Booster Shots

Oddities, musings and news from the health world

Category: ADHD

Toddler TV time linked to poorer fourth-grade classroom attention, math and exercise

May 4, 2010 | 12:40 pm

Children who at 2 1/2 logged a lot of time in front of the TV appear to suffer ill effects from the experience seven years later when they're on the threshold of 'tween-dom, a new study finds.

A large-scale, long-running Canadian study of children found that for every extra hour of TV time a toddler watches weekly, she is likely in fourth grade to have lower levels of classroom engagement and poorer performance in math, is more likely to be the victim of bullying, to be sedentary and to have a higher body-mass index. On average, the 1,314 children enrolled in the study watched 8.82 hours per week of television at 29 months. They watched an average of 14.85 hours a week by the time they were 4 1/2 years old -- and higher levels of viewing at this age increased their risks down the road, as well.

"Early childhood television exposure undermines attention," the group says of its findings. While other studies have suggested as much, few have followed children well beyond their early viewing years to gauge the longer-term effect on kids' ability to sit and listen to classroom instructions and stick with a learning task through completion. At 2 1/2,  toddler's brains are laying down the foundation for many of the "effortful control" skills they'll need to learn and prosper in academic settings. So researchers at the Institut de la Statistique du Quebec surmised that tv-viewing rates at that age might have far-reaching effects on performance in classrooms once the material became more challenging.

"Our results suggest that early television exposure could eventually foster risk toward a more passive rather than active disposition when attending to learning situations," the authors write.

Fourth-grade teachers were far more likely to believe a student who had watched a lot of TV as a toddler was or would be a victim of other kids' taunts or abuse. And parents of children who watched a lot of TV were more likely to report that in fourth grade, their child spent more time playing video games, was less physically fit and less likely to be drawn to active pursuits. Not surprisingly, perhaps, those kids also were slightly heavier than their peers who had watched less TV as toddlers.

The American Academy of Pediatrics urges parents of children under 2 not to sit their children in front of the television, but it's a recommendation widely disregarded in the United States, where children under 2 routinely log and average of close to an hour and a half of TV a day. A recent study  in Pediatrics found watching TV in the first two years of life conferred no benefits in terms of language or motor skills.

 Here's an interesting view by pediatricians of what kids aren't doing when they're in front of the tube.

--Melissa Healy

  


Improving child health depends on healthy relationships

May 3, 2010 |  1:39 pm

Child Behavioral and emotional problems are seen in increasingly younger children, and at least some of these children are diagnosed with mental disorders and prescribed psychotropic drugs to control their symptoms. But this medical approach may overlook a common cause of disruptive child behaviors: parenting.

An editorial in Monday's issue of the Archives of Pediatrics & Adolescent Medicine calls on health experts to consider the importance of caregiver relationships in the physical and mental development of children. The editorial is part of a theme issue focusing on child health in early life and outside influences, including caregiving, television, maternal use of antidepressants and nicotine, and exposure to trauma.

In their commentary, Dr. David Rubin and Kathleen Noonan, an attorney, both with the Children's Hospital of Philadelphia, note that misbehaving children are easily labeled with depression, attention-deficit hyperactivity disorder, bipolar disorder, conduct disorder or other diagnosable mental illnesses that often lead to drug therapies instead of shining a light on the roots of the behavior problem, which may exist in the child's relationship to his or her parents, foster parents or other caregivers.

"Missing from the discussion is that at the heart of many of these disruptive behaviors are the biological effects of failed relationships, failed attachment, and multiple traumatic disruptions," the authors wrote.

Instead of psychiatric diagnoses and medications, therapies could focus on relationships. They note that an intervention called Parent-Child Interaction Therapy is promising but not widely available.

Supporting secure and functional caregiver relationships could have a huge impact on child health and, they said, "lead to the sustained changes in the brain that will promote resiliency in children."

