July 4, 2014

Warning of Suicide Risk with Antidepressants Had Unintended Consequences

Remember several years ago, when the FDA issued warnings about the risk of suicide for children and adolescents who were taking antidepressants? Well, stand by for an attitude adjustment. A study published last month in BMJ showed that the effort to save children probably harmed them instead.

The researchers tracked an increase in suicide attempts that seem to have been the result of depressed youngsters failing to seek treatment at all. They said the study shows how public health warnings that were intended to do good sometimes can backfire, especially if the subject is sensitive and gets a lot of media attention.

As the Washington Post recalled, the FDA issued warnings in 2003 and 2004 of an increase in suicidal thoughts among some children and adolescents who were taking a certain class of antidepressants (selective serotonin reuptake inhibitors, or SSRIs); you might recognize some of their brand names — Paxil and Zoloft.

So dire was the potential for harm that the FDA required manufacturers of the drugs to include a “black box” warning on the label. Such warnings denote the highest level of concern about side effects, including death. The warnings specified that the drugs presented an increased risk of suicidal thoughts and behaviors in youths who take them.

The media were all over this story, and the study’s researchers said the coverage focused more on the tiny percentage of patients with those thoughts than on the vastly larger number of youths who benefited from antidepressants.

After the warning, antidepressant prescriptions declined sharply among kids 10 to 17 years old, and among young adults from 18 to 29. Coincidentally, the researchers found, the number of suicide attempts rose by more than 1 in 5 among the younger group, and by more than 1 in 3 among the older group.

Of course the media’s lapel-grabbing headlines — “FDA links drugs to being suicidal” (New York Times), and “FDA confirms antidepressants raise children’s suicide risk” (The Washington Post) — “became frightening alarms to clinicians, parents and young people,” the researchers wrote. But consumers bore some responsibility as well.

“There was a sort of overreaction by the media, but also an excessive caution on the part of patients,” Christine Lu, a Harvard Medical School researcher and co-author of the BMJ study, told The Post. “Lots of people who needed treatment steered clear because of the fear factor. … For any drug, there are risks, for sure. But there’s also the risk of leaving the underlying condition untreated.”

Her team plotted the rise in suicide attempts by studying reports of nonfatal poisonings involving psychiatric medicines, which is a common indicator of attempted suicides. They thought the likely number of suicide attempts probably was much higher, because they didn’t track other suicide methods and poisonings that went unreported.

As The Post noted, the BMJ findings dovetail with a 2007 study in the American Journal of Psychiatry that showed a steep decline in antidepressant prescriptions after the feds issued the warnings.

That study didn’t prove that suicides rose as a direct result of fewer such prescriptions, but experts said there weren’t a lot of other explanations.

Despite their conclusion, the BMJ researchers don’t believe that the FDA was wrong in issuing the warning 10 years ago. But “FDA advisories and boxed warnings can be crude and inadequate ways to communicate new and sometimes frightening scientific information to the public,” they wrote.

And the researchers point out that media attention can raise awareness of medical situations people should know about, like the risk of Reye’s syndrome in children who are given aspirin. But, they said, sometimes “the information may be oversimplified and distorted when communicated in the media.”

Not every scientific mind agreed that advisories were too bold. In Discover magazine, an article by The Neuroskeptic titled “The FDA’s Antidepressant Warning Didn’t Really ‘Backfire,” took issue with the study’s conclusions:

“And while the authors never outright state that the FDA’s warning caused the extra suicide attempts,” it said, “they strongly imply that, using phrases such as ‘It is disturbing that after the health advisories, warnings, and media reports [...] we found substantial reductions in antidepressant treatment and simultaneous, small but meaningful increases in suicide attempts.’ “Are they right to be disturbed? By my reading – no. Their data just don’t support a causal effect.”
Neuroskeptic’s argument is interesting and rather geeky, and deserves consideration. The lesson here is that both regulators and the people who watch them must not be alarmists when communicating drug risks. And the lesson for parents with children who are depressed is to discuss frankly and fully the risks and benefits of all treatments. Like all drugs, antidepressants might be exactly what some people need, and not the best option for others.

It’s a matter of the degree of illness and managing its risk.

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May 16, 2014

Turning Childhood Into Illness

Hearing about the booming numbers of kids diagnosed with worrisome conditions like attention deficit hyperactivity disorder and bipolar disorder can make parenthood seem like punishment. But according to one reasoned mind, kids are no sicker now than they used to be, it’s just that we’re turning childhood into an illness.

Writing on KevinMD.com, Dr. Allen Frances, a psychiatrist and professor emeritus at Duke University, wants people to reject commonly heard “statistics” such as:


  • ADHD has more than tripled in 20 years, and is diagnosed in 1 in 5 teenage boys.

  • Autism occurs in 1 in 68 children and that 20 years ago, it was 1 in 500.

  • Bipolar disorder increased recently by 40-fold.

Too often, said Frances, children are “mislabeled for behaviors that used to be considered part of normal variation.”

What he calls “misplaced diagnostic exuberance” is a product of classroom research that showed that the youngest kids in class are much more likely than the oldest to be diagnosed as having ADHD, and to receive stimulant treatment. (See our blog, “Should Age Determine When Kids Start School?”)

“It is shameful,” writes Frances, “that simple immaturity due to being younger is now mislabeled as mental illness and mistreated with a pill.”

He says diagnosing ADHD should be reserved for kids who have “an early onset of very severe and persistent symptoms displayed in a wide variety of family, school, and social contexts.” That requires not only thorough evaluation, but a period of watchful waiting. That’s more frustrating for many parents and caregivers than rushing to diagnostic judgment and treatment. Make that overtreatment.

Among the harms of such overtreatment for the 2 in 3 active kids who have been misdiagnosed with ADHD is suffering from unnecessary stigma, reduced expectations and drug side effects.

“We need to do a better job of protecting our children from such widespread careless diagnosis and reckless treatment,” he says.”

He blames marketing and greed by pharmaceutical companies for fueling this diagnostic fire. “Massive and cleverly misleading marketing has transformed the stimulant drug market from a minor player to a $10-billion-a-year cash cow,” he notes. “This is great for executives and shareholders but bad for the kids who are mislabeled and mistreated.”

He, like other doctors we’ve written about, wants to reduce the “formidable lobbying” of the pharmaceutical industry, and stop it from advertising directly to consumers.

He wants resources spent on schools, educational tools, not on hawking drugs. “What makes more sense,” he asks, “promiscuous use of pills or smaller class sizes and more facilities for physical activity that allow kids to blow off steam?”

“It is completely irrational to shortchange our schools and then spend a bundle on misguided medical treatment for normally active kids who don’t do well in a stressed school environment.”

“[L]et’s diagnosis and treat our classrooms and playgrounds,” Frances concludes, “not overdiagnose and overtreat our children.”

In other words, let a kid be a kid.

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January 10, 2014

Having a Conversation with a Child with Autism

Many people feel awkward around someone who is different — in color, gender, nationality or physical/mental ability. It’s part of the human condition, but so is compassion and understanding. Kathleeen O’Grady, a research associate at Concordia University in Montreal and the mother of a son with autism, helps to expand our humanity with advice on how to communicate with a youngster who has autism.

Writing on KevinMd.com, O’Grady notes that an estimated 1 in 88 children is diagnosed with autism, a neurological disorder often characterized by difficulty with social interaction. That can make holding a conversation challenging, but it doesn’t mean you should leave kids with autism out of one.

“Contrary to popular belief,” O’Grady writes, “most kids with autism are not anti-social. Yet, many “neurotypicals” still struggle when it comes to including a child with autism in the conversation. Those that do try, often fail because they don’t know a few essential rules that can help make the interaction possible.”

Here are O’Grady’s three rules for communicating with a kid who has autism.

1. Don’t start the conversation with a question.

Even a simple question like, “How are you?” or “What’s your favorite color?” can seem like a test to some children with autism. And if they fail the first question, the conversation is over before it starts.

These kids generally know what you are saying or how to answer, but sometimes their answer sometimes gets “trapped” between the thought and the expression of it. Any environmental change or interference — background noise, pace of speech, accent or their own anxiety when exposed to new places and people — can make the answer to even a simple question enormously difficult.

So start a conversation with a statement they can build on: “I love your shirt;” or “Cool dinosaurs” are observations that invite a child to comment in kind if he or she wants to. Then you can build on it, conversationally.

2. Be patient.

Usually, kids with autism don’t need you to speak slowly, but they do need time to form a response. “Too often,” O’Grady writes, “I’ve seen adults wait for a child’s response to a question, and when the response doesn’t come, immediately throw another question out there in hopes that the child will respond to the second attempt.

“If they’d simply waited another 20 or so seconds, they may have had a response to their first query.” But throw out another, and the child might get confused and freeze up trying to figure out if they should respond to the first or second query.

Just wait. And just when you think you’ve waited long enough, count out five more seconds in your head, and wait again. Each child has his or her own response time, so it may take a few tries to figure out how long they need.

3. Don’t take it personally, and try again later.

Some adults try and fail to engage children with autism. They presume that the child doesn’t like them or is anti-social generally. Neither is likely to be the case.

Kids on the autism spectrum sometimes just don’t respond to social communication — even when they are fully able, and even when they understand what’s going on.

Maybe the child is imagining something terrific in his or her head — a video game, a piece of music — that is so powerful that he or she can’t be pulled out of the imaginary world and into yours at that moment. In other words, you can’t compete.

Sometimes the environment is overwhelming, and makes the child too anxious or overloaded with sensory stimuli to respond. Sometimes, a kid just doesn’t feel like talking.

It’s not personal. Try again to convince him or her that joining your conversation is worth the effort. If there’s still no response, the mood will pass. Try again later.

The bottom line, O’Grady says, is that you should never leave a child with autism out of the conversation. “Chances are,” she says, “they want to engage, but they need to do so on their terms and within their abilities. Make the effort, and not only will you make a child happy, it’ll make your day too.”

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November 29, 2013

Justice for a Senseless Case of Untreated Jaundice

Although jaundice is not a welcome trait for a newborn, it’s not uncommon. About 6 in 10 U.S. newborns are at least mildly jaundiced — they have a tell-tale yellowish cast that signals elevated blood levels of bilirubin. It’s a naturally occurring reddish-yellow pigment in bile and blood, but if levels that are too high are left untreated, it can cause brain damage.

Usually, the danger is effectively neutralized with light therapy that turns toxic bilirubin into a water-soluble form the bodily easily eliminates. More difficult cases might need blood transfusions to rid the tiny body of its poison.

Six years ago, New York Methodist Hospital discharged a newborn without a proper exam despite his symptoms of jaundice. Even though his mother reported his yellowing skin, his doctor, Ioanis Atoynatan, did not follow up.

Six years later, Jaelin Sence, brain-damaged and permanently handicapped, received a $26 million judgment from a jury for the tragic case of malpractice.

“I don’t know if I’ve seen a more preventable case,” said his attorney, Thomas Moore, on the DailyNews.com. “It’s heartbreaking to see a child like this.”

Jaelin can’t use his arms and legs, and has never said “mama” or “dada.”

Fewer than 48 hours after he was born, Jaelin was sent home from Methodist Hospital despite rapidly yellowing eyes. Nurses apparently disregarded his mother’s concerns, and told her the problem would resolve on its own.

But Jaelin grew worse, and when he began vomiting, his parents rushed him to Kings County Hospital, where was diagnosed with hyperbilirubinemia (kernicterus) — the severe jaundice that causes brain damage and cerebral palsy.

Doctors performed two blood transfusions, but they couldn’t save Jaelin from the dire damage.

“They couldn’t save my son’s brain, but they saved his life,” Myrtho Sence told the Daily News.

The defense said it plans to appeal the jury’s award, but if it stands, it will allow the Sence family to provide 24-hour-a-day care for Jaelin.

All newborns are at risk for jaundice, but certain factors can predispose a baby toward it, including premature birth, incompatible mother-child blood groups and bruising.

To learn more about this kind of preventable brain injury, see our backgrounder.

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October 18, 2013

Doctors Are Prescribing Fewer Psychotropic Drugs

A few years ago, we blogged about the high, atypical use of antipsychotic medicine for children, and the disturbing questions such practices sparked about such widespread use of these powerful drugs. We also wrote about how the boom in diagnoses for attention deficit hyperactivity disorder (ADHD) can lead to overmedicating.

A recent study published the journal Pediatrics, however, shows that by the end of 2009, psychiatric medications were used less often for young children.

Psychotropic drugs, which affect one’s mental state and often his or her cognitive abilities, are powerful meds that can be life-saving for some people. But, like all drugs, they carry risks as well as benefits. Children, whose brains are still developing, could be particularly vulnerable to psychotropic side effects.

We’ve written, for example, about the risk of suicide for some drugs that treat attention deficit hyperactivity disorder (ADHD). And in 2004, the FDA issued a warning about the association between antidepressant use among children and suicide risk.

More recently, an association between diabetes and the use of antipsychotics by children has been shown.

So the fact that the percentage of children who are prescribed antipsychotics, stimulants and antidepressants during doctor visits is lower than it was in the mid-2000s is good news.

Dr. Tanya Froehlich, the study’s senior author, told Reuters.com, "I'm very excited that the use of these drugs in this age group seems to be stabilizing.

