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Divorce Increases Risk Of Ritalin Use

January 24th, 2011

Divorce puts children at higher risk of Ritalin use compared to kids whose parents stay together, says new research by a University of Alberta sociologist, who cautions that this doesn’t necessarily mean that divorce is harmful to a child. The study appears in this week’s issue of the Canadian Medical Association Journal.

Dr. Lisa Strohschein found that there is a “significantly higher” risk of Ritalin use–nearly twice as high–for children whose parents divorce compared to children whose parents remain together. It is the first study to follow children over time and evaluate whether experiencing parental divorce increases the risk for subsequent Ritalin use, a drug commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD). Previous studies have only compared the proportion of children taking Ritalin in two- biological parent homes versus single parent households. While such studies showed that living in a single parent household was a risk factor for Ritalin use, Strohschein suggests that a snapshot comparison across different family types provides an incomplete picture. There are a number of other ways–including being born to a never-married mother–that a child can come to live in a single-parent household.

“So the question was, ‘is it possible that divorce acts a stressful life event that creates adjustment problems for children, which might increase acting out behaviour, leading to a prescription for Ritalin”‘” said Strohschein.

She was drawn to look at Ritalin usage because prescriptions to children for Ritalin have skyrocketed over the past two decades, leading to concern over whether it is being appropriately prescribed.

Using data from the National Longitudinal Survey of Children and Youth (NLSCY) from 1994 to 2000, Strohschein restricted her sample to almost 5000 children who, at initial interview, lived in a two-biological parent household and were not Ritalin users. Between 1994 and 2000, 633 of these children (13.2 per cent) experienced the divorce of their parents. The percentage of children taking methylphenidate, or Ritalin, during that time was 3.3 per cent for children whose parents remained married and 6.1 per cent for children whose parents divorced during this time period. The findings complement previous research by showing that it is not just living in a single parent household, but parental divorce that is associated with greater risk.

One potential explanation for the higher use of Ritalin could be that divorce is stressful and some kids develop mental health problems and are then appropriately prescribed the drug, says Strohschein. “But a second possibility could be that ADHD has a genetic component so the association between parental divorce and Ritalin use in children exists because parents themselves have personality features that make it less likely their marriages will last,” she said. “On the other hand there is also the very public perception that divorce is always bad for kids and so when children of divorce come to the attention of the health-care system–possibly because parents anticipate their child must be going through adjustment problems–doctors may be more likely to diagnose a problem and prescribe Ritalin.

“If this latter case is the real explanation, then there is the possibility that Ritalin is being prescribed inappropriately.”

The message, says Strohschein, is to educate parents and doctors that not all kids develop mental health problems when their parents divorce. Instead, there is a need to look at the circumstances in the child’s life before, during and after the divorce event to determine if the child is actually having problems coping. “In other words, it’s too extreme to assume all children are adversely affected by divorce,” she said. “We want to be very careful in ensuring that children who really need help receive treatment and avoid giving medication to kids who may not be well served by it.”

ADHD Drug Does Stunt Growth

December 16th, 2010

After 3 Years on Ritalin, Kids Are Shorter, Lighter Than Peers

From WebMD.com

After three years on the ADHD drug Ritalin, kids are about an inch shorter and 4.4 pounds lighter than their peers, a major U.S. study shows.

The symptoms of childhood ADHD — attention deficit hyperactivity disorder — usually get dramatically better soon after kids start taking stimulant drugs. But this benefit may come with a cost, says James Swanson, PhD, director of the Child Development Center at the University of California, Irvine.

“Yes, there is a growth suppression effect with stimulant ADHD medications,” Swanson tells WebMD. “It is going to occur at the age of treatment, and over three years it will accumulate.”

Whether these kids eventually grow to normal size remains a question. Kids entered the study in 1999 at ages 7 to 9. The current report is a snapshot taken three years later. The 10-year results — when the kids are at their adult height — won’t be in for two more years.

“The big question now is whether there is any effect on these kids’ ultimate height,” Swanson says. “We don’t know if by the time they are 18 they will regain the height.”

The finding appears to end decades of debate over whether stimulant medications affect children’s growth. Less than 10 years ago, a National Institutes of Health panel concluded that the drugs carried no long-term growth risk.

That opinion was so widely accepted that the study authors — who include most of the leading ADHD researchers in the U.S. — did not warn parents that the study medication might carry this risk.

At the time, researchers thought that any short-term stunting of growth would be made up by a hypothesized “growth spurt” that would occur with continued treatment. But Swanson and colleagues saw no evidence of such a growth spurt.

Another widely accepted theory was that ADHD itself stunted kids’ growth. But in a surprise finding, the study found that ADHD kids who do not take stimulant drugs are much larger than kids without ADHD. And these untreated kids continued to grow much faster than kids taking stimulant drugs.

Swanson says that children who had been taking ADHD drugs before the study began were smaller than kids who had not yet started treatment. Those who first began treatment at the start of the study were normal in size, but grew more slowly than normal kids as the study went on.

After three years, the growth suppression seemed to reach its maximum effect. That’s also when the effect of the ADHD drug used in the study — immediate-release Ritalin three times a day, every day of the year — seemed to wear off.

“We compared the effect of medication relative to just pure behavioral treatment,” Swanson says. “That effect was substantial at 14 months and reduced a bit at 24 months. But at 36 months the relative advantage of ADHD drugs over behavioral treatment is gone.”

Swanson and colleagues note that the study did not test the sustained-release stimulant medications that are now the standard treatment for ADHD.

Omar Khwaja, MD, PhD, a neurologist at Children’s Hospital inBoston, last year analyzed studies of different ADHD drugs and found strong evidence that ADHD drugs do, indeed, stunt children’s growth. In fact, Khwaja and colleagues calculated a growth effect that almost exactly matches the effect seen in the Swanson study.

But Khwaja agrees with Swanson that nobody yet knows what the long-term results of this side effect will be.

“Whether there will be rebound growth at end of puberty, the jury is still out,” Khwaja tells WebMD.

“Parents have to be aware that stimulants are an enormous benefit to a lot of children with ADHD, but there is reason to be cautious with all medicines that affect the brain,” he says.”Growth monitoring should be standard practice for kids taking these medications.”

Swanson and colleagues report their findings in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Posted in ADD/ADHD, Children & Pregnancy, Drugs & Prescriptions | Comments Off

Pool Chlorine Implicated In Childhood Asthma
November 7th, 2010

From Science A Go Go.com

The chlorine used to disinfect indoor swimming pools may be implicated in the surge of childhood asthma in developed countries, suggests research in Occupational and Environmental Medicine.

Trichloramine, or nitrogen trichloride, a highly concentrated volatile by-product of chlorination, that is readily inhaled and generated during contact between chlorine and organic matter such as urine or sweat, seems to be the culprit.

The research team measured levels of lung proteins (SP-A, SP-B, and CC16) associated with cellular damage in the blood samples of 226 healthy primary school children from rural and urban schools. The children had swum regularly at indoor pools weekly or fortnightly since early childhood.

Blood samples from 16 children, aged between 5 and 14, and 13 adults, aged between 26 and 47, were also analysed before and after a session in an indoor pool to test for the immediacy of the effects of trichloramine.

Finally, the researchers assessed the prevalence of childhood asthma, using data from a survey of almost 2000 children aged between 7 and 14, carried out between 1996 and 1999.

The results showed that regular attendance at indoor swimming pools was consistently and significantly associated with the destruction of the cellular barriers protecting the deep lung (respiratory epithelium), making them “leaky” and potentially more vulnerable to the passage of allergens.

The effects were cumulative, and for children who swam the most frequently, equivalent to the damage found in the lungs of regular smokers, say the authors.

The immediacy of the damage done was evident in the levels of the marker proteins, which were significantly higher after just one hour spent at the poolside, without swimming.

An increase in IgE, a risk factor for asthma, was not associated with regular swimming itself, but was linked to an increase in the smaller of the proteins indicative of lung damage (SP-B). Furthermore, chest tightness after exercise, and overall prevalence of asthma, were both linked to the cumulative amount of time spent at indoor pools.

The effects were the same for children wherever they lived, and remained after taking account of other environmental pollutants. But they were strongest in the youngest children.

The authors point out that swimming is recommended for asthmatics because the hot humid air in pools compensates for the effects of exercise, but not if the air is laden with toxins. Levels of trichloramine can vary greatly, depending on how crowded a pool is, how clean the swimmers are, and how well ventilated the area is.

The authors conclude that chlorinated indoor swimming pools might explain the rise in diagnoses of childhood asthma. “The question needs to be raised as to whether it would not be prudent in the future to move towards non-chlorine based disinfectants, or at least to reinforce water and air quality control in indoor poolsin order to minimise exposure to these reactive chemicals,” they add.

Dr. Perlmutter’s comment:

Fortunately, there are wonderful alternatives to chlorine including ozone and ion pool sterilizers.

Posted in Ailments, Asthma, Children & Pregnancy, Toxins & Harmful Ingredients | Comments Off

ADHD may be moderated by mom’s love, study finds
October 16th, 2010

From American Psychological Association

Maternal affection, or warmth, is related to lower rates of attention-deficit hyperactivity disorder (ADHD) among low-birth-weight twins, says a report published this spring in the Journal of Counseling and Clinical Psychology (Vol. 72, No. 2).

In their study of 2,232 5-year-old twins, half of whom had low birth weight, researchers found a significant interaction between children’s birth weight and maternal warmth in predicting mothers’ and teachers’ ratings of ADHD, says lead researcher Terrie Moffitt, PhD, a professor of psychology at King’s College in London and the University of Wisconsin-Madison.

The study stemmed from observations of lingering problems with hyperactivity and intellectual deficits among Romanian orphans who were adopted into English families. Psychiatrist Sir Michael Rutter, MD, of the Institute of Psychiatry in London, had previously argued that deprivation of caregiver warmth in the orphanage might be a key factor in that finding. Moffitt and her team sought to investigate his claim.

“We also reasoned from other studies that warmth is a good indicator of a parent’s overall investment in child-rearing, so it might be a factor that could prevent hyperactivity and intellectual deficits in at-risk children, such as those with low birth weight,” she adds.

In the current study, maternal warmth was coded from mothers’ audiotaped answers to open-ended questions about their feelings for their children, she says. Then, both teachers and parents were asked to rate the children’s ADHD symptoms. Each child also took an IQ test. (The study found no significant indication that maternal warmth affected IQ.)

The researchers coded a mother’s warmth on a six-point scale, based on tone of voice, spontaneity, sympathy and empathy toward the child. They indicated “high warmth” and “moderately high warmth” when mothers expressed definite warmth, enthusiasm, interest in and enjoyment of the child, exemplified by comments like “she is a delight; she is so happy; I love taking her out; she is my ray of sunshine.” They coded “some warmth” when mothers showed a detached and rather clinical approach, with little or no warmth of tone but moderate understanding, sympathy and concern. “Very little warmth” showed up when there was only a slight amount of understanding, sympathy, concern or enthusiasm about or interest in the child.

Within the sample, 20 percent of twins had mothers who expressed low warmth, 37 percent had mothers who expressed moderate warmth and 43 percent had mothers who expressed high warmth. The results of twins with the same mother, but varying degrees of warmth expressed toward them were particularly useful to the researchers, Moffitt says.

Low-birth-weight children who had more warm, loving relationships with their mothers were less likely to be described as having ADHD symptoms by parents and teachers, a correlational finding that may suggest that high levels of warmth protect some children from poor behavioral outcomes, Moffitt says. Moreover, low levels of warmth appeared to exacerbate the behavioral problems associated with low birth weight.

“Some researchers have argued lately that what parents do has little effect on their children,” Moffitt says. “Some have said that parents’ actions only matter if the acts are very extreme, such as child abuse. This paper provides one small bit of initial evidence to the contrary. A simple natural parental inclination to be warm and affectionate toward children did matter for children’s outcomes in this study.”

The findings suggest emphasizing warmth might be a useful addition to parent education curricula, she says.

“Parent training programs have been proven to be effective, but in addition to emphasizing monitoring, control and consistent discipline, they might wish to encourage parents to express affection too,” Moffitt says.

Posted in ADD/ADHD, Ailments, Children & Pregnancy | Comments Off

40 Percent of 3-month-old Infants Are Regularly Watching TV, DVDs Or Videos
September 29th, 2010

From Newswise

A large number of parents are ignoring warnings from the American Academy of Pediatrics and are allowing their very young children to watch television, DVDs or videos so that by 3 months of age 40 percent of infants are regular viewers. That number jumps to 90 percent of 2-year-olds, according to a new study by researchers at the University of Washington and Seattle Childrens Hospital Research Institute. The findings are being published today in the Archives of Pediatrics and Adolescent Medicine. The study is the first to look at the trajectory of media viewing in the first two years of life and to explore the content of what is being watched. The research also explores parents reasons for permitting it. Exposure to TV takes time away from more developmentally appropriate activities such as a parent or adult caregiver and an infant engaging in free play with dolls, blocks or cars, said Frederick Zimmerman, lead author of the study and a UW associate professor of health services. While appropriate television viewing at the right age can be helpful for both children and parents, excessive viewing before age 3 has been shown to be associated with problems of attention control, aggressive behavior and poor cognitive development. Early television viewing has exploded in recent years, and is one of the major public health issues facing American children.

Co-authors of the study are Dr. Dimitri Christakis, a pediatrics researcher at Seattle Childrens Hospital Research Institute and a UW associate professor of medicine, and Andrew Meltzoff, co-director of the UWs Institute for Learning and Brain Sciences. This study is important because it teaches us about the media diet of infants who are too young to speak for themselves. Most parents seek whats best for their child, and we discovered that many parents believe that they are providing educational and brain development opportunities by exposing their babies to 10 to 20 hours of viewing per week, said Meltzoff, a developmental psychologist who is the Job and Gertrud Tamaki endowed chair in psychology at the UW.

We need more research on both the positive and negative effects of a steady diet of baby TV and DVD viewing. But parents should feel confident that high-quality social interaction with babies, including reading and talking with them, provides all the stimulation that the growing brain needs. Its not as though TV or a DVD provides an extra vitamin of some kind in the first two years of life, where we concentrated our research in this study. This area is one in which science, health and public policy all meet. We need to get our facts right so we can productively advise parents who so desperately want to do the right thing. The researchers conducted random telephone surveys of more than 1,000 families in Minnesota and Washington with a child born in the previous two years, and found the median age at which infants were regularly exposed to media was 9 months. Among those who watched TV, DVDs or videos, the average daily viewing time jumped from one hour per day for those children younger than 12 months to more than 1 hours a day by 24 months.

The three most important and common reasons cited by parents for allowing their children to watch TV, DVDs or videos were:

29 percent believed these media were educational or were good for the childs brain.

23 percent said viewing was enjoyable or relaxing for the child.

21 percent used these media as an electronic babysitter so they could do other things.

Even though educational content was the top reason given by parents, only about half the infant viewing time was reported to be in what researchers classified as a childrens educational category. This included educational TV programs such as Sesame Street and Arthur and DVDs or videos such as Blues Clues. The remaining viewing time was roughly split among childrens non-educational programs, baby DVDs or videos and grown-up television. Although parents believe in the educational value of TV, DVDs and videos, just 32 percent of parents always watched with their children. Parents also had an inflated idea of how much of these media other children were watching and believed that their children viewed less than the average amount. The study indicated that the perceived average viewing for other families is 73 percent higher than the actual average. At the end of the day the amount of TV viewing is based on what parents think is normal, said Zimmerman. Perceptions of norms tend to shape behavior even if those norms are inflated. So what can parents do to reduce the amount of time their kids spend in front of the tube? Zimmerman has several suggestions. Parents often turn to TV for a break. A better suggestion would be to provide kids with simple activities to do. When parents are cooking, for example, they could have a low drawer with plastic dishes or wooden spoons available that a child can play with or make noise. This gives the child something to be engaged with while taking pressure off the parent.

“A parent can also enjoy reading a fun or familiar book to a child, he said. The child benefits from being close while the parent can get a breather. Children thrive on physical closeness.

Zimmerman and Christakis are the authors of the book The Elephant in the Living Room, Make Television Work for Your Kids and Meltzoff is co-author of The Scientist in the Crib: What Early Learning Tells Us about the Mind.

Dr. Perlmutter’s comment:

This supports the guidlines we provide in Raise a Smarter Child by Kindergarten

Posted in Brain Development, Children & Pregnancy | Comments Off

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