-- Shari Roan 

Photo credit: Luis Sinco / Los Angeles Times


Nearly half of kids with mental disorders go without treatment, study finds

December 13, 2009 |  9:02 pm

If your child broke an arm or had a nasty bout of pneumonia, you’d probably visit the doctor. But a new study from researchers at the National Institute of Mental Health finds that only 55% of kids with a mental disorder sought professional treatment.

Kids What’s more, that figure represents an increase in use of mental health services, according to a report being published online Monday by the journal Pediatrics.

The researchers wanted to establish a baseline on the prevalence of six mental health disorders affecting children and adolescents between the ages of 8 and 15. Using data from 3,042 kids who took part in the National Health and Nutrition Examination Survey, they  found:

The researchers, led by Kathleen Merikangas of NIMH, found that mental disorders – especially ADHD – were more prevalent among kids with lower socioeconomic status. One exception was the category of anxiety disorders, which were more common among children of higher socioeconomic status.

Still, only 32% of those kids visited a doctor for the condition. Overall, African American and Mexican American children were less likely than whites to get treatment.

-- Karen Kaplan

Photo: U.S. scientists say more than 1 out of 10 kids suffers from some kind of mental disorder. Credit: Stacey Wescott / Chicago Tribune


The mind unchecked: Is a toddler's lack of self-control key to early learning?

December 1, 2009 | 12:57 pm

Anyone who's seen a young toddler "at work" can tell that her learning style is a study in chaos. She moves from banging pots and pans to tormenting the cat to demanding food to bursting into tears when she can't open the back door and hurdle off the deck--all in the span of minutes.

But when it comes to, say, the daunting task of mastering language, that same baby is a turbo-charged learning machine. She is building her toolkit of words and phrases by the hour, forming sentences that not only get her needs met but generally comply with rules we would never think to try to teach her.

How does this distractible little creature manage to derive so much information from her surroundings when she seems to be moving too fast to make sense of anything? Why, if we adults are so good at learning and doing things, is she so much better and faster at learning something as complex as, say, a language?

Maybe, suggests an intriguing article published today in the journal Current Directions in Psychological Science, it's because her underdeveloped powers of paying attention, of filtering out distractions and of imposing regular patterns on her experiences. Maybe it's because she lacks the very thing that makes her dad so good at filtering out distractions and getting things done--a fully formed prefrontal cortex.

Babies are born with the foremost part of the brain--the prefrontal cortex--almost completely undeveloped. For children developing normally, it takes about four years for that so-called "seat of higher reasoning" to catch up with the rest of the brain in size and complexity. (For children with attention-deficit hyperactivity disorder, the maturation of the prefrontal cortex takes longer; for those with autism, the prefrontal cortex develops early.) This would explain why toddlers (and some with ADHD) are inattentive, distractible, do not remember what you told them 15 seconds ago, and "live in the moment": when developed, the prefrontal cortex plays a key role in suppressing impulses, focusing on the task at hand and setting priorities among competing demands.

 Yet, by the time a typical baby is 4, she will have learned to speak (in fact, she may never be quiet), and will have learned all kinds of complex behaviors--that small creatures with fur are fun to torment, that climbing up a slide's ladder will yield a fun ride down, that stealing a friend's toy will bring momentary triumph but will also cause her friend to cry and a teacher to intervene.

In those crucial four years, a toddler's accumulation of knowledge about her world may be unhampered by the discipline imposed by the prefrontal cortex, suggests a trio of neuroscientists from the University of Pennsylvania and Stanford University. She vacuums up experience raw, the way she'd ingest anything she found on the carpet. Her prefrontal cortex doesn't stand in the way and try to keep her "on task." It won't make her reject the use of a pan as, say, a hat because hats cannot be made of shiny metal.

In language, her underdeveloped powers of attention will keep her from getting bogged down by pesky exceptions to rules of grammar or syntax. So, she'll always apply the most general rules she knows--say, that adding an "s" makes things plural. She'll incorrectly say, "the mouses are running away," because her underdeveloped prefrontal cortex didn't slow her down and take note that the plural of "mouse" is "mice."