"It's good to get a gauge on what we're doing with psychotropic medications in this age group, because we really don't know what these medications do to the developing brain."

Earlier studies looked at the use of psychotropic drugs among preschoolers, but they usually focused on one class of medication or only one segment of the population. For this study, national data for about 43,500 doctors' visits from 1994 to 2009 was used, involving kids ages 2 to 5.

In that time span, Reuters explained, the proportion of psychotropic drug prescriptions varied between one prescription for every 217 doctors' visits in 1998 and one for every 54 visits in 2004.

Between 1994 and 1997, about 1% of preschoolers left the doctor’s office with a psychotropic prescription. Between 1998 and 2001, the percentage declined to about 0.8%. It rose to a high of about 1.5% between 2002 and 2005, and dropped to 1% between 2006 and 2009.

Although the latest figure wasn’t the lowest, it was still notable because the decrease and stabilization occurred while increasing numbers of children were diagnosed with behavioral disorders. More diagnoses, but less treatment with heavy drugs.

The study didn’t explain the lowest rate between 2006 and 2009, but the researchers suggested it might be because of a greater awareness of the meds’ possible side effects.

The drugs have been widely prescribed to address disruptive behavior by preschoolers, so perhaps other behavioral interventions are being tried first, and with at least some success.

"The thing pediatricians should be asking themselves is, ‘Are we really following the guidelines in treating these children?' which is trying behavioral therapy and then going to the medications," Froehlich told Reuters.

See our blog, “Does Your Kid Really Need a Psychotropic Drug,” if you think your doctor might prescribe one to address your child’s behavioral issue. Learn more about these medicines on the National Institutes of Health site, Mental Health Medications.

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October 11, 2013

Not Every Child Who Stutters Needs Treatment

If your preschooler is a stutterer, there’s good news from a study recently published in the journal Pediatrics. Four-year-olds who stuttered were not found to be different from their peers when it comes to temperament or mental health. Also, their language skills, nonverbal cognition (the nonword ability to think and process information) and health-related quality of life was superior to that of children who didn't stutter.

As interpreted by MedPageToday.com, the study results support the idea that parents should watch and wait instead of trying to intervene as soon as their youngster begins to stutter.

Long-term stutterers often report a lower quality of life, and they may experience lower educational achievement and a higher incidence of psychological problems, such as social phobias. But the Pediatrics report refutes the idea that all stutterers have poorer health outcomes.

Most young children aren’t aware of stuttering, and generally they don’t react to stuttering behavior, especially when it first begins.

Among the study’s findings:


  • More than 8 in 100 children stuttered by the age of 3; more than 11 in 100 did so by age 4.

  • More than 6 in 100 children recovered within one year of the onset of stuttering, and four of them had professional help, typically from a speech pathologist.

  • This rate of stuttering was about twice that of previous reports.


Among factors that predicted the onset of stuttering onset were:

  • mothers with higher education;

  • male gender;

  • twins.


It’s interesting to note that family history of stuttering was not among predicting factors.

Most children, the study shows, resolve their stuttering disorder within about 4 years from its onset, but intervention can help those who don't. Current guidelines, according to MedPage Today, advise parents to wait one year to see if kids will recover on their own before launching into expensive, time-intensive treatment. The new study suggests suggest many could wait longer.

"What we used to think was a disorder that required earlier intervention is a disorder that we could do a more watch-and-see approach with," Irv Wollman, clinical director of speech-language pathology at Cincinnati Children’s Hospital Medical Center told MedPage Today. "Rushing into early intervention may not necessarily be the route to go."

There’s a difference, though, between stuttering and the more troubling symptoms of such distress at the disorder that kids avoid talking, or they talk only with increased physical effort. If that describes your child, it’s time to consult with a speech-language pathologist.

Otherwise, the researchers said the more conservative, wait-and-see approach would reserve scarce resources for the few children for whom stuttering doesn't resolve and who suffer adverse outcomes.

At least one powerful voice has been raised in opposition to that advice. As reported on MedPage Today, The Stuttering Foundation called the study conclusions a "blunder" that could mislead parents into believing that there's little cause for concern or no immediate need to seek help.

"The biggest problem with the data,” said Jane Fraser, president of the foundation, “is that it stops at age 4, just when one might expect to see some harmful effects from stuttering. It is far too early to interpret the findings because we do not know how many of these children continued to stutter and what effects it had on them and their lives."

For The Stuttering Foundation’s advice to parents, link here.

