Are ADHD Stimulants Working?

A common ADHD treatment is stimulant medication. Methylphenidate is popular, with trade names of Ritalin, Concerta, Daytrana, and Metadate. An amphetamine salt (trade name Adderall) is also used quite a bit.

Dosages are typically prescribed based on a child’s size. It is not uncommon for these dosages to be too high. Parents may notice a trade-off in symptoms, for example, when their child’s attention is improved but he is more physically agitated. This is one clue that the dosage may not be appropriate. Or, an “over-medicated” child might be sluggish, less creative, and (while medications are active in his system) lose his spunky personality. In other words, too much medication can smother the best parts of ADHD.

Stimulant medications take effect quickly. Within about 30 minutes, medication impacts thinking and behavior. Measuring the impact of stimulant medication has historically been difficult. Parents are left to their own observations, the hard-to-read self reports of their child, and input from teachers. With detailed behavior observations (such as how long a medication takes to act on the child, and what happens as the medication wears off), some gains can be made.

But, there is a better way to determine if a stimulant medication is effective. It’s called the Test of Variables of Attention (TOVA). It’s simple, short (about 20 minutes), and accurate. This test can be repeated time and again. A recommended use of TOVA is to compare a child’s “baseline” (performance without medication) against a medication trial. For example, baseline results can be compared for how a child does with 5mg methylphenidate. Since results are ready as soon as the test is finished, physicians and parents have real-time information to consider dosage or prescription adjustments.

A common finding from the TOVA test is that dosages are too high–meaning that unnecessary side effects can be reduced with the lessening of medication, while positive effects can remain. Test results can be very helpful for prescribing doctors. They also give parents clear directions on next steps in treatment and help with peace of mind.

The TOVA is also used as a standard part of ADHD assessments. From 2003 to 2007, there was a 22% increase in kids with parent-reported ADHD, according to the CDC. Research continues to find higher rates of ADHD. There is no single cause of ADHD, but some factors are known to contribute to it.

 

 

4% of Teens on Antidepressants

The Centers for Disease Control reported recently that about 1 in 25 teenagers take antidepressant medications, writes the Huffington Post. Depressive episodes in adolescents can look different from adult depression. For one, teens tend to show more irritability than sadness. Another difference is that teens are not as adept as adults in articulating issues associated with depression. Teens who meet criteria for a diagnosis of depression also usually have at least 4 of the following symptoms: (1) loss of interest in activities that used to be pleasurable to them, (2) changes in appetite or weight–either increases or decreases, (3) sleep problems, including troubles falling or staying asleep, or sleeping too much, (4) seeming either physically slowed-down or physically agitated and restless, (5) feeling fatigued or out of energy often, (6) feelings of guilt or worthlessness, (7) problems concentrating or making decisions, (8) recurrent thoughts of death or suicide. Depression is more likely to affect females. It also runs in families. Children who have not yet reached puberty are more likely to have depression in conjunction with other disorders–such as ADHD, Anxiety, or Disruptive Behavior Disorders.

If you suspect a teenager you know may be depressed, you should take action. Schedule an evaluation with a child psychologist. There are evidence-based treatments for depression, most of which are based in cogntive-behavioral therapies. You should notice symptom improvement after 12-16 weeks of treatment. If improvement is slow or nil, consider making an appointment with a child psychiatrist to discuss medication that may be appropriate as an adjunct to therapy.

No TV for Toddlers

Mental health professionals have long urged parents to limit kids’ TV time. Excessive TV watching has been linked to ADHD symptoms, and other concerns. Now, the American Academy of Pediatrics has recommended even stricter measures on TV. As in, no TV for children two years old or younger. Young children who watch TV have higher chances of developing sleep problems and speech delays. Beyond the speed of the frames (which seem to train young brains to attend only to super-fast stimuli), the content of programs is impossible for most babies to understand. In fact, according to Rachel Rettner’s new article, studies have shown that 18-month-olds “have the same reaction to a TV program regardless of whether it’s going forward or backward.” Yes parents, this would even be true for “educational programs” like Sesame Street. Likewise, the Baby Einstein shows have not been shown to help IQ.

What’s more, toddlers who watch TV  miss out on an ultra-serious, critical event: play! Good, old-fashioned play is the developmental task for small children. It helps them build interpersonal skills, problem-solving techniques, and enhances creativity. Even having TV on “in the background” appears to have negative effects on children. Parents who watch TV while young children are around don’t interact with children as often. Solid development in speech, social skills, and emotion regulation happens when children engage in real-life dialogue with people around them. Play-dates, sports, clubs, social activities, and especially one-to-one time with parents are the best ways for children to learn and grow, and to develop into smart, effective, and well-adjusted adults.

Pesticides Linked to ADHD Symptoms

Pesticides Linked to ADHD Symptoms

The “organic movement” has roots (pardon the pun) in studies about harmful effects of pesticides. Pesticides Linked to ADHD Symptoms. A new study (conducted by Canadian researchers used data collected from nearly 1,140 children participating in the United States Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey) suggests more bad news about pesticides. There seems to be a link between level of exposure to pesticides and the development of ADHD symptoms. This MSN Childhood Health article (by Leah Zerbe Rodale) states that “this study is the first to look at everyday exposure levels in children from around the country. And as it turns out, U.S. kids are exposed to harmful levels of pesticides in their food, day in and day out.” The take-home message is: avoid using pesticides around your own lawn, and–if possible–try to buy organic foods.

BFFs are Good for Kids

BFFs are Good for Kids

According to a 2007 Columbia University study, about 1 in 70 preschoolers take psychiatric medications

Toddlers on Psychiatric Medications

According to a 2007 Columbia University study, about 1 in 70 preschoolers take psychiatric medications—including stimulants, antidepressants, mood stabilizers, antipsychotics, and antianxiety drugs. It is not possible to say—without knowing these children personally—if medications are appropriate. But we do know that psychiatric drugs are not approved by the FDA for children under 6. There is simply not enough information to know how very young brains and body will respond—over time—to these medications.

As a child psychologist, I have worked with hundreds of children on psychiatric medications. In many cases, medications were necessary for the children’s safety and well-being. Almost every parent I’ve worked with has agreed to their child’s taking medication because they really believed it was the best way to get back on track. Few parents are excited about medications, but look instead to outweigh the downsides of out-of-control behaviors, moods, and urges.

But, here’s the thing. Medication is not the only option. It should never be the first option. The fields of child psychiatry and child psychology have solid, evidence-based research that shows the effectiveness of non-invasive treatments—therapy, sensory integration, parent/teacher education, and coaching.

If you’re wondering if your toddler is “abnormal,” see a child psychologist. This doctor should spend time with your child, you, and get a detailed history of the problem. Child psychologists can conduct standardized measures that have been validated to use on very young children. Mental illness is hard to characterize in preschoolers. You need an expert. There’s a national shortage of child psychologists and child psychiatrists, but it is worth the wait to see one. There is nothing less at stake than the health and welfare of the one you love most—your child.

This CNN article by Kelley King Heyworth is a thorough dialogue about the dilemma of putting toddlers on psychiatric medications.

 

 

ADHD on the Rise

ADHD on the Rise

The Centers for Disease Control reports a rise in the number of children diagnosed with ADHD.

Their report indicates a 10% rise in pediatric ADHD in the Midwest in the past 10 years. The looming question—to which no one can provide a definitive answer—is this: Does the increase mean more kids with “real” ADHD, or just more kids with the ADHD label? The difference is critical.

ADHD is considered a “mental disorder,” and as such is defined by the American Psychiatric Association (APA). It is believed to affect, according to APA’s most recent diagnostic manual, 3%-7% of school-aged children. If prevalence rates are said to be significantly higher (and they are, according to this article by the CDC), it is fair to use the term “epidemic” to describe the rise in ADHD.

ADHD symptoms can be “caused” by numerous triggers: vision problems, hearing problems, spinal misalignments, poor sleep and/or diet, underdeveloped prefrontal lobes in the brain, and structural “abnormalities” in other brain parts. Environmental triggers such as television, video games, and busy schedules can add to a child’s propensity to develop ADHD symptoms.

Are symptoms the same thing as the diagnosis? No. A psychiatric diagnosis confers that that the caues of “problems” are known. It is not simply confirming that a variety of symptoms are present. When a mental health professional diagnoses ADHD, she confirms that she KNOWS, for example, that hearing problems are not the primary cause of a child’s inattention. An ADHD diagnosis confirms that food allergies are not the primary cause of hyperactivity. An ADHD diagnosis proposes that ADHD problems do not stem from an untreated sleep disorder. The problem with the current ways in which children get diagnosed is that many (competent and well-meaning) care providers simply do not have the time, information, or other resources to properly evaluate a child for ADHD. Is it any wonder that ADHD is so easily and so often misdiagnosed and, thus, mistreated?

To get an accurate ADHD diagnosis, Plum Tree evaluates a child with a series of interviews, observations, and tests to determine if ADHD is the appropriate diagnosis. An ADHD diagnosis should only be applied after the mental health provider has:

  • Spent lots of time with your child (more than 15 minutes)
  • Obtained a detailed and structured history of your child’s health, behavior, and functioning from you AND others, including school professionals, babysitters, etc.
  • Administered a computer test (TOVA) to measure objectively your child’s inattention and impulsivity rates
  • Ruled out other mental health conditions and the possibilities of other health conditions

 

Social Media Effects on Children

Social Media Effects on Children

A CNN article reviews the role of electronic media in children’s lives—the good, the bad, and the narcissistic. The research was conducted by Larry D. Rosen, Ph.D., professor of psychology at California State University, Dominguez Hills, and technology researcher. Below is a summary of the major trends observed by Dr. Rosen. Social Media Effects on Children.

Positive Results

– Social media is a great tool for engaging and captivating children
– Online networking can teach socialization
– Online users show more “virtual empathy”
– Social Media can help children establish a sense of self

Negative Results

– Students using social media during study breaks received lower grades
– Children who use social media tend to be more narcissistic
– Research suggests social media can increase anxiety and depression in children

Dr. Weller suggests that parents stay up-to-date on social media trends. Become familiar with what sites your child uses. (St. Charles school district has recently offered teen-led classes to parents for help with this). Like anything done in mindful moderation, social media can play a role in a well-balanced life.

What is a Child and Adolescent Psychologist

What is a Child and Adolescent Psychologist?

Clinical psychologists have doctoral-level training to provide therapy (including coaching) and consultation, and psychological testing.

Coaching Can Improve Performance

Psychologists review why people “choke” under pressure. We know that preparing and practicing for high-stress situations can improve performance. Coaching is a good way to do this.