The authors call this period of disorderly learning "cognition without control." They note that it happens beyond babyhood as well: deep sleep, during which the prefrontal cortex is generally quiet and the sensory cortex is working overtime, would seem to afford even adults a nightly return to cognition without control--and an opportunity to do what babies seem to do so well: to derive broad inferences from recently learned things without getting too bogged down in petty exceptions and details.

This is a theory, not a finding, note the authors, led by University of Pennsylvania's Sharon L. Thompson-Schill: that evolution may have favored a delay in the maturation of the brain's "braking system" as a means of allowing rough-but-rapid learning of complex matter such as language and social conventions. But it's a theory that might help clinicians and educators begin to identify what are the best windows for teaching very young children and for helping kids with developmental differences to learn as well.

-- Melissa Healy


Internet addiction: a 21st century epidemic with some more at risk than others?

October 5, 2009 |  5:37 pm

Psychiatrists struggling to draft a new manual to diagnose mental illness haven't agreed it's a mental illness yet. But mental health professionals are already gauging, parsing and analyzing Internet addiction, which bears all the hallmarks of addictive behavior.

And they are asking, as Washington University's Drs. Dimitri Christakis and Megan Moreno did in a commentary published in the Archives of Pediatric and Adolescent Medicine on Monday, "will Internet addiction becomes a 21st century epidemic?"

If there were a medication for it, this process of declaring Internet addiction a true illness would probably go faster. But for now, there's little more by way of treatment than pulling the plug. We live in a world where going online has become as essential and inescapable as, say, eating. And pulling the plug isn't much of an answer.

So, prevention becomes a pretty important strategy. And if professionals are to prevent Internet addiction (if it exists), they must know who is most likely to fall prey to the affliction, so they can, perhaps, intervene early to avert it.

A two-year study tracked more than 2,000 young teens in 10 middle schools across southern Taiwan, and found that 233 subjects--10.8%--could be classified as having an addiction to the Internet. Males were more likely to fall into that category.Those who played online games were more vulnerable. And teens who used the Internet everyday and/or 20 hours a week or more were more likely to be deemed addicted.

And what other features did potential Internet addicts show? For boys, those with attention deficit and hyperactivity disorder (ADHD) and those who exhibited significant hostility were more likely to have a dysfunctional dependence on the Internet. For girls, having ADHD and hostility also heightened the risk of Internet addiction. But two more groups of girls--those with social phobias and those suffering depression--also were at greater risk.

ADHD had the strongest association with Internet-addicted behavior. And no wonder, observed the study's authors: "Internet behavior is characterized by rapid response, immediate reward and multiple windows with  different activities, which may reduce feelings of boredom or delayed aversion in adolescents with ADHD.

The study was conducted by psychiatrists from Kaohsiung Medical University Hospital in Taiwan.

-- Melissa Healy


ADHD drug recalled for carrying too high a dose*

August 14, 2009 |  9:01 pm

The Federal Drug Administration announced Friday that generic drug maker Barr Laboratories Inc. has issued a recall of its 20-miligram* tablets of Dextroamphetamine Saccharate, Amphetamine Aspartate and Amphetamine Sulfate -- medications typically prescribed to control symptoms of attention deficit and hyperactivity disorder. The recalled pills bear the lot number 311756.

Barr is conducting the recall after some of the pills in the affected order were found to exceed weight specifications. Patients taking them could get too high a dose of the stimulant, leading to heart arrhythmia, stomach upset, elevated blood pressure, sweating, insomnia, diarrhea or constipation and neuropsychiatric symptoms such as agitation, tics, euphoria or mania.

The medications involved in the recall are peach-colored oval tablets, imprinted with b/973 on one side and 2/0 on the other. The affected lot was distributed by Barr from June 11 to June 16.

Consumers who have medications from the affected lot should stop taking them immediately and return them to their pharmacist. Those with questions can call Barr at (888) 743-5578 from 8 a.m. to 8 p.m. EDT Monday to Friday.

--Melissa Healy

*An earlier version of this posting incorrectly identified the dose affected as 20-gram


ADHD stimulants raises kids' heart attack risks, FDA holds its fire on safety warnings

June 15, 2009 |  1:08 pm

Taking stimulant medications to treat symptoms of attention deficit and hyperactivity disorder (ADHD) modestly drives up a child's risk of suffering a sudden fatal heart attack, a new study shows. The Food and Drug Administration helped sponsor the latest effort to clarify the risks of ADHD medication. But the agency cautioned Monday that the study's findings were too weak to justify a change in its safety recommendations for physicians prescribing stimulant drugs to young patients.

"It's not a robust finding," said Dr. Robert Temple, director of the FDA's Office of Drug Evaluation. In a group of 564 children who died of sudden cardiac failure between 1985 and 1996, researchers found that 10 were thought to be taking stimulant medications at the time of their death. Among a matched group of youngsters who were killed in car accidents in the same period, only two were thought to be under treatment with stimulant medications.

Researchers assumed that for the children in car crashes, stimulant use was unlikely to be a contributing factor to death. So when they found a higher rate of stimulant use among children who died of sudden cardiac arrest, the difference suggested that the medications were a factor contributing to death by heart attack. They considered the difference "significant" -- meaning it was highly unlikely to have been a chance event. The study came out Monday online in the American Journal of Psychiatry.

The FDA already has urged physicians to consider a child's personal and family history of cardiovascular disease before prescribing stimulant medications for ADHD and to lean against prescribing stimulants for children with underlying heart disease. But such a condition is difficult to detect in most children. As a result, the American Heart Assn.  has proposed that all kids being prescribed ADHD medications should first be screened for heart disease with echo- or electro-cardiogram. The FDA recommends such screening only in cases where a physician suspects heart disease may be present. 

ADHD researcher Dr. Benedetto Vitiello of the National Institute of Mental Health acknowledged the study is unlikely to settle the debate over routine heart-disease screening for kids treated with stimulant medications. Instead, physicians and ADHD patients and their parents will probably have to wait for the results of two more studies due to be released next fall and winter. Those studies will look at rates of heart attack and stroke -- whether fatal or not -- in children and adults who take stimulant medication for ADHD and compare them to cardiovascular events in populations not on ADHD medication.

-- Melissa Healy


Brain drugs won't go away, so best give them some thought

April 20, 2009 |  1:05 pm

Ritalin If pills can make us better mentally -- and it seems clear they can -- it's time to answer the question of whether we should let them. 

For some people, the question is already moot. In the April 27 issue of the New Yorker, writer Margaret Talbot explores the issue of brain medications in "Brain Gain: The underground world of 'neuroenhancing' drugs."

She writes: "In recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted."

She tells her story in some part through a recent Harvard graduate named Alex. He makes a compelling case for what can be accomplished with a little help.

Some neuroscientists and ethicists have already answered the bigger question among themselves. Says a recent blog post from Times staff writer Melissa Healy: "Pop a smart pill? Why not, says a group of neuroethicists"

-- Tami Dennis

Photo: Ritalin -- the little helper for people with attention deficit hyperactivity disorder and overworked, over-stressed students -- is going mainstream.

Credit: Keith Beaty/Toronto Star/ZUMA Press


ADHD drugs cause hallucinations in some kids, study says

January 26, 2009 |  9:00 am

Ritalin1Doctors have known that some children and adolescents taking stimulant medications for attention deficit hyperactivity disorder experience psychiatric symptoms from the drugs, such as hallucinations, hearing voices, paranoia and mania. In 2007, the Food and Drug Administration ordered manufacturers of stimulant medications to add new warnings about psychiatric and cardiovascular side effects to package inserts. And patient medication guides are also required to explain the risks of ADHD drug treatments. At the time of the FDA order, experts estimated the risk of an adverse psychiatric event from medication use at about 1 in 1,000 children.

A report published today in the journal Pediatrics, however, estimates the incidence of psychotic symptoms at 1.48 per 100 person-years. (Person-years is defined as total years of treatment with a drug. For example, 100 people taking a drug one year is 100 person-years.) The statistic was based on data from 49 randomized, controlled trials of ADHD medications. In those same studies, no psychotic symptoms were reported in children who did not receive medication. Moreover, an analysis of spontaneous adverse-event reports to the FDA showed more than 800 reports of psychosis or mania. Psychotic symptoms were found with every ADHD drug tested.