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August 23, 2013

Recognizing and Treating Anxiety Disorders

No parent wants to see his or her child suffering. When the distress is emotional, it can be harder to address because nothing hurts; everything hurts.

Writing on PsychCentral.com, psychologist Marla W. Deibler, a specialist in anxiety and obsessive-compulsive disorders, has some guidance for parents to recognize their child’s anxiety problems, and what to do about them.

Deibler says anxiety disorders are among the most common psychological problems children and adolescents experience—about 13 in 100 U.S. kids suffer from them. Such problems are the greatest predictors of adult problems including substance abuse and a variety of mood disorders. So identifying them early and getting them treated is key to positive long-term outcomes.

Anxiety itself is neither good nor bad—it’s an appropriate response to many circumstances, it’s how our bodies register stress so that we can confront and diffuse it. But if anxiety is excessive, it’s hard to turn off. It can become so overwhelming that we’re unable to function, to perform our regular routines.

Deibler identifies six common anxiety disorders parents should watch out for.

1. Generalized Anxiety Disorder (GAD) is characterized by persistent, pervasive worry that is difficult to control.

Children with GAD are chronic worrywarts. They fret about family, friend and romantic relationships; academic performance; recreational performance. They concerns might be legitimate, but they exaggerate them, and obsess about them.

They worry about not measuring up to the expectations of others. They might have a hard time sleeping, they might constantly seek reassurance. They’re often irritable, and have stomach- or headaches.

2. Separation Anxiety Disorder is expressed by severe distress when kids are separated from their caregivers. Generally, it begins when they are younger than 10.

Separation anxiety is a normal stage of child development from late infancy to several years later. But cause for concern is when it the degree is extreme and acute every time a child is separated from the caregiver(s). Such an extreme is clinically significant if it interferes with a kid’s ability to engage in age-appropriate activities—school, play dates, sports, etc.

Children with separation anxiety might seem excessively clingy, reluctant to do anything requiring separation. They, too, can complain of stomach- and headaches.

3. Social Anxiety Disorder is recognized by excessive concern about being judged by others. It’s not just being shy—it’s being anxious and extremely worried about embarrassing yourself. Kids with this disorder freeze at the prospect of performing or speaking in public; even doing such simple acts as eating or writing if somebody’s watching. And, either imagined or real, judging.

These kids are afraid of being criticized or humiliated. Older kids might avoid situations they believe will make them anxious, and younger kids might act out--crying, or having a tantrum. They also might feel breathless, dizzy, lightheaded, have a racing heart rate or stomachache.

4. Selective Mutism (SM) makes a child unable to speak in certain settings, even though he or she is otherwise able to talk and interact.

SM typically presents in a child as being able to talk freely at home and other comfortable settings, but unable to do so at school or in the presence of strangers. These children might gesture or use other nonverbal efforts to communicate, but can’t seem to speak.

5. Specific Phobias are characterized by excessive and irrational fears about things or situations not usually considered to be dangerous.

The source of the fear might be dogs or other animals, storms, insects, blood/injections or heights. The fear is so strong as to be debilitating. Youngsters might not understand how unreasonable their fear is. Often, they address this by avoiding the stimulus. They also might act out and experience a racing heart, breathlessness, trembling, dizziness, lightheadedness, sweating or stomachaches.

6. Obsessive Compulsive Disorder is recognized by persistent intrusive thoughts, images or impulses (obsessions) and repetitive behaviors and/or mental acts a kid feels he or she must perform as a response. It’s like a rule that must be followed.

The compulsive behavior is done with the goal of reducing or neutralizing anxiety or distress caused by the obsession.

This disorder, which can present in early childhood, may be exhibited by excessive hand washing, locking and relocking doors, touching or tapping items or spots in a certain order, counting, rewriting, rereading or doing anything in a certain sequence.

Common obsessions include a fear of germs or illness, or harm coming to oneself or one’s family if the child doesn’t engage in compulsive rituals.

The time to treat your child’s anxiety disorder is when it interferes with his or her ability to function every day. Your child’s anxiety is excessive when:


  • It’s unrealistic or irrational.

  • The level of distress far exceeds the seriousness of its cause.

  • It results in perfectionism, or the child having unrealistically high expectations of himself or herself.

  • It’s unwanted and uncontrollable.

  • It results in avoidance or inability to engage in activities the child would otherwise enjoy.


