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Your Child

Adult and Childhood ADHD Two Different Disorders?

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A couple of recent studies are taking a new look at the differences in adult and childhood ADHD.

They suggest that adult ADHD is not just a continuation of childhood ADHD, but that the two are different disorders entirely.

In addition, the researchers say that adult-onset ADHD might actually be more common than childhood onset.

The two studies used similar methodology and showed fairly similar results.

The first study, conducted by a team at the Federal University of Rio Grande do Sul in Brazil, evaluated more than 5,000 individuals born in the city of Pelotas in 1993. Approximately 9 percent of them were diagnosed with childhood ADHD — a fairly average rate. Twelve percent of the subjects met criteria for ADHD in adulthood — significantly higher than the researchers expected — but there was very little overlap between the groups. In fact, only 12.6 percent of the adults with ADHD had shown diagnosable signs of the disorder in childhood.

The second study, which looked at 2,040 twins born in England and Wales from 1994-5, found that of 166 subjects who met the criteria for adult ADHD, more than half (67.5 percent) showed no symptoms of ADHD in childhood. Of the 247 individuals who had met the criteria for ADHD in childhood, less than 22 percent retained that diagnosis into adulthood.

These reports support findings from a third study from New Zealand, published in 2015. Researchers followed subjects from birth to age 38. Of the patients who showed signs of ADHD in adulthood in that study, 90 percent had demonstrated no signs of the disorder in childhood.

While the results from these studies suggests that the widely accepted definition of ADHD – a disorder that develops in childhood, is occasionally “outgrown” as the patient ages- may need to be reassessed.

However, not everyone is on board with the recent findings. Some experts suggest that the study’s authors may have simply missed symptoms of ADHD in childhood in cases where it didn’t seem to become apparent until adulthood.

“Because these concerns suggest that the UK, Brazil, and New Zealand studies may have underestimated the persistence of ADHD and overestimated the prevalence of adult-onset ADHD, it would be a mistake for practitioners to assume that most adults referred to them with ADHD symptoms will not have a history of ADHD in youth,” write Stephen Faraone, Ph.D., and Joseph Biederman, M.D., in an editorial cautioning the ADHD community to interpret the two most recent studies with a grain of salt. They called the findings “premature.”

In both of these studies and in previous research, adult ADHD has been linked to high levels of criminal behavior, substance abuse, traffic accidents and suicide attempts. These troubling correlations remained even after the authors adjusted for the existence of other psychiatric disorders — proving once again that whether it develops in childhood or adulthood, untreated ADHD is serious business.

Both of the studies challenge conventional beliefs that childhood onset ADHD is more likely to continue into adulthood. Many experts would like to see more research on this topic to verify these findings

The two studies were published in the July 2016 issue of JAMA Psychiatry.

Story source: Devon Frye, http://www.additudemag.com/adhdblogs/19/12040.html

Your Teen

Acetaminophen, No Threat To Child's Liver

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With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

Your Baby

Benefits of Waiting to Clamp the Umbilical Cord

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Could waiting just three minutes before clamping the umbilical cord after childbirth make a difference in your child’s motor and social skills? According to a new Swedish study, children of mothers that delay cord clamping, reap the benefits later in life – especially for boys.

Delaying cord clamping is already known to benefit babies by increasing iron levels in their blood for the first few months of life, researchers write in the most recent edition of JAMA Pediatrics.

“There is quite a lot of brain development just after birth,” said lead author Dr. Ola Andersson of Uppsala University in Sweden. “Iron is needed for that process.”

For the study, researchers followed up on 263 Swedish children born at full term to healthy mothers about four years earlier.

As newborns, the children had been part of a larger study in which a total of 382 babies were randomly assigned to either early cord clamping (within 10 seconds of birth) or late cord clamping (at least three minutes after birth).

Four years later, the children were similarly intelligent regardless of when their cords had been clamped, but there were some notable differences.

“When you just meet a child, you wouldn’t see or notice any differences,” Andersson told Reuters Health. “But we could see the differences in fine motor function.”

The children were tested for IQ, motor skills and behavior. Parents also reported on their children’s communication, problem solving and social skills.

Results of the study showed that overall brain development and behavior scores were similar for both groups, and there was no significant difference in IQ scores.

However, more children in the delayed cord clamping group had a mature pencil grip on the fine motor skills test and better skills on some social aspects compared to those whose cords were clamped early.

Researchers found that boys benefitted much more than girls.

Iron deficiency is much more common among male infants than among females, Andersson said.

“Girls have higher iron stores when they are born,” he said.

Delaying cord clamping by three minutes allows an extra 3.5 ounces of blood to transfuse to the baby, which is equivalent to a half a gallon of blood for an adult, Andersson said.

“There’s a lot of iron in that volume,” he said. “Even three minutes can have quite a lot of effect on the iron in the blood in the body for a long time after birth.”

The new study provides evidence of benefit for full-term babies in a developed country where nutritional deficiency is extremely rare, Andersson said.

“When a baby transitions from inside the womb to outside the womb, if you think about what nature does, it is not to clamp the cord immediately,” said Dr. Heike Rabe of the Brighton and Sussex Medical School and University Hospitals in the UK.

Why do doctors traditionally clamp the cord quickly? About 60 years ago, doctors began clamping the cord almost immediately because it was thought that it would reduce the risk of hemorrhage for the mother. Doctors now know that is not the case.

Even though the scientific understanding behind cord clamping has changed, it’s still difficult for some doctors to change how they’ve always done things.  Today, parents can have more say in how their baby is born and whom they choose to deliver their child.

Parents-to-be should discuss their wishes with their OB/GYN or family doctor ahead of time and weigh the pros and cons of delaying cord clamping for their particular birthing process.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/05/26/us-gynecology-pediatrics-cord-neurodevel-idUSKBN0OB2ET20150526

 

 

Your Child

ADHD: Behavioral Therapy First Before Drugs

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Researchers have been studying the possible benefits of using behavioral therapy as a first choice in treatment for children with attention-deficit hyperactivity disorder (ADHD).

One paper found that children’s ADHD problems improve quicker when behavioral therapy is started initially instead of medications, the New York Times reported. . Another paper noted that this treatment progression is less expensive over time.

If the effectiveness of the behavior therapy-first approach is confirmed in larger studies, experts say it could change standard medical practice for children with ADHD, which currently favors medications as first-line treatments.

Medications were most effective when used as supplemental, second-line treatment for children with ADHD who required the drugs. In many cases, the drugs were effective at doses lower than normally prescribed, according to the findings in the Journal of Child & Adolescent Psychology.

"We showed that the sequence in which you give treatments makes a big difference in outcomes," study co-leader William Pelham Florida International University, told The Times.

"The children who started with behavioral modification were doing significantly better than those who began with medication by the end, no matter what treatment combination they ended up with," he said.

Some experts noted that the research focused on behaviors and not some of the other complications associated with ADHD such as attention and learning problems.

"I think this is a very important study, and the take-home is that low-cost behavioral treatment is very effective, but the irony is that that option is seldom available to parents," Mark Stein, a professor of psychiatry and pediatrics at the University of Washington, told The Times.

One resource for more information on finding a specialist in behavioral and cognitive therapies is, http://www.abct.org/Home. Click on the “Find a CBT Therapist” link.

Another online resource is, www.additudemag.com, which offers information on the program, COPE (Community Parent Education) and how to locate one in your community.

Story Source: WebMD News from HealthDay, http://www.webmd.com/add-adhd/childhood-adhd/news/20160218/behavioral-therapy-adhd

Your Teen

Are Energy Drinks Rotting Your Teen’s Teeth?

2:00 to read

A lot of parents know that too many high sugar sodas are not only hazardous to their child’s waistline and health, but they can also cause cavities. But what about the energy drinks teens are gulping down? A new study suggests those drinks could be stripping the enamel right off their teeth.   

In a study published in the May/June issue of General Dentistry, researchers have looked for the first time at the effects of energy drinks on teeth. It turns out there's often a lot of citric acid in the drinks.

To give drinks a long shelf life and to enhance flavors, preservatives are added. It’s the preservatives that are very good at stripping the enamel off of teeth.

Dentists are especially worried about teens. 30 to 50 percent are now drinking energy and sports drinks and losing enamel. Once it's gone, teeth are more prone to cavities and more likely to decay.

"We are well aware of the damage that sugar does in the mouth and in the whole body — the role it can play in obesity, diabetes, etc," says Poonam Jain, an associate professor in the School of Dental Medicine at Southern Illinois University, Edwardsville, and the lead author of the study. "But the average consumer is not very well aware that acid does all kinds of damage, too."

To measure just how energy and sports drinks affect teeth, the researchers looked at the fluoride levels, pH, and something called "titratable acidity" of 13 sports drinks and nine energy drinks, including Gatorade and Red Bull.

The researchers then measured how much enamel the drinks took off teeth, dousing sliced-up molars in a petri dish with the beverages for 15 minutes, followed by artificial saliva for two hours. This was repeated four times a day for five days.

The researchers found that teeth lost enamel with exposure to both kinds of drinks, but energy drinks took off a lot more enamel than sports drinks.

Drink labels list citric acid in the ingredients, but they don’t have to show the precise amount.

The American Beverage Association (ABA) was quick to respond to the study.  

"It is irresponsible to blame foods, beverages or any other single factor for enamel loss and tooth decay (dental caries or cavities)," the ABA said in a statement responding to Jain's paper. "Science tells us that individual susceptibility to both dental cavities and tooth erosion varies depending on a person's dental hygiene behavior, lifestyle, total diet and genetic make-up."

"This study was not conducted on humans and in no way mirrors reality," the ABA noted in its statement. "People do not keep any kind of liquid in their mouths for 15 minute intervals over five day periods. Thus, the findings of this paper simply cannot be applied to real life situations."

Jain is concerned about health effects beyond cavities. She says consuming a lot of citric acid can lead to loss of bone mass and kidney stones. "This has become a big concern because people are drinking more of these drinks and less milk," she says.

Dentist Dr. Jennifer Bone, spokesperson for Academy of General Dentistry, the organization that publishes the journal, said in the statement that teens and adults should curb their intake of these types of drinks. If they're going to drink one anyway, she recommends they chew sugar-free gum or rinse their mouth with water after drinking the beverage.

"Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal," Bone said.

Sources: http://www.cbsnews.com/sections/health/main204.shtml?tag=hdr;cnav

http://www.npr.org/blogs/health

Daily Dose

Treating Ear Infections

Plenty if ear infections going around, so what's the best treatment?It has been very busy in my office with plenty of ear infections going around.  Once you have taken your child to the pediatrician and they have indeed been diagnosed with an ear infection (otitis), what’s next?

Like many things in medicine there is not one right answer to that question and there continues to be a debate on the treatment of ear infections.  The many articles that have been published in past years have looked at the prevalence of certain bacteria in causing ear infections, the role of viruses as a cause of ear infections and even when and if to treat an ear infection. The articles did not seem to have a clear consensus.  You may have noticed that too if you have seen different doctors who have different opinions about otitis treatment. Now, two recent articles in the New England Journal of Medicine (Jan. 2011) once again looked at antibiotic use for the treatment of ear infections.  In two double blind, placebo controlled, randomized trials (the gold standard for studies) researchers defined otitis as the “acute onset and presence of middle-ear effusion (fluid), bulging tympanic membrane (ear drum), erythema (redness) and pain. The studies were done in Europe and the United States, and looked at whether children between 6 months and 35 months of age improved more quickly if they received an antibiotic rather than a placebo (no antibiotic). This debate had been ongoing, and both of these studies showed that the children who received antibiotics had symptom resolution more quickly than those who were given placebo.  The study also showed that those who received antibiotics were more likely to develop diarrhea. (bummer, hate those side effects!) Given these recent studies I think that the consensus would be that young children with documented ear infections should receive a course of antibiotics. That would typically mean children 2 and under. But, these studies did not look at the practice of what is called “watchful waiting” which has been advocated for older children. When a child over the age of two complains of ear pain, and is then examined and found to have an ear infection it may not always be necessary to prescribe an antibiotic. If the child is old enough to easily evaluate and does not appear ill it may be appropriate to be conservative about antibiotic use, and to provide pain relief with topical ear drops and oral pain relievers such as acetaminophen or ibuprofen. In many cases in an older child, the pain and infection will resolve over several days and an antibiotic will not be necessary. I often write a prescription for a parent to use if their child seems to become more uncomfortable, or the pain persists. In most cases these prescriptions have not been used. Doctors should take into account the history of previous ear infections, parental concerns as well as concerns about excessive use of antibiotics. “Watchful waiting” requires educating parents and having a discussion as to the pros and cons of antibiotic use. Each case may be a little different. Ear infections are still one of the most common reasons a child receives an antibiotic. These two articles now help clear up the debate about antibiotic use in younger children. “Watchful waiting” may still be appropriate for an older child with a simple ear infection. That’s your daily dose for today.  We’ll chat again tomorrow.

Your Toddler

Proof That Reading to Your Child is Good for Them

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Not only do small children love being read to but a new study confirms that it is actually good for them.

Brain scans taken of 19 preschoolers whose parents regularly read to them showed heightened activity in important areas of the brain. Experts have long theorized that reading to young children on a consistent basis has a positive impact on their brain development; researchers say this study provides hard evidence that it does.

 The study’s leader Dr. John Hutton, of Cincinnati Children's Hospital Medical Center,

 and his team used functional MRI scans to measure real-time brain activity in 19 children, aged 3 to 5 years, as they listened to stories and to sounds other than speech.

Parents were interviewed about "cognitive stimulation" at home, including how often they read to their children. Based on their responses, the number ranged from two nights a week to every night.

Overall, Hutton's team found, the more often children had story time at home, the more brain activity they showed while listening to stories in the research lab.

The impact was largely seen in the area of the brain that is used to obtain meaning from words. There was "particularly robust" activity, the researchers said, in areas where mental images are formed from what is heard.

"When children listen to stories, they have to put it all together in their mind's eye," Hutton explained.

Even though children's books have pictures, he added, that's different from watching all the action play out on a TV or computer screen.

When a child is listening to a story being read to them, they are engaging a different part of the brain than when they are passively sitting in front of a screen with images.

The American Academy of Pediatrics (AAP) advises parents to read to their children every day, starting at birth. That pre-kindergarten time is a critical time for brain development, Hutton said. Other research has found that children with poor reading skills in first grade usually do not "catch up" with their peers.

Hutton believes that a traditional story time provides a critical "back-and-forth" between parents and children.

"It's not just a nice thing to do with your child," he said. "It's important to their cognitive, social and emotional development."

Reading to your child can help him or her build a lifelong relationship with the written word. That skill will help them be able to navigate more easily in school, later on in business and can bring hours of personal pleasure through the stories of gifted writers.

Source: Amy Norton, http://consumer.healthday.com/cognitive-health-information-26/brain-health-news-80/brain-scans-show-why-reading-to-kids-is-good-for-them-701897.html

 

 

Your Baby

Sing to Soothe Your Crying Baby

1:30

Have you ever reached the end of your patience trying to soothe a crying baby? Next time, switch to singing instead of talking. You may be surprised at the results.

Researchers at the University of Montreal in Canada, found that infants respond sooner and stop crying longer when listening to a song instead of speech.

The small study involved 30 healthy infants, aged between 6 and 9 months. The purpose of the research study was to investigate how the emotional self-control of the infants would be influenced when they are exposed to music or speech.   

The researchers maintained the objectivity of the study by not using any sounds that could have been recognized by the children.

For their study, researchers at the University of Montreal in Canada, played Turkish music and two types of speech -- ‘baby-talk' and regular adult-directed dialogue to the infants.

Researchers deliberately chose a language and music that would be unfamiliar to the babies.

Mothers were placed behind the children to avoid contact and the environment cleared of any other possible stimuli.

After playing both the music and regular speech to the children, researchers found that singing was twice as effective at calming distressed babies compared to exposure to regular dialogue: Babies remained calm for an average duration of nine minutes before breaking out in tears, while dialogue -- both the ‘baby-talk' and adult speech -- kept them calm for less than half that time.

The findings are significant, authors note, because Western mothers speak more to their babies, than sing.

"Our findings leave little doubt about the efficacy of singing nursery rhymes for maintaining infants' composure for extended periods," said study co-author Isabelle Peretz in a statement.

"These findings speak to the intrinsic importance of music, and of nursery rhymes in particular, which appeal to our desire for simplicity, and repetition."

Next time your baby is cranky, don’t be bashful; break out all the nursery rhymes you know and sing away. It may be the just the sound your baby wants to hear.

The study was published in 2015 in the journal Infancy.

Story source: http://www.ctvnews.ca/health/singing-more-effective-than-talking-to-soothe-babies-study-1.2631472

 

 

Your Child

1 in 10 Kids Have an Alcoholic Parent

2.00 to read

Since the passing of singing legend, Whitney Houston, the public has heard almost non-stop about her battle with serious drinking and drug problems. We’ve also learned that her 18-year-old daughter has had her own trouble with drugs and alcohol. They may be celebrities, but they share one thing in common with many American families - the long-term effects of alcohol abuse.

More than 1 in 10 U.S. children are living with an alcoholic parent and are at increased risk of developing a host of health problems of their own, according to a new government study released on Thursday.

Researchers at the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed national survey data from 2005 through 2010. They found that on average, 7.5 million children, under the age of 18, lived with a parent abusing alcohol during any given year. That’s about 10.5 percent of the under 18 population.

About 6.1 million of the children, lived in a 2-parent household where one or both of the adults abused alcohol.

Researchers said that of the 1.4 million children who lived in a single parent home where the adult had a drinking issue, the overwhelming majority was in female-head of households. The figure given was 1.1 million households.

"The enormity of this public health problem goes well beyond these tragic numbers as studies have shown that the children of parents with untreated alcohol disorders are at far greater risk for developing alcohol and other problems in life," SAMHSA representative Pamela Hyde said in a statement.

The study said that children of alcoholics were at a greater risk for mental health problems including anxiety and depression.

Another not surprising discovery was that these children were at higher risk for being abused or neglected by their parents. They were also more likely to have thinking or language difficulties and four times more likely to develop alcohol problems of their own.

While this study looks at how many children live with an alcoholic parent, the American Academy of Child & Adolescent Psychiatry (AACAP) reports that if you substitute relative for parent then the statistic changes to one in five adult Americans have lived with an alcoholic relative while growing up.  Again, the statistic is pretty staggering.

What can be done to help children of alcoholics? There are support groups and resources available, but understanding family members, friends, teachers, coaches and counselors can also help lead these children down a more positive path.  

Children and adolescents of alcoholic parents can benefit from educational programs and mutual-help groups such as programs for children of alcoholics, Al-Anon, and Alateen. Early professional help is also important in preventing more serious problems for the child, including reducing risk for future alcoholism.  Child and adolescent psychiatrists can diagnose and treat problems in children of alcoholics. They can also help the child to understand they are not responsible for the drinking problems of their parents and that the child can be helped even if the parent is in denial and refusing to seek help.

Some resources for families dealing with alcohol abuse are:

1. National Association for Children of Alcoholics- www.nacoa.net

2. Al-Anon – www.al-anon.alateen.org

3. Adult Children of Alcoholics – www.adultchildren.org

4. The American Academy of Child & Adolescent Psychiatry- www.aacap.org

Sources: http://www.reuters.com/article/2012/02/16/us-usa-drinking-study-idUSTRE81F0CB20120216  / http://www.aacap.org/

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