DC Child Accident & Safety Blog

A new, large study by the Centers for Disease Control and Prevention (CDC) should help redirect the concern of parents who still wonder if vaccines have a role in children developing autism.

The science-based medical establishment has not wavered from the position that children should be vaccinated against a variety of diseases (See our blog, “Feds Say Childhood Vaccine Schedule Is Safe and Effective”), but a campaign devoid of science and juiced by quackery keeps planting the seeds of skepticism about whether vaccines do more harm than good.

As reported last week on NPR, the answer, again, is a categorical “no.” The CDC study found no connection between the number of vaccines a child received and his or her risk of autism spectrum disorder. And even though kids get more vaccines than they used to, they’re far less able to provoke an immune response than older versions.

That’s because newer vaccines have fewer antigens. Those substances cause the body to produce antibodies, which are proteins that fight infection. Our bodies are experienced antibody-producers because we’re routinely exposed to microbes, whether they’re the bacteria responsible for a sinus infection or a virus that results in a cold sore. In other words, antibody production is a natural, vital part of human life. To believe it’s responsible for causing a mental disorder is nonsensical.

The CDC study compared the vaccine histories of about 250 children diagnosed with autism spectrum disorder with the histories of 750 kids who weren’t. Researchers compared medical records to see how many antigens each child received and whether that affected the risk of autism. The results, published in The Journal of Pediatrics, were clear.

"The amount of antigens from vaccines received on one day of vaccination or in total during the first two years of life is not related to the development of autism spectrum disorder in children," said lead author Frank DeStefano, director of the Immunization Safety Office of the CDC. Because kids, like everyone else, are constantly exposed to antigens from bacteria and viruses, "It's not really clear why a few more antigens from vaccines would be something that the immune system could not handle," he said.

The the number of vaccines a kid is supposed to get has increased, but the number of antigens in vaccines has decreased. A lot. In the late 1990s, vaccinations exposed children to several thousand antigens, the study said. By 2012, that number was 315.

That’s because the science of vaccination has improved; it’s more precise in how antibodies kick-start the immune system.

The problem with supporters of quack science is not only that they leave their children and others in their community vulnerable to the problems vaccines address, they also divert resources into worthless pursuits that otherwise would contribute to the body of science, not waste time trying to overcome it.

"I certainly hope that a carefully conducted study like this will get a lot of play, and that some people will find this convincing," Ellen Wright Clayton told NPR. She’s a professor at Vanderbilt University who contributed to a report on vaccine safety for the Institute of Medicine. “That would let researchers pursue more important questions.

"The sad part is, by focusing on the question of whether vaccines cause autism spectrum disorders, they're missing the opportunity to look at what the real causes are," she said. "It's not vaccines."

College is when kids become adults and, for many, begin to navigate the world mostly by themselves. It’s also when, in some cases, the symptoms of mental illness begin to present or get worse.

A collaborative report by KaiserHealthNews.org and NPR recently explained how some campuses are implementing systems to address the growing population of students with mental health needs. The growing demand is attributed to a couple of factors: a society more tolerant of the need to help people with mental illness so that students feel more comfortable seeking help at school, and more teenagers getting mental health treatment earlier who otherwise wouldn’t have made it to college at all.

According to the story, the average college counseling center sees 1 in 10 of the school's enrolled students each year.

At the University of Virginia, Charlottesville, for example, the counseling center uses a triage system to be able to see as many students as possible. When a student calls the counseling line, he or she gets a 20-minute phone consultation with a therapist. Discussion subjects include sleeping and eating habits, attendance, substance use and whether they're having thoughts of self-harm.

Students in crisis are seen by counselors immediately. If appropriate, prescriptions for medication are authorized. One in 4 callers is referred to off-campus therapists right away.

Last year, the program was able to accommodate 9,000 counseling center visits with only 12 full-time therapists for a student body of about 25,000.

Alison Malmon, president and founder of Active Minds, a mental health advocacy group with chapters on campuses across the country, told Kaiser/NPR that schools are getting better at meeting the mental health needs of their students. It’s not ideal, but it’s a big step forward.

To anyone who has felt the social/academic/away-from-home pressure of attending college, results of the Association for University and College Counseling Center Directors Annual Survey (2011) will come as no surprise. Anxiety has outpaced depression as the No. 1 student complaint.

That’s a consequence, no doubt, of the tight job outlook in our pinched economy. But as one former director of the UVA counseling center said, "We really want students to know it's OK to reach out for help, and there's no shame in having anxiety or depression… . It's just part of the human condition."

To find a chapter of Active Minds, click here. To learn more about treatment for depression among teenagers, see our blog. And here are tips for finding a psychotherapist.

Save the Children, one of my favorite charities, is headquartered just 20 miles from Newtown, Connecticut. In this time of sorrow, it's published a practical list of ten things adults can do to help kids cope. Read the whole list and details on Save the Children's web site. Here's the abbreviated list:

Limit television time.
Listen to your children carefully.
Give reassurance.
Be alert for significant changes in behavior.
Understand children's unique needs.
Give your children extra time and attention.
Be a model for your children -- they will learn from your behavior.
Watch your own behavior and make a point of being sensitive to the crisis.
Help children return to a normal routine.
Encourage volunteer work -- doing something for others.

School violence happens often enough that this is a topic we've already covered in this blog, in a good Q&A last March, that you can read here. It also includes a list of warning signals that a child might have violence in their future.

Americans are conflicted about fish. Some of us like to catch them, some of us like to release them and many of us eat them. Health professionals say that fish is good for us (it’s high in protein, most varieties are low in fat and many have heart-healthy properties), that we should eat more. Others take care to note that some varieties of fish are particularly prone to toxic exposure to mercury.

So what’s a pregnant woman to do, especially in light of a new study that shows that a prospective mom’s fish-rich diet can offer protection against the child later developing behaviors associated with attention-deficit/hyperactivity disorder (ADHD)? Especially in light of the Journal of the American Medical Association’s advice (JAMA) that for pregnant women, mothers who are breastfeeding and women of childbearing age, fish consumption is important for its DHA, an omega-3 fatty acid that aids infant brain development?

The new study, published in the Archives of Pediatric and Adolescent Medicine, involved children born during the 1990s in Massachusetts; 515 women who had just given birth completed a dietary survey and about 420 provided samples of their hair for mercury testing. About eight years later, researchers tested the kids to assess behaviors associated with ADHD.

The results, as reported on ScienceNews.org, ranged from children with almost no ADHD-related behaviors to some with clear clinical disease. The mother’s hair-mercury level related to where her child fell along the spectrum.

The data, the researchers said, demonstrate that a woman can eat fish regularly, but also maintain a low-mercury diet. “It really depends on the type of fish that you’re eating,” one of the authors told ScienceNews. Some study participants had been eating more than two servings of fish weekly but tested for relatively little mercury.

Like lead, mercury is a potent neurotoxin that has been linked to many health problems, including delays in neural development. To see our post about the toxic nature of lead, click here.

In the study, children of women with hair mercury levels in the top 20 percent of those tested showed a 50 to 60 percent increased risk of ADHD-related behaviors. But the kids with ADHD-related traits “were still considered to be within the normal range,” the researcher said, “and not maladaptive.” (On some components of the childrens’ assessment for attention, boys showed a greater sensitivity to mercury than girls.)

Other studies have reached similar results. One based in Canada, according to ScienceNews, found an association between elevated mercury concentrations in children at birth and at school age, and an increased risk of ADHD by about age 11. That study also confirmed earlier evidence suggesting a link between lead and ADHD.

Some studies, however, indicate a genetic susceptibility to ADHD in some people. Environmental pollutants, too, are considered by some people to be risk factors. They include tobacco smoke and possibly polychlorinated biphenyls (PCBs), certain pesticides and bisphenol A (BPA).

The new study didn’t collect data on the species of fish the mothers ate. But its researchers said that previous studies have shown that tuna, swordfish and shark can be particularly high in mercury; salmon and cod tend to be relatively low in the toxic metal.

Whether it’s a marker of our “take a pill, solve a problem” mentality or a genuine effort to address a medical diagnosis with less than laserlike precision, a whole lot of kids are taking a whole lot of seriously psychotropic drugs for problems that don’t necessarily require them.

Psychotropic drugs alter perception, emotion and/or behavior. We’ve covered their misuse in general, but this study focused on children at doctors' offices. It followed a similar study last year that surmised that the increase of these powerful agents for youngsters was probably due to inpatient use.

As reported last month by Reuters, antipsychotic drugs are prescribed in nearly 1 in 3 of all visits by children and teens to psychiatrists in the U.S. That’s a significant increase from the 1990s, when it was about 1 in 11 such visits.

The study of this practice was published in the Archives of General Psychiatry. It concludes that the increase is the result of doctors prescribing the drugs for disruptive behaviors, such as attention deficit/hyperactivity disorder (ADHD), never mind that the FDA does not approve antipsychotics to treat those disorders in kids.

They are approved to treat schizophrenia, bipolar disorder and irritability with autism.

Use of them for other purposes is deemed “off-label,” which isn’t illegal, provided the drug manufacturers don’t promote them for such uses.

The study couldn’t say whether the prescriptions were unnecessary, but their effectiveness for disorders such as ADHD is uncertain. And, like all drugs, they carry the potential for side effects. Antipsychotic drugs can promote weight gain and have been linked to diabetes.

Last year, according to Reuters, a large study of children found that kids who took antipsychotic drugs were four times more likely to develop diabetes than their peers who weren’t taking them.

In September, an FDA advisory panel expressed concern about the drugs’ appropriateness for children, and urged the agency to monitor weight gain and metabolic diseases (diabetes) in children who take them.

Antipsychotic drug use is increasing across all demographic groups, but it’s most accelerated for children and teens. It’s difficult to cite exact numbers because the research concerns only prescriptions written during doctor office visits—clinics, community health centers or other facilities weren’t included. Another complication to being exact about antipsychotic drug use in children is that researchers don’t know how long each patient took the drug or if any prescription was written at a repeat visit by the same patient.

The new study’s lead author has his own prescription for parents whose children might be given an antipsychotic drug prescription at a doctor’s appointment. He advises them to ask more questions about the drugs—why is it being prescribed, what are the intended effects, how soon are they expected to appear, what are the side effects (see our blog, “Questions Patients Should Always Ask”)—and also if there are any alternative treatments.

He said psychosocial interventions (training for parents to manage the behavior from certain disorders) can reduce aggressive and disruptive behaviors in kids. But they take time, and they’re more expensive.

"Perhaps if they were more available, we wouldn't have as much use of these antipsychotic medications," he told Reuters.

When awareness of a disease or disorder hits critical mass, often its rate of diagnosis increases. That provokes the chicken-and-egg question of which came first, the incidence of disorder or the awareness of it?

In recent years, many people have looked at autism, and the spectrum of autism disorders, through that lens. A recent study boosts the notion that the prevalence of autism in children is increasing. The U.S. Centers for Disease Control and Prevention concluded that 1 in 88 8-year-olds has some form of autism. The previous estimate was 1 in 110.

Based on 2008 data, the updated figure is sure to fuel debate, according to the Los Angeles Times, over whether a growing environmental threat could be responsible. “But autism researchers around the country said the CDC data—including striking geographic and racial variations in the rates and how they have changed—suggest that rising awareness of the disorder, better detection and improved access to services can explain much of the surge, and perhaps all of it.”

Some experts questioned the validity of relying on records to reach the new estimate.
David Mandell, an autism expert at the University of Pennsylvania, told The Times that the CDC's numbers primarily reflect the degree to which the diagnosis and services have become established in different places and among different groups.

"As the diagnosis is associated with more and more services, this becomes a less and less rigorous way to determine the prevalence of autism," he said, referring to the CDC's methods.

Among the CDC’s results:

• Utah, which has widespread screening programs, had the highest rate—1 in 47 children.


• New Jersey, which also boasts generous autism services, is next at 1 in 49.


• Alabama, one of the poorest states in the country, ranked last. Its autism rate fell between 2006 and 2008 from 1 in 167 to 1 in 208.

The study did have limitations. Researchers looked at tens of thousands of health and special education records in 14 states, looking for an autism diagnosis or symptoms that might indicate one. In some areas, researchers had access only to health records, not school records, and prevalence estimates there generally were lower.

The researchers’ goal was to focus attention on the need for more vigorous screening early in life. Early intervention has been shown to confer the best long-term prospects for autistic children. More than 1 in 5 children deemed autistic by the CDC had no such diagnosis in their records.

A recent series of studies in the journal Nature indicated that the genetic origin of autism is complicated and involves multiple genes. The cause of autism is unknown. There is no blood test or other biological marker—it’s diagnosed by symptoms, which are social and communication difficulties starting in early childhood, and repetitive behaviors or abnormally intense interests. The severity of symptoms can vary widely. Boys are more likely to have the disorder, and whites somewhat more likely than minorities. Ultimately, a diagnosis involves clinical judgment.

Some people, including representatives of Autism Speaks, an advocacy group, believe that the disorder is becoming epidemic in the United States. Others say raised awareness of the disorder enables health-care providers and school authorities to deem a child autistic.

To learn the symptoms of autism, link here. Autism Speaks’ Autism Response Team (ART) members are trained to connect families with information, resources and opportunities. Contact them at 888-288-4762.

A milestone in child development, at least for many parents, is when the kid finally sleeps through the night. But a recent study suggests that it’s a good idea for parents to monitor how the wee ones are sleeping as well as how long.

Published in the journal Pediatrics, the study shows that children who have problems breathing while they sleep are more likely to experience behavioral problems such as hyperactivity and aggressiveness when they get older. They’re also more likely to have emotional issues such as difficult peer relationships.

Researchers from the University of Michigan and the Albert Einstein College of Medicine at Yeshiva University followed the sleeping patterns of more than 11,000 children for six years. They found that kids who snored, breathed heavily through their mouths and experienced apnea—long pauses between breaths during sleep—were at risk.

Collectively known as sleep-disordered breathing (SDB), the problem peaks when children are between 2 and 6 years old, but can occur when they are younger. Approximately 1 in 10 children snores regularly and 2 to 4 in 100 have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids, but be wary of the “quick-fix” of tonsillectomy—as we have reported, that surgical procedure is often unnecessary, and to conclude that tonsils contribute to sleep disorders requires careful diagnosis.

Quite simply, the study’s authors said, “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Although earlier studies indicated sleep problems could signal later difficulties, they involved only small numbers of patients, short follow-up of a single symptom or limited control of individual traits such as low birth weight that could be responsible for some symptoms.

In the new, more substantial study, children whose symptoms peaked between the ages of six and 18 months were much more likely to experience behavioral problems when they were 7 compared with children who breathe normally during sleep. Children whose SDB symptoms persisted throughout the evaluation period, and were most severe at 30 months, expressed the most severe behavioral problems.

Researchers theorize that SDB might be responsible for behavioral problems because of its effect on the brain. Decreased oxygen levels and increased carbon dioxide interrupts the restorative process of sleep and disrupts various chemical systems. Such malfunctions can impair one’s ability to pay attention, plan ahead and organize. They also impede one’s ability to regulate emotions.

To learn more about SDB and treatment options, consult the AAO-HNS fact sheet.

Mental illness. Depression. Suicide. The dark side of the human condition is sad whenever and whomever it strikes. But when the victims are young people, it seems unacceptably unnatural. Yet suicide is the third most common cause of death among teenagers.

So programs such as TeenScreen that survey young people to determine their risk of depression make sense. Those who seem to be at risk are referred for treatment. But John Horgan, writing in Scientific American, raises profound questions about whether screening teens for mental illness is really a good idea for them, or only for a society that wants to feel as though it is doing something.

Some people are opposed to this mental health screening, contending that these issues are private for the youngsters and their families. They contend that they also promote overprescribing of psychiatric medications.

Horgan agrees with the latter concern, noting that:

• Psychiatrists say that more than 1 in 10 children suffer from mental illnesses — from attention-deficit disorder to full blown psychosis. In 2008, the General Accounting Office estimated that 1 in 16 children is “seriously mentally ill.”


• The number of children so mentally disabled that their families are eligible for government assistance has swelled from 16,200 in 1987 to 561,569 in 2007, a 35-fold increase. During the same period, those requiring government assistance for all other ailments declined from 728,110 to 559,448.


• 3.5 million U.S. children take Ritalin and similar medications for (attention deficit hyperactivity disorder) ADHD, up from only 150,000 or so in the late 1970s -- or about 1 in 23 children from 4 to 17.


• U.S.children consume three times as many ADHD medications as the rest of the world’s children combined.


• A 2002 study estimates that 1 in 40 children 18 or younger takes antidepressants. Numerous studies indicate that whereas antidepressants can provide short-term relief for some children, some treated with antidepressants may experience side effects ranging from anxiety and insomnia to full-blown mania and psychosis.


• Since 1995, the number of children diagnosed with bipolar disorder has multiplied more than 40-fold to roughly 800,000.


• Children diagnosed as bipolar are treated with drugs — notably antipsychotics normally prescribed for adult schizophrenics — that have severe physiological as well as mental side effects, including obesity, diabetes and involuntary tremors.


• More than 500,000 children (including infants) ingest antipsychotics, a trend The New York Times reported has been aggressively promoted by manufacturers of antipsychotics.

The promoters of TeenScreen, Horgan writes, have ties to the pharmaceutical industry.
Some psychiatrists advocate medicating young people deemed to be “at risk” of schizophrenia based on behavior less than compelling or because they have schizophrenic relatives.

"Mental illness is devastating for children as well as adults," Horgan concludes, "and medication, when used wisely and sparingly, can help. But clearly our current approach to treating disturbed young people is broken."

Certainly, a disturbed, dangerously unhappy teenager deserves medical attention and appropriate intervention. But before parents agree to an aggressive regimen of psychotropic drugs, they should fully inform themselves of the side effects and risks. There are a lot of ways to treat depression. Drugs is only one.

It’s parental instinct to want to make a child’s world as safe and normal as possible. And when that world is different from the one most other children live in, parents want to know why.

When a pediatrician’s patient lives in the world of autism, explaining the whys and whats to the parents is particularly daunting. Writing in the New York Times recently, Dr. Perri Klass addressed how she relates to parents of autistic children who want to know the cause and, for prospective parents, how they can reduce the risk for children they’re planning to have.

“[A]lthough there is more research in this area than ever before,” she writes, “it sometimes feels as if it’s getting harder, not easier, to provide answers that do justice to the evidence and also offer practical guidance.”

Autism is a complex disorder that research has shown is driven by both genetic and environmental factors. As Klass describes, “Genes matter, but we usually can’t tell how. Environmental exposures matter, but we usually don’t know which.”

Not much there for parents to work with.

A study of autism in twins showed that fraternal twins were both likely to have the disorder, which seems to compromise the strength of the genetic component (since fraternal twins share fewer genes than identical twins).

A couple of generations ago, when ignorance about all mental disorders was evident far more than common sense, autism was blamed on remote parenting. More recently, a noisy campaign was based on fake science supposedly indicating an association between childhood vaccinations and autism, a theory that has been wholly discredited.

But the genetic influences have been proved scientifically sound, and autism spectrum disorder has been described by the American Psychiatric Association as “among the most heritable of psychiatric disorders.”

This evolution of understanding has led scientists to accept that autism results both from genetic predisposition and from environmental influence. But “environment” is a fluid concept.

As one researcher quoted by Klass put it, it’s “everything that’s not the inherited DNA.” Parents might wonder about the chemical ingredients of the placenta’s soup, about the mother’s nutritional profile, her stress level, about the caustic cleaning products under the sink … They’re all part of a developing fetus’s environment.

According to Klass, “The causal links most strongly supported by research include rubella (measles) infection during pregnancy and prenatal exposure to medications like thalidomide and valproic acid, an anti-seizure drug.” Air pollution and exposure to pesticides have an association with autism, but there’s no evidence of causality.

Phthalates, which are chemicals found in flexible plastic products such as shower curtains and other household furnishings such as carpet and shampoo, can leach out in microscopic amounts and disrupt a variety of developmental processes, including brain development. But, again, they haven’t been shown to be a cause of autism, only as an association with its symptoms.

Bottom line: Autism is a custom-made disorder, and probably the result of several factors.
“So it’s hard — and frustrating — to offer prospective parents advice about avoiding risks we still can’t clearly identify,” Klass observes, “and factors that may differ from family to family.”

You can’t completely sanitize your environment, you can’t turn your uterus into a scientific “clean” room — potential toxins are simply a part life. But Klass does offer prospective parents concerned about autism some advice that’s more a prescription of common sense than a prophylactic:

• Take prenatal vitamins before trying to conceive.


• Ensure your immunizations are up to date.


• Get good prenatal care.


• Discuss the risks and benefits of any medications you take with your doctor.


• Avoid pesticides.


• Don’t microwave food plastic containers.


• Use fragrance-free personal products.

“Still, Klass concludes, “it’s hard to talk about this without terrifying parents. And I wonder if in giving advice about prevention, we risk repeating the errors of the past, making parents feel they’re to blame for a child’s autism because they failed to micromanage an environment full of complex agents with potential to interact with fetal genes in a range of damaging but poorly understood disruptions.”

A new study published in the journal Pediatrics offers insight into why children with attention-deficit/hyperactivity disorder (ADHD) are able to observe safety measures when crossing the street, but often fail to do so.

Seventy-eight children from 7 to 10 years years old were involved in the study. Thirty-nine were diagnosed with ADHD and 39 were typically developing children. Researchers looked at three things: (1) how they evaluated their environment before crossing the street; (2) how they decided to begin crossing; and (3) how safe was the environment after the decision to cross was made.

No significant differences emerged in the latter two factors, but the children with ADHD chose riskier pedestrian environments in which to cross. Researchers concluded that this reflected trouble within the brain's "executive function" -- that is, the kids with ADHD were less able to process perceived information necessary to permit a safe cross.

Many adolescents diagnosed with depression and attention deficity-hyperactivity disorder (ADHD) are prescribed both methylphenidate (Ritalin) and fluoxetine (Prozac). A study on rats given the two drugs might give humans pause.

As reported in the Los Angeles Times, the study showed that adult rats who got that drug combination as pups were more likely than those with no early exposure to psychotropic drugs to choose highly sugared water over plain water, and to linger in a compartment where they had gotten a dose of cocaine, which suggests they were hoping for more. Those are disturbing signs of developing addiction.

"Taking Ritalin and Prozac together during adolescence appears to set in motion subtle changes in brain function that, in adulthood, makes an individual more sensitive to reward as well as to stress, and more likely to exhibit the pessimism and hopelessness seen in depression," was how The Times summarized the study published in the Journal of Neuroscience.

The study's authors wrote, "combining methyphenidate and fluoxetine early in life may lead to lifelong behavioral and chemical abnormalities." They said the drugs--one a stimulant, one an anti-depressant--in combination appeared to act on the brain in much the same way as does cocaine.

Those drugs affect production of certain proteins in the brain's reward circuitry. If it's disrupted during adolescence, the adult later might struggle with the ability to regulate mood and to moderate reward-seeking behavior such as eating or sexual activity.

Baby rats who got only Prozac seemed more sensitive to rewards as adults, but were also more resilient to stress than those who didn't. The rats who got only Ritalin demonstrated less inclination toward sugar water, as well as a "significant aversion to cocaine" as adults--a sign that treating ADHD might thwart drug abuse later. But they also showed greater sensitivity to stress later on.

A rat is not a kid, and a trial subject rat is not depressed or afflicted with ADHD. So no straight line can be drawn between the study results and a child with these disorders who takes these drugs. If the study is notable, it is too preliminary for parents to withhold these drugs if they've been prescribed for their children with mood and behavioral problems. It's never too early, however, for a conversation with your doctor about the appropriate use of prescription drugs, and alternative treatments.

Of all neurodevelopmental disorders, autism has been deemed the one most likely to be inherited. But this study shows that genes exert only moderate susceptibility for autism, and that its environmental component is substantial.

Autism is a complex disorder whose signature is the disruption of the normal course of social, communicative and cognitive development. Diagnosis is made in early childhood, and symptoms manifest by the time a child is 3 years old. In the last generation, a substantial increase in the prevalence of autism has been reported, from 4 or 5 per 10,000 in the 1960s to around 40 per 10,000 children today. It's even more common to be somewhere on the "autism spectrum" -- as many as one in 100 children qualify. The increase in recent years often is ascribed to better recognition, not necessarily to a greater occurrence.

The study appears to be the largest "population-based twin study of autism that used contemporary standards for the diagnosis of autism," a standard necessary to examine genetic influences. As the authors report, "The results suggest that environmental factors common to twins explain about 55% of the liability to autism. Although genetic factors also play an important role, they are of substantially lower magnitude than estimates from prior twin studies of autism."

In another study related to autism published in in the Archives of General Psychiatry, prenatal exposure to the most widely prescribed kind of antidepressants--including Celexa, Lexapro, Prozac, Paxil and Zoloft— is associated with a modest increase in the risk of developing autism, especially during the first trimester.

"The potential risk associated with exposure," the authors wrote, "must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings."

Prescriptions of anti-psychotic drugs like Risperdal for pre-school kids have doubled in the last few years, according to a recent study from Columbia University. Now there are an estimated 500,000 children and adolescents receiving such drugs in the United States. Is it too much?

Only four in ten of the preschoolers who receive prescriptions for these powerful drugs have been given a proper mental health assessment, according to the Columbia study. That worries some experts. As one told the New York Times:

“There are too many children getting on too many of these drugs too soon.”

This quote was from Dr. Mark Olfson, professor of clinical psychiatry at Columbia and lead researcher in the new study, which was financed by the government.

Olfson and other researchers worry that the drugs can interfere with physical and mental development in young children. What many kids need is talk therapy, but it's cheaper and more convenient to medicate them, they say.

Read more in the Times' article here.

An article recently published in the Journal of American Medical Association documents findings that associate atypical antipsychotics to weight gain in children who are first-time users of the drugs. The study, headed by Dr. Christoph Correll in New York, includes 272 youths age 4 to 19 and is “the largest and most definitive to date to establish a link between the drugs and weight gain,” writes Jonathan Rockoff of the Wall Street Journal.

The JAMA study examined four top-selling atypical antipsychotics (powerful drugs prescribed to treat schizophrenia and bipolar disorder): Abilify, Risperdal, Seroquel and Zyprexa. Among them, Zyprexa was found to cause the most weight gain: 19 pounds in 11 weeks. It was also found to “significantly raise levels of blood sugar, cholesterol, insulin and triglycerides,” thereby increasing users’ risk of diabetes and heart problems. Patients taking other three medications had an average of 10 to 13 pounds of weight gain.

Dr. Correll, the lead author of the study, recommends using extra caution in prescribing these atypical antipsychotics to youths under the age of 18, and encourages psychiatrists to frequently monitor the weight and metabolic rate of those who are taking these drugs.

One in five American teenagers have an episode of depression before they turn 18. If untreated, adolescent-onset depression often returns during adulthood and becomes a chronic and persistent condition that is crippling and even life-threatening. One of the risk factors is having a depressed parent: that increases the odds of becoming depressed in one's teen years by two- to three-fold.

But an article appearing in the latest Journal of American Medical Association has good news, as reported by Shirley Wang of The Wall Street Journal: a multicenter trial conducted in 4 U.S. cities found that a group prevention program effectively reduced the risk of subsequent depression for a target group of teenagers.

The study involved 316 “at-risk” teenagers (ages 13-17). All had a history of clinical depression and parents who had had depressive disorders. The youths were assigned to either a group cognitive behavioral prevention program or usual mental health care. After 9 months of treatment, of the teenagers who were assigned to the group CB prevention program and whose parents were not depressed at the time of the study, only 11.7% had a new depressive episode. In contrast, among teenagers in usual care whose parents were not depressed at the time, 40% experienced another episode of depression.

Although the prevention program only worked for teenagers whose parents were not currently depressed, the new finding is still encouraging, shedding light on future research directions and clinical recommendations.

Nearly two million American teenagers are afflicted with depression, and major medical groups are now recommending that pediatricians give a simple but detailed questionnaire to all their teenage patients to try to detect this condition so that treatment can be offered.

About 1 out of 20 teens suffer from depression, which has been linked to lower grades, more physical illness and drug use, as well as early pregnancy.

Questionnaires can accurately identify teens prone to depression, plus there's new evidence that therapy and/or some antidepressants can benefit them, according to a report from the U.S. Preventive Services Task Force, published in the April 2009 edition of the journal Pediatrics .

Accompanying the task force advisory in Pediatrics is a research review saying there have been few studies on the accuracy of depression screening tests, but the tests "have performed fairly well" among adolescents. Treatment can help with symptoms of depression, say the reviewers from Kaiser Permanente and the Oregon Evidence-Based Practice Center in Portland, Ore.

But careful monitoring is vital since there's "convincing evidence" that antidepressants can increase suicidal behavior in teens, according to the Preventive Services Task Force report.

The new recommendation reverses what the task force said in 2002, when it reported that there was not enough evidence to recommend for or against routine screening of adolescents for depression.

Thirty-nine million prescriptions were written for American children in 2008 for drugs like Adderall and Concerta to treat attention deficit hyperactive disorder (ADHD), but new research suggests the drugs have only short-term benefit and may pose more harm to children than good if given for more than two years.

In a report in the Washington Post by Shankar Vendatam, scientists involved in a large federal study of the drugs sharply disagreed with one another about what the public should be told about their study results. One psychologist in the group of researchers said that parents needed to know that careful comparisons of the children in the study showed definite advantages of the drug treatment only in the first twenty-four months of use, and that longer use resulted in stunted growth, with drug-treated children typically an inch shorter and six pounds lighter than non-drug treated peers after 36 months of treatment. Another psychiatrist who participated in the study said long-term benefits were real but hard to demonstrate statistically.

The study is called the Multimodal Treatment Study of Children With ADHD (MTA). When its initial results were first published in 1999, a clear advantage was seen for behavior improvement in children who had taken the ADHD drugs in the first fourteen months of the study, compared to children who received only talk therapy or no treatment at all, and those results ignited a huge wave of popularity for the ADHD drugs with pediatricians and parents. But as the researchers have continued to follow the same children over the years, the advantage of drug therapy, at least as measurable statistically, disappeared.

Statistics, of course, do not necessarily apply in any one individual case. The take-away for parents is to be careful about any long-term use of drugs in their children and to continue to ask questions of doctors, and reach your own informed decisions about what to do.

Nearly every week, we hear more evidence that American children are over-medicated, especially with drugs that affect mood and behavior. Most recently, a panel of experts has denounced the overuse of Risperdal, a powerful antipsychotic drug, for attention deficit disorder. The drug has too many side effects, including potential development of permanent muscle twitching, to justify its use in mild conditions like ADD for which other options exist, according to the expert panel convened by the Food & Drug Administration to advise it on labeling changes.

What is behind the explosion in use of antipsychotic drugs in children (besides Risperdal, they include Zyprexa, Seroquel, Abilify and Geodon) is a drumbeat of support from leaders in child psychiatry. But that leadership is tainted by their ties to the drug industry -- ties that frequently don't get mentioned in public when these same doctors are lecturing their colleagues and advising worried parents. One leader, Dr. Joseph Biederman, a child psychiatrist at Harvard, was revealed by a Congressional investigation to have accepted $1.4 million from manufacturers of antipsychotic drugs that he did not disclose to his university. Another psychiatrist leader, Dr. Charles B. Nemeroff of Emory, had to step down as chair of psychiatry after it was revealed that much of his consulting pay from drug makers, which totaled over $2.8 million in seven years, had been hidden from his university.

Now another influential psychiatrist has been exposed for his secret ties to the drug industry. He is Dr. Frederick Goodwin, former chief of the National Institute of Mental Health, who hosted a popular show on National Public Radio, "The Infinite Mind." Senator Charles Grassley of Iowa released data to the New York Times showing that Dr. Goodwin received $1.3 million from drug manufacturers from 2000 to 2007 for giving marketing lectures to other doctors. The money was never mentioned on his radio show, and NPR now says the show has been canceled and all reruns will stop soon.

According to the Times' Gardiner Harris, on one day in 2005, Dr. Goodwin received $2,500 from GlaxoSmithKline to give a talk about its mood stabilizer drug Lamictal at a Ritz Carlton resort in Florida. On his radio show broadcast the same day, Dr. Goodwin said that children with bipolar disorder who did not get treatment could suffer brain damage (a controversial prognosis) but he reassured his listeners that mood stabilizer drugs were a safe and effective way to treat the problem.

Senator Grassley has sponsored legislation to require drug makers to post publicly all the payments they make to doctor consultants. That would help the public to know whether the recommendations they see from doctors for medicating their children are truly unbiased or should be taken with a grain of salt.

The largest study done yet of anxiety disorders in children and adolescents suggests that a combination of therapy and antidepressant medications is most effective tor treating disabling anxiety in these age groups.

The particular kind of therapy that was effective is called "cognitive behavior therapy" or "talk therapy." The difference between the combination of therapy and medication and each individual treatment alone was dramatic: 8 in 10 children who had the combination improved significantly, as opposed to 6 in 10 of those who had either the medication or the therapy alone.

The doctors who commented on the study in the article say this is something parents and insurance companies should both be very aware of.

Infants who have a sibling with autism are at higher risk of becoming autistic themselves. At the University of Washington, researchers are testing whether or not a special intervention can be done to reduce the chances of autism in these high-risk babies.

Half of the mothers in the study will be taught to notice subtle cues from the babies and how to seize on these cues as opportunities to engage and communicate with them. These cues, it is hypothesized, indicate when the baby is "reaching out" to its parents.

If the study confirms the hypothesis, it means we will have a non-biochemical way of reducing the risk of autism.

Sometimes children pose a greater risk to themselves than their surroundings do, as any mental health specialist could tell you. An alarming new study shows that the recent decline in the use of anti-depressants in children and teenagers has coincided with an increase in youth suicides.

Anti-depressant use among youths began to go down four years ago, when the Food and Drug Administration (FDA) issued an advisory regarding children and teens who were on anti-depressants and subsequently committed suicide. Later, in 2004, the FDA made a rule saying that anti-depressants had to be labeled for increased suicide risk in pediatric patients. In December 2006, the FDA expanded this rule so that it covered anti-depressant use in young adults as well.

Evidently there was cause for concern four years ago, but this new research suggests that these warnings are doing more harm than good. Prescriptions for these medications declined sharply after the FDA issued the warnings. But the youth suicide rates went up. Likewise, before 2003, an increase in anti-depressant prescription correlated with a decrease in youth suicide:

The researchers found that the reverse corollary was true. Increases in SSRI prescription rates coincided with decreases in suicide rates from 1998 to 2003. In the U.S., a 91 per cent increase in prescription rates coincided with a 33 per cent decrease in suicide rates.

The researchers therefore concluded that the FDA's analysis was flawed, pointing out that the FDA's study (suggesting a link between anti-depressant use and higher youth suicide rates) relied on a biased sample.

That said, there is always some ambiguity in this kind of research. That's why researchers must do multiple studies and why people need to get information from multiple sources. To find more information on mental health in children and teenagers, these links are a good place to start:

National Institute of Mental Health--Depression

National Institute of Mental Health--Children and Adolescents and Treatment of Children with Mental Disorders

Mental Health America--Disorders and Treatments