Discuss fears with your child. Be open, honest and listen. Ask open-ended, nonjudgmental questions to learn more about how he or she is feeling. An open-ended question is: Why do you think you’re so afraid of dogs? A closed, judgment-laced question is: “You’ve never been bitten by a dog, why are you afraid of them?

Don’t dismiss any of your child’s feelings, don’t express in words or body language that you think their problem is silly or dramatic.

Don’t reinforce the fear by appearing anxious yourself or by allowing avoidance behavior or school absence. That might reduce anxiety in the short-term, but it prevents children from having to learn adaptive coping skills.

Remember, anxiety tends to increase when what causes it is unpredictable, unfamiliar or imminent. So prepare children for anxiety-provoking situations by discussing them in advance, talking about what could happen, how they might feel, what they might do and, if the worst were to happen, how would they manage that.

But if anxiety is excessive and isn’t getting better, seek professional help from a psychologist who specializes in treating children. Sometimes behavioral therapy is sufficient; sometimes medication must be prescribed. (See our blog about combining therapy and medication to treat anxiety.)

To learn more and to find a child psychologist, link to the American Psychological Association.

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August 16, 2013

Anesthesia Drug May Cause Brain Damage in Kids Undergoing Surgery

Drugs that fall under the category of “anesthesia” are powerful in their ability to separate you from the sensation of pain, and when you’re on the operating room table you wouldn’t want it any other way. But a recent study suggests that for youngsters, at least one of these drugs can have ominous effects.

As reported by AboutLawsuits.com, the drug ketamine can have a toxic effect on developing neurons that can cause learning and memory disorders as well as behavioral problems.

The association was described in a study published in the journal Neural Regeneration Research. It found that children younger than 3 who underwent surgery for an extended period or repeatedly got ketamine for multiple surgeries, exhibited learning and memory disorders and behavioral abnormalities when they reached school age.

The research, which was conducted on rats, not kids, found signs of neural toxicity and neuron death caused by the drug. In case there’s any doubt of ketamine’s power, it has been implicated as a “date rape” drug that leaves victims unable to move or remember what happened. It’s in the same class of drugs as PCP (phencyclidine), a dangerous “recreational” drug, and propofol, the drug that killed Michael Jackson.

Ketamine is a common anesthetic used in combination with a sedative. Apart from pediatric uses, it’s also common in veterinary medicine. Short term side effects sometimes include hallucinations and elevated blood pressure.

The Neural Regeneration Research scientists replicated results found in other studies. They expressed concern that ketamine might cause long-term neurological damage in children, prompting disabled learning and memory function. Dyslexia, hyperactivity and attention deficit hyperactivity disorder (ADHD) were mentioned specifically.

“Researchers,” said AboutLawsuits, “urge health-care providers and parents to weigh the risks with the benefits when considering using ketamine during surgery.”

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April 5, 2013

More Proof that Vaccines Have Nothing to Do With Autism

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."

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January 18, 2013

More Resources for Mental Health Treatment on College Campuses

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.

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December 15, 2012

Helping Kids Cope with the Unspeakable

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.

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October 19, 2012

Is It Safe for Pregnant Women to Eat Fish?

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.

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September 21, 2012

Does Your Kid Really Need Antipsychotic Drugs?

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.

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April 13, 2012

Autism Rates Rise

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.

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March 26, 2012

Early Sleep Problems Signal Later Emotional Troubles

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.

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September 19, 2011

Treatment for Depression Among Teens Is Troubling

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.

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August 14, 2011

Helping Parents Through the Autism Maze

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.”

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August 1, 2011

Crossing a Street Safely When You Have ADHD

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.

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July 25, 2011

Rat Study Suggests Problems for Ritalin & Prozac Combo for Teens

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.

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July 7, 2011

Research Shows Environment Is Main Factor in Autism

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."

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September 1, 2010

Are Too Many Pre-Schoolers Being Put on Anti-Psychotic Drugs?

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.

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October 29, 2009

Do Mental Health Drugs Make Kids Fat?

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.

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June 3, 2009

Depression Prevention Works for Some At-Risk Teenagers

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.

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March 30, 2009

Teens Need Routine Screening for Depression

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.

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March 27, 2009

New Questions about Drugs for Attention Deficit Disorder in Kids

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.

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November 21, 2008

Overmedicating Children and Doctors' Conflicts of Interest

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.

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October 31, 2008

Therapy and Medication Combo Treatment for Anxiety

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.

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January 7, 2008

Study Will Test If Extra Attention Can Reduce Autism Risk

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.

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September 25, 2007

Child and Teen Suicide Up and Anti-Depressant Use Down

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

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