Just under 8% of U.S. children, ages 4 to 17, have been diagnosed with ADHD, according to a survey conducted in 2003 by the Centers for Disease Control and Prevention. More than half of these children were taking a medication for the disorder. However, the research reported today shows that psychotic symptoms occurred even in children who were not considered at high risk for psychosis or mania, such as children who abuse drugs or have other mental illnesses. In more than 90% of the cases, the children had never experienced hallucinations or psychosis. In most cases, the hallucinations were visual and tactile and involved seeing or feeling bugs, worms or snakes. The symptoms typically disappeared after the children stopped taking ADHD medication.

It's not clear just why some children experience psychotic reactions to the drugs or what causes the symptoms. However, doctors should explain to parents that any psychosis or mania that occurs during treatment could be from the drug itself, said the authors of the report. And, they add, their paper is fresh evidence regarding the limitations of short-term clinical trials. The clinical trials of stimulant drugs showed a much lower rate of psychotic symptoms, but it wasn't until the medications were widely prescribed in a broad range of people that psychotic adverse events became prominent.

-- Shari Roan

Photo credit: Keith Beaty/Toronto Star/ZUMA Press    


Easing ADHD is a walk in the park

October 16, 2008 |  4:02 pm

As many as 2 million American children have attention deficit hyperactivity disorder, a condition that makes it hard for children to control their behavior or pay attention. That means that in a class of 25 or 30 kids, Kid2 it's likely one of them will have the often disruptive condition. And parents know that getting a simple homework assignment done can take hours longer than it should.

Treatment can include behavioral management, medications such as Adderal or Ritalin, or some combination of both. But a new study in the Journal of Attention Disorders shows that parents might try a simple romp through nature as a way of gaining some peaceful, attentive time with their ADHD kids.

Researchers from the University of Illinois took children with the condition on 20-minute walks. On various days, they walked through urban downtowns, through residential neighborhoods, and through a grassy, tree-filled park. Each child took all three walks, and then was tested only against himself or herself on a standard neurocognitive test that measures attention. In the test, for which studying and preparation is useless, a series of numbers is given, and the child has to recite the series backwards.

The walk in the green space proved best for improving attention.

"What this particular study tells us is that the physical environment matters," said Frances Kuo, an author of the study. "We don't know what it is about the park, exactly –- the greenness or lack of buildings –- that seems to improve attention, but the study tells us that even though everything else was the same –- who the child was with, the levels of noise, the length of time, the time of day, whether the child was on medication -– if we kept everything else the same, we just changed the environment, we still saw a measurable difference in children's symptoms. And that's completely new. No one has done a study looking at a child in different environments, in a controlled comparison where everything else is the same."

The kids who were on medications skipped their doses of drugs on the days of the walks, and researchers found that a dose of nature was, at least for a while, as effective as a dose of medication.

It makes sense, in that sort of "well, it can't hurt" way. Parks are generally more peaceful and soothing in themselves than bustling downtowns or distracting residential areas. And it's easy enough to give it a try, what with a romp through nature being good for kids under any circumstances.

"I could imagine parents hearing about this research and immediately applying it -– just trying it out –- taking their child to the park either when their child's symptoms are exacerbated or as a regular routine. It's not that hard to incorporate, especially if they have a green backyard or if they can get to a neighborhood park," said Andrea Faber Taylor, lead author of the study. "Again, we can't say for sure that it would work for any given child –- but there's probably very little risk involved in encouraging your child to play outdoors and seeing if their symptoms improve."

Come to think of it, it might work for children and adults who don't have ADHD. Those of us who just have standard mental fatigue and a now-and-then inability to stay focused might benefit from a regular dose of calming nature. What could it hurt?

-- Susan Brink

Photo: A child plays on straw bales in Germany. Credit: Michael Probst / AP



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