell if your child should be checked for ADD or ADHD

This article gives much information on ADD/ADHD including medicines and other treatment options.

Does the child have ADD/ADHD?
 

Attention Deficit Disorder (ADD) is a medical condition with problems in attention, focus, distraction, organization and impulse control. Attention Deficit Hyperactivity Disorder (ADHD) also has more motor hyperactivity than expected for children of similar age/maturity levels.
 

Valid, reliable screening forms for ADD, such as the Connors Scale or the free Internet-available Vanderbilt Scale, are much more accurate when filled out by multiple teachers observing children in groups, in addition to rating parental and therapist/nurse/doctor observations. These multiple observer’s rating scales do as well as specific “on/off task” computer tests especially now that kids are so familiar with video games.
 

Although we know that certain brain areas mediated by neurotransmitters dopamine and norepinephrine may be the source of impulse and focus problems, we have not been able to translate research into a clear ADD/ADHD test. No brain image, blood or neurological test is currently available. So parents and teachers use observations and rating forms to screen for possible ADD/ADHD.
 

What to try before medicines?
 

How helpful an active parent/school evaluation can be! It is important to find out the child’s academic ability as measured by cognitive and achievement tests. Are there specific areas of underachievement (eg., just the math) or is there general lack of success? It is necessary to diagnose defiant, manipulative, negative-attention-seeking behavior. Does the child do more homework than texting, video games and phone time?
 

Parental supports and consequences for school grades should be clarified. Is the student anxious, frustrated, sick, unable to see well, depressed, hungry, sleepy, worried about home life or using illegal substances? Once a parent/school evaluation has been done, parents and school can try accommodations to help needy students receive tutoring, prompts, sessions with school counselors and better communication with parents. Is there homework, and has the homework been done and brought to school?
 

School accommodations such as a 504 Plan and Individual Education Plan have helped many impatient, disorganized, distracted students, but these plans depend on 100 percent student and parent participation with the school.
 

Medicines for ADD/ADHD
 

Try school evaluations, academic extra help, therapy, and good pediatric evaluation first. Because there are potential benefits and possible major adverse side effects, all custodial “parents” need to be part of the medicine discussion. Today, this may include married, divorced, or never-married parents or custodial relatives.
 

Types of medicines
 

Stimulants are controlled substances. They are written on a special nonrefillable script for medicines with abuse and addiction potential. Each script is follow by the U.S. Department of Justice Drug Enforcement Administration. Urine drug screens and Kasper reports (indicate prescriptions from multiple doctors) follow controlled substance stimulant scripts. Stimulants are increasingly used inappropriately without prescriptions by older students who hope for “cognitive enhancement,” or a quick fix at the last minute as they cram for exams or finish papers.
 

Types of stimulants
 

Methylphenidates are Ritalin, Methylin, Focalin, Metadate, Concerta and Daytrana.
Mixed amphetamines are Dexadrine, Adderall and Vyvanse.
 

Possible adverse side effects
 

1. Cardiac risk, especially for unrecognized pre-existing heart problems.
2. Increased pulse and blood pressure.
3. Appetite suppression and rebound binge eating.
4. G.I. upset.
5. Decreased growth.
6. Transient tics or twitches
7. Insomnia
8. Rare brief psychotic reactions or obsessive over-focus.
 

Nonstimulant Strattera: It can be used with seizure disorder. Takes one to two months for maximum benefit.
Possible adverse side effects: Similar to stimulants except no tics.
 

Nonstimulants Intuniv (Tenex, Guanfacine) and Kapvay (Clonidine)
Possible adverse side effects:
 

1. Sedation
2. May lower pulse and blood pressure
3. Do not discontinue quickly!
 

Thanks for your attention, and I hope you were not reading this with one hand on your phone and the other on the steering wheel! Our whole society is distracted, hurried, overstimulated and overstressed.
 

First, try to set priorities in your own life. Limit the video games. Turn off the TV. Increase your child’s exercise and active learning time. Second, work with your school, child and therapist. See your child psychiatrist when you are already trying the nonmedical approaches and we will work with you to coordinate nonmedical and possible medical intervention.

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Children of pregnant women who use anti-epileptic drug may have increased risk of autism

Pregnant mothers who use valproate, an anti-epilepsy drug, may have children with an increased risk of autism. Dont jump to assume causation.  With the finding that autism is noted in families with other neuro-psychiatric illness, there may be some confounding variables in this observation. - JR

Maternal use of valproate (a drug used for the treatment of epilepsy and other neuropsychological disorders) during pregnancy was associated with a significantly increased risk of autism in offspring, according to a study in the April 24 issue of JAMA. The authors caution that these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.

"Anti-epileptic drug exposure during pregnancy has been associated with an increased risk for congenital malformations and delayed cognitive development in the offspring, but little is known about the risk of other serious neuropsychiatric disorders," according to background information in the article.

Jakob Christensen, Ph.D., of Aarhus University Hospital, Aarhus, Denmark, and colleagues evaluated the association between maternal use of valproate during pregnancy and the risk of autism spectrum disorder and childhood autism in offspring. The population-based study included all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). Data were analyzed and adjusted for potential confounders (factors that can influence outcomes) such as maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity. Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first.

The analysis included 655,615 children born from 1996 through 2006. The average age of the children at end of follow-up was 8.8 years. During the study period, 5,437 children were diagnosed with autism spectrum disorder, including 2,067 with childhood autism. The researchers identified 2,644 children exposed to antiepileptic drugs during pregnancy, including 508 exposed to valproate. The authors found that use of valproate during pregnancy was associated with an absolute risk of 4.42 percent for autism spectrum disorder and an absolute risk of 2.50 percent for childhood autism.

"In this population-based cohort study, children of women who used valproate during pregnancy had a higher risk of autism spectrum disorder and childhood autism compared with children of women who did not use valproate. Their risks were also higher than those for children of women who were previous users of valproate but who stopped before their pregnancy," the researchers write.

"Because autism spectrum disorders are serious conditions with lifelong implications for affected children and their families, even a moderate increase in risk may have major health importance. Still, the absolute risk of autism spectrum disorder was less than 5 percent, which is important to take into account when counseling women about the use of valproate in pregnancy."

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