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Children's Health Issues

The TVClubHouse: General Discussions ARCHIVES: 2006 Jun. ~ 2006 Dec.: Health Center (ARCHIVES): Children's Health Issues users admin

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Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 4:47 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 12, 2003


What’s Wrong with my Child?

Part 1 of 3: Crossing the Line


(Ivanhoe Broadcast News) -- Is it simply a bout of the blues or severe depression? Is it just a temper tantrum or a serious behavior problem? For parents, the line between growing pains and a serious mental disorder is often fuzzy. Here's how to recognize when your child has crossed the line.

A walk in the park is not how Marykaye Henline describes life with son Christopher. Despite friends reminding her that all boys are a handful, she knew something was wrong.

At age 5, Marykaye took Christopher to get professional help. Starting at 4 months old, he refused to sleep alone. In preschool, he defied teachers and beat up classmