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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Children's Mental Health. Show all posts
Showing posts with label Children's Mental Health. Show all posts

Monday, October 14, 2013

National Trends in Psychotropic Medication Use in Young Children: 1994–2009

By Vilawan Chirdkiatgumchai, and others
Pediatrics
doi: 10.1542/peds.2013-1546

OBJECTIVE: To examine recent national trends in psychotropic use for very young children at US outpatient medical visits.

METHODS: Data for 2- to 5-year-old children (N = 43 598) from the 1994–2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys were used to estimate the weighted percentage of visits with psychotropic prescriptions. Multivariable logistic regression was used to identify factors associated with psychotropic use. Time effects were examined in 4-year blocks (1994–1997, 1998–2001, 2002–2005, and 2006–2009).

RESULTS: Psychotropic prescription rates were 0.98% from 1994–1997, 0.83% from 1998–2001, 1.45% from 2002–2005, and 1.00% from 2006–2009. The likelihood of preschool psychotropic use was highest in 2002–2005 (1994–1997 adjusted odds ratio [AOR] versus 2002–2005: 0.67; 1998–2001 AOR versus 2002–2005: 0.63; 2006–2009 AOR versus 2002–2005: 0.64), then diminished such that the 2006–2009 probability of use did not differ from 1994–1997 or from 1998–2001. Boys (AOR versus girls: 1.64), white children (AOR versus other race: 1.42), older children (AOR for 4 to 5 vs 2 to 3 year olds: 3.87), and those lacking private insurance (AOR versus privately insured: 2.38) were more likely than children from other groups to receive psychotropic prescriptions.

CONCLUSIONS: Psychotropic prescription was notable for peak usage in 2002–2005 and sociodemographic disparities in use. Further study is needed to discern why psychotropic use in very young children stabilized in 2006–2009, as well as reasons for increased use in boys, white children, and those lacking private health insurance.

Tuesday, August 27, 2013

U.S. Probes Use of Antipsychotic Drugs on Children

By LUCETTE LAGNADO
The Wall Street Journal
Originally published August 12, 2013

Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young.

The inspector general's office at Department of Health and Human Services says it recently began a review of antipsychotic-drug use by Medicaid recipients age 17 and under. And various agencies within HHS are requiring officials in all 50 states to tighten oversight of prescriptions for such drugs to Medicaid-eligible young people.

The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation's No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.

The entire story is here.

Sunday, August 4, 2013

Concussion Study Makes Case for Reducing Contact Drills for Youth Players

By KEN BELSON
The New York Times
Published: July 25, 2013

Youth football players are not more vulnerable to head hits in games if they take part in fewer contact drills during practices, a new study published in the Annals of Biomedical Engineering showed.

(cut)

The study’s conclusion — that the amount of practice does not influence the number of head hits absorbed during games — may bolster calls to reduce the frequency of contact drills in youth football leagues. N.F.L., college and high school teams have already scaled back the number of contact drills in practices.

The entire story is here.

Tuesday, June 11, 2013

Pediatricians warned children of military personnel face mental health risks

By Ryan Jaslow
CBS News
Originally posted May 27, 2012

Children of military personnel may be at an increased risk for social, emotional and behavioral problems, according to a new report from the American Academy of Pediatrics.

Published May 27, Memorial Day, in the academy's journal Pediatrics, the new clinical report aims to raise awareness among pediatricians for the mental health needs for military children.

Authored by Dr. Ben S. Siegel and Dr. Beth Ellen Davis, who serve as members on the Committee On Psychosocial Aspects of Child and Family Health and Section on Uniformed Services, the report points out about 60 percent of U.S. service members have families while about 2.3 million military members have been deployed since the start of the wars in Afghanistan and Iraq about a decade ago.

The entire article is here.

Sunday, June 2, 2013

Schoolmates of suicide victims at higher risk

By Kathryn Doyle
Reuters
Originally published May 21, 2013

Teens who have a classmate die of suicide are more likely to consider taking, or attempt to take, their own lives, according to a new study.

The idea that suicide might be "contagious" has been around for centuries, senior author Dr. Ian Colman, who studies mental health at the University of Ottawa, told Reuters Health.

Past studies supported the idea, but none had looked at such a large body of students, he said.
"There were a lot of surprising things about this study, we were surprised that the effect lasted so long and just how strong it was," Colman said.

Colman and his colleagues used data from a long-running national survey of more than 8,000 Canadian kids aged 12 to 17 years old. Students were asked about suicides of schoolmates, friends and their own thoughts of suicide, and researchers checked in with the kids two years later.

By the age of 17, one in four kids had a schoolmate who had committed suicide, and one in five knew the deceased personally, according to results published in the Canadian Medical Association Journal.

The entire article is here.

Source Article: Association between exposure to suicide and suicidality outcomes in youth

CMAJ 2013. DOI:10.1503/cmaj.121377

Abstract

Background: Ecological studies support the hypothesis that suicide may be "contagious" (i.e., exposure to suicide may increase the risk of suicide and related outcomes). However, this association has not been adequately assessed in prospective studies. We sought to determine the association between exposure to suicide and suicidality outcomes in Canadian youth.

Methods: We used baseline information from the Canadian National Longitudinal Survey of Children and Youth between 1998/99 and 2006/07 with follow-up assessments 2 years later. We included all respondents aged 12–17 years in cycles 3–7 with reported measures of exposure to suicide.

Results: We included 8766 youth aged 12–13 years, 7802 aged 14–15 years and 5496 aged 16–17 years. Exposure to a schoolmate's suicide was associated with ideation at baseline among respondents aged 12–13 years (odds ratio [OR] 5.06, 95% confidence interval [CI] 3.04–8.40), 14–15 years (OR 2.93, 95% CI 2.02–4.24) and 16–17 years (OR 2.23, 95% CI 1.43–3.48). Such exposure was associated with attempts among respondents aged 12–13 years (OR 4.57, 95% CI 2.39–8.71), 14–15 years (OR 3.99, 95% CI 2.46–6.45) and 16–17 years (OR 3.22, 95% CI 1.62–6.41). Personally knowing someone who died by suicide was associated with suicidality outcomes for all age groups. We also assessed 2-year outcomes among respondents aged 12–15 years: a schoolmate's suicide predicted suicide attempts among participants aged 12–13 years (OR 3.07, 95% CI 1.05–8.96) and 14–15 years (OR 2.72, 95% CI 1.47–5.04). Among those who reported a schoolmate's suicide, personally knowing the decedent did not alter the risk of suicidality.

Interpretation: We found that exposure to suicide predicts suicide ideation and attempts. Our results support school-wide interventions over current targeted interventions, particularly over strategies that target interventions toward children closest to the decedent.


The source article is here.

Friday, May 31, 2013

Not robots: children's perspectives on authenticity, moral agency and stimulant drug treatments

By Ilina Singh
J Med Ethics 2013;39:359-366 doi:10.1136/medethics-2011-100224

Abstract

In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve their capacity for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions.

The entire article is here.

1 in 5 U.S. Kids Has a Mental Health Disorder: CDC

By Brenda Goodman
HealthDay Reporter
Originally published May 16, 2013

As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.

Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.

The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.

The entire story is 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.

Tuesday, October 2, 2012

California Is First State to Ban Gay ‘Cure’ for Minors


By ERIK ECKHOLM
The New York Times
Originally published September 30, 2012

California has become the first state to ban the use for minors of disputed therapies to “overcome” homosexuality, a step hailed by gay rights groups across the country that say the therapies have caused dangerous emotional harm to gay and lesbian teenagers.

“This bill bans nonscientific ‘therapies’ that have driven young people to depression and suicide,” Gov. Jerry Brown said in a statement on Saturday after he signed the bill into law. “These practices have no basis in science or medicine, and they will now be relegated to the dustbin of quackery.”

The law, which is to take effect on Jan. 1, states that no “mental health provider” shall provide minors with therapy intended to change their sexual orientation, including efforts to “change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.”

The entire story is here.


Saturday, September 29, 2012

More U.S. Kids Prescribed Off-Label Antipsychotics: Study


By Mary Elizabeth Dallas
MedicineNet.com
Originally published on September 18, 2012

Over the past decade, off-label use of antipsychotic drugs has increased among children enrolled in Medicaid, according to a new study representing 35 percent of children in the United States.

Off-label drug use is a term used to describe when drugs are prescribed using a dosage, type of dosage or for a purpose that hasn't yet been approved by the U.S. Food and Drug Administration.

In the study, researchers from the Children's Hospital of Philadelphia found a 62 percent jump in the number of publicly insured children between the ages of 3 and 18 taking antipsychotics. In 2007 alone, 65 percent of the 354,000 children on these drugs were taking them for uses that have not been approved by the FDA, the investigators pointed out.

"We knew that the number of children prescribed antipsychotics had grown steadily over the past two decades, particularly among children with public insurance," study author Meredith Matone, a researcher at PolicyLab, said in a hospital news release. "With this study, we wanted to learn more about why these drugs are being used so often, what diagnoses they're being used to treat, and how prescribing patterns changed over the course of the last decade."


Thursday, May 17, 2012

Can You Call a 9-Year-Old a Psychopath?

By Jennifer Kahn
The New York Times
Originally published May 11, 2012

One day last summer, Anne and her husband, Miguel, took their 9-year-old son, Michael, to a Florida elementary school for the first day of what the family chose to call “summer camp.” For years, Anne and Miguel have struggled to understand their eldest son, an elegant boy with high-planed cheeks, wide eyes and curly light brown hair, whose periodic rages alternate with moments of chilly detachment. Michael’s eight-week program was, in reality, a highly structured psychological study — less summer camp than camp of last resort.

Michael’s problems started, according to his mother, around age 3, shortly after his brother Allan was born. At the time, she said, Michael was mostly just acting “like a brat,” but his behavior soon escalated to throwing tantrums during which he would scream and shriek inconsolably. These weren’t ordinary toddler’s fits. “It wasn’t, ‘I’m tired’ or ‘I’m frustrated’ — the normal things kids do,” Anne remembered. “His behavior was really out there. And it would happen for hours and hours each day, no matter what we did.” For several years, Michael screamed every time his parents told him to put on his shoes or perform other ordinary tasks, like retrieving one of his toys from the living room. “Going somewhere, staying somewhere — anything would set him off,” Miguel said. These furies lasted well beyond toddlerhood. At 8, Michael would still fly into a rage when Anne or Miguel tried to get him ready for school, punching the wall and kicking holes in the door. Left unwatched, he would cut up his trousers with scissors or methodically pull his hair out. He would also vent his anger by slamming the toilet seat down again and again until it broke.

Wednesday, May 9, 2012

Psychoactive Medication Use Among Children In Foster Care

The Children's Hospital of Philadelphia
"Hope Lives Here"
Originally published April 30, 2012

A few months after the federal Government Accountability Office (GAO) issued a report on the use of psychoactive drugs by children in foster care in five states, a national study from PolicyLab at The Children's Hospital of Philadelphia describes prescription patterns over time in 48 states. The updated findings show the percentage of children in foster care taking antipsychotics - a class of psychoactive drugs associated with serious side effects for children - continued to climb in the last decade. At the same time, a slight decline was seen in the use of other psychoactive medications, including the percentage of children receiving 3 or more classes of these medications at once (polypharmacy).

Psychoactive drugs prescribed at higher rates for foster children

As public scrutiny has increased about the use of psychoactive medication by children over the past decade, children in foster care continue to be prescribed these drugs at exceptionally high rates compared with the general population of U.S. children. According to the PolicyLab study, 1 in 10 school-aged children (aged 6-11) and 1 in 6 adolescents (aged 12-18) in foster care were taking antipsychotics by 2007.

The entire story is here.

Contact: Dana Mortensen, Children's Hospital of Philadelphia, 267-426-6092

Friday, February 3, 2012

Ritalin Gone Wrong

By L. ALAN SROUFE
The New York Times
Opinion
Published: January 28, 2012

The molecular model of Ritalin
THREE million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage ofdrugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning.

But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?

In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.

As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see.

Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

The entire story is here.

Monday, July 18, 2011

Parents' Military Deployment May Harm Kids' Mental Health

MedicineNet.com

Children with a parent on long-term military deployment in Iraq or Afghanistan are at increased risk for mental health problems, new research suggests.

In the study, published in the July 4 online edition of the Archives of Pediatrics and Adolescent Medicine, researchers examined the medical records of 307,520 U.S. children, aged 5 to 17, who had at least one parent on active duty in the U.S. Army and received outpatient care between 2003 and 2006.

During that time period, nearly 17% of the children were diagnosed with a mental health disorder. The most common conditions were depression, behavioral problems, anxiety, stress and sleep disorders, the investigators found.

More than 62% of the children's parents were deployed at least once during the study period, with deployments averaging 11 months. Mental health problems were more likely to be diagnosed among children who had a parent who was deployed at least once to Iraq or Afghanistan. The risk of a mental health problem among the children rose with increased length of parents' deployment.

"We observed a clear dose-response pattern such that children of parents who spent more time deployed between 2003 and 2006 fared worse than children whose parents were deployed for a shorter duration," wrote Alyssa J. Mansfield, then of the University of North Carolina at Chapel Hill, now of the National Center for Posttraumatic Stress Disorder in Honolulu, and colleagues. "Similar to findings among military spouses, prolonged deployment appears to be taking a mental health toll on children."

In an accompanying commentary, Dr. Stephen J. Cozza, from the Uniformed Services University School of Medicine in Bethesda, Md., noted that as of 2009, 44% of active duty military members have children (an estimated total of 1.2 million children), in addition to 43% of Reserve and National Guard members. Since 2001, about 2 million U.S. military personnel have deployed at least once.

The study provides "an important contribution to our understanding of a child's health and its relationship to parental combat deployment," Cozza said in a journal news release.

"Brief screening for anxiety, depression, behavioral problems, academic difficulties, peer relational problems, or high-risk behaviors (such as substance misuse or unsafe sexual practices) is warranted and will help identify treatment needs," Cozza concluded.