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Showing posts with label ADHD. Show all posts
Showing posts with label ADHD. Show all posts

Friday, July 31, 2020

Antipsychotics for Children With ADHD Should Be a Last Resort

Jeannette Y. Wick
pharmacytimes.com
Originally published 20 Feb 20

Here is an excerpt:

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder), and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD, and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment. ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts. Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.

The info is here.

Monday, July 15, 2019

Why parents are struggling to find mental health care for their children

Bernard Wolfson
Kaiser Health News/PBS.org
Originally posted May 7, 2019

Here is an excerpt:

Think about how perverse this is. Mental health professionals say that with children, early intervention is crucial to avoid more severe and costly problems later on. Yet even parents with good insurance struggle to find care for their children.

The U.S. faces a growing shortage of mental health professionals trained to work with young people — at a time when depression and anxiety are on the rise. Suicide was the No. 2 cause of death for children and young adults from age 10 to 24 in 2017, after accidents.

There is only one practicing child and adolescent psychiatrist in the U.S. for about every 1,800 children who need one, according to data from the American Academy of Child & Adolescent Psychiatry.

Not only is it hard to get appointments with psychiatrists and therapists, but the ones who are available often don’t accept insurance.

“This country currently lacks the capacity to provide the mental health support that young people need,” says Dr. Steven Adelsheim, director of the Stanford University psychiatry department’s Center for Youth Mental Health and Wellbeing.

The info is here.

Sunday, July 16, 2017

Masked Marketing: Pharmaceutical Company Funding of ADHD Patient Advocacy Groups

Marnie Klein
Hastings Center
Originally posted June 29, 2017

In 1971, the United Nations passed a resolution prohibiting its member nations from advertising psychotropic drugs to the general public. More than 40 years later, this resolution has done little to halt pharmaceutical companies from marketing stimulants as treatments for attention deficit-hyperactivity disorder. The means by which, and the ethical dilemmas involved when, pharmaceutical companies market their products was discussed earlier this month at the annual PharmedOut conference, which investigated how industry influences medical discourse.

Alan Schwarz, the author of ADHD Nation, exposed how drug companies have, often covertly, sponsored educational resources and patient advocacy groups. These groups face a difficult conflict of interest: by accepting drug company funding, they can increase their reach to those looking for resources; however, their neutrality is compromised, particularly when they fail to disclose the funding source. The New England Journal of Medicine reports that pharmaceutical industry-sponsored advocacy groups may be likely to support drugs, as well as policy proposals, that cater to their sponsors’ financial interests.

One such pharmaceutical company is Shire. One of the British company’s highest-grossing products is Adderall, a stimulant used in treating ADHD that has earned the company billions in sales to date. Shire sponsors ADHD patient-advocacy groups, like Children and Adults with ADHD (CHADD).

The article is here.

Tuesday, June 2, 2015

Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries

By Alan Schwarz
The New York Times
Originally published May 16, 2014

More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.

The entire article is here.

Saturday, August 9, 2014

The New Normal: How the definition of disease impacts enhancement

By Ray Purcell
The Neuroethics Blog
Originally posted July 24, 2014

Here is an excerpt:

Why does the definition of disease matter? Enhancement is typically defined relative to normal abilities. Anjan Chatterjee of the University of Pennsylvania suggested that “Therapy is treating disease, whereas enhancement is improving “normal” abilities. Most people would probably agree that therapy is desirable. By contrast, enhancing normal abilities gives pause to many.” However, many neuroethicists have wrestled with clearly defining enhancement. The director of Emory’s Center for Ethics, Paul Root Wolpe argued (2002) that the enhancement debate centers on the ability of substances or therapeutics to directly affect the brain in ways that are not necessary to restore health and, certainly, to date the cognitive enhancement debate has focused primarily on pharmaceuticals, many of which are approved to treat disorders but can have effects on healthy individuals as well. Perhaps the best examples of this are methylphenidate (Ritalin) and modafinil (Provigil) which are prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy respectively, but are increasingly being used by students and professionals to boost cognitive performance at school and in the workplace. 

Sunday, May 18, 2014

Many Ivy League students don't view ADHD medication misuse as cheating: 18 percent use stimulants to help them study

By Science Daily
Source: American Academy of Pediatrics
Originally published May 1, 2014

Summary

Nearly one in five students at an Ivy League college reported misusing a prescription stimulant while studying, and one-third of students did not view such misuse as cheating, according to a new study. Stimulants are used to treat attention-deficit/hyperactivity disorder (ADHD). Recent studies have shown that students without ADHD are misusing these medications in hopes of gaining an academic edge.

The entire article is here.

Monday, December 30, 2013

The Selling of ADHD

By Alan Schwarz
The New York Times
Originally posted December 14, 2013


Here is an excerpt:

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

The entire story is here.

Thursday, May 9, 2013

Most Docs Don't Follow ADHD Treatment Guidelines for Preschoolers: Study

By Robert Preidt
MedicineNet.com
Originally published on May 4, 2013

About 90 percent of pediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.

Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., and colleagues.

The American Academy of Pediatrics (AAP) guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behavior-management counseling is unsuccessful.  (Emphasis added)

The entire story is here.

Click here to review the guidelines.

A similar story can be found in Time.

Saturday, April 6, 2013

A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise

By ALAN SCHWARZ and SARAH COHEN
The New York Times
Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The entire story is here.

Wednesday, February 13, 2013

Easing ADHD without meds

Psychologists are using research-backed behavioral interventions that effectively treat children with ADHD.

By Rebecca A. Clay
February 2013, Vol 44, No. 2
Print version: page 44

Because of his attention-deficit/hyperactivity disorder (ADHD), the 10-year-old boy rarely even tried to answer the questions on the math and language arts worksheets his fourth-grade teacher asked students to complete during class. Not only that, he often bothered the students who did.

Then the teacher made an important change to the boy's worksheets: She wrote the correct answers on them with invisible markers so that the boy could reveal the correct answer by coloring over the space as soon as he finished a question. The teacher also randomly inserted stars he could uncover by coloring and told him he would earn a reward for collecting four stars. The strategy paid off: The boy was soon answering every question and getting 84 percent of them correct.

Giving immediate feedback is just one of many simple and effective behavioral approaches to improving children's attention, says psychologist Nancy A. Neef, PhD, who described the invisible marker experiment in a chapter on treating ADHD she co-authored in the 2012 "APA Handbook of Behavior Analysis." With ADHD affecting an estimated 7 percent of American children ages 3 to 17, psychologists are developing behavioral interventions that parents, teachers and others can use to help kids focus and control their impulses. Others are conducting research that demonstrates that more exercise and longer sleep can help.

That's good news for kids, says Neef, who believes that parents, teachers and pediatricians are sometimes too quick to jump to prescribing medication for ADHD.

"Particularly in the case of stimulant medications, which are the most common treatment for ADHD, we don't know an awful lot about the long-term side effects," says Neef, a professor of special education at The Ohio State University.

And medication doesn't address problems related to children's academic performance and relationships with family members, peers and others. "Even though medication can be effective and very helpful, it's not a panacea," Neef says.

Behavioral interventions

Surprisingly, nonpharmacological approaches are also controversial, especially among the medical community.

"If you read the professional guidelines for psychiatrists or sometimes pediatricians, the treatment that is emphasized for kids with ADHD is a pharmacological one," says Gregory A. Fabiano, PhD, an associate professor of counseling, school and educational psychology at the State University of New York at Buffalo.

The entire story is here.

Tuesday, February 12, 2013

Drowned in a Stream of Prescriptions

By ALAN SCHWARZ
The New York Times
Published: February 2, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

The entire story is here.

Sunday, February 3, 2013

Diagnosis of ADHD on the Rise in this Study

Recent Trends in Childhood Attention-Deficit/Hyperactivity Disorder

Darios Getahun, MD, PhD; Steven J. Jacobsen, MD, PhD; Michael J. Fassett, MD; Wansu Chen, MS; Kitaw Demissie, MD, PhD; George G. Rhoads, MD, MPH
JAMA Pediatr. 2013;():1-7. doi:10.1001/2013.jamapediatrics.401.

Objective
To examine trends in attention-deficit/hyperactivity disorder (ADHD) by race/ethnicity, age, sex, and median household income.

Design
An ecologic study of trends in the diagnosis of ADHD using the Kaiser Permanente Southern California (KPSC) health plan medical records. Rates of ADHD diagnosis were derived using Poisson regression analyses after adjustments for potential confounders.

Setting  
Kaiser Permanente Southern California, Pasadena.

Participants  
All children who received care at the KPSC from January 1, 2001, through December 31, 2010 (n = 842 830).

Main Exposure
Period of ADHD diagnosis (in years).

Main Outcome Measures
Incidence of physician-diagnosed ADHD in children aged 5 to 11 years.

Results  
Rates of ADHD diagnosis were 2.5% in 2001 and 3.1% in 2010, a relative increase of 24%. From 2001 to 2010, the rate increased among whites (4.7%-5.6%; relative risk [RR] = 1.3; 95% CI, 1.2-1.4), blacks (2.6%- 4.1%; RR = 1.7; 95% CI, 1.5-1.9), and Hispanics (1.7%-2.5%; RR = 1.6; 95% CI, 1.5-1.7). Rates for Asian/Pacific Islander and other racial groups remained unchanged over time. The increase in ADHD diagnosis among blacks was largely driven by an increase in females (RR = 1.9; 95% CI, 1.5-2.3). Although boys were more likely to be diagnosed as having ADHD than girls, results suggest the sex gap for blacks may be closing over time. Children living in high-income households were at increased risk of diagnosis.

Conclusions  
The findings suggest that the rate of ADHD diagnosis among children in the health plan notably has increased over time. We observed disproportionately high ADHD diagnosis rates among white children and notable increases among black girls.

The entire study can be found here.

Wednesday, October 17, 2012

Attention Disorder or Not, Pills to Help in School

By ALAN SCHWARZ
The New York Times
Originally published October 9, 2012

Here is an excerpt:

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.

Monday, April 9, 2012

Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis.

By Katrin Bruchmuller, Jurgen Margraf, and Silvia Schneider
Journal of Consulting and Clinical Psychology, Vol 80(1), Feb 2012, 128-138.
 
Abstract
 
Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male–female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6–9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) and International Classification of Diseases (10th rev.; ICD–10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would.
 
Method: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM–IV/ICD–10 criteria of ADHD. Vignettes 2–4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created.
 
Results: In Vignettes 2–4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes.
 
Conclusions: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.

Wednesday, September 7, 2011

Nearly 1 in 10 U.S. Kids Diagnosed With ADHD

By Alan Mozes
MedicineNet.com

Over the last decade, an increasing number of American children have been diagnosed with attention-deficit hyperactivity disorder (ADHD), a new government survey reveals.

Researchers from the U.S. Centers for Disease Control and Prevention found that between 2007 and 2009, an average of 9% of children between the ages of 5 and 17 were diagnosed with the disorder. This compared with just under 7% between 1998 and 2000.

The survey also indicated that previously notable racial differences in ADHD incidence rates have narrowed considerably since the turn of the millennium, with prevalence now comparable among whites, blacks and some Hispanic groups.

"We don't have the data to say for certain what explains these patterns, but I would caution against concluding that what we have here is a real increase in the occurrence of this condition," stressed study author Dr. Lara J. Akinbami, a medical officer with the National Center for Health Statistics. The findings appear in an Aug. 18 report from the agency.

"In fact, it would be hard for me to argue that what we see here is a true change in prevalence," Akinbami added. "Instead, I would say that most probably what we found has a lot to do with better access to health care among a broader group of children, and doctors who have become more and more familiar with this condition and now have better tools to screen for it. So, this is probably about better screening, rather than a real increase, and that means we may continue to see this pattern unfold."

According to the National Institutes of Health, ADHD is the most common behavioral disorder among children.

Children with ADHD are apt to have problems staying focused, and often suffer learning and behavioral problems as a result of a tendency to engage in hyperactive and/or impulsive behaviors.

The entire article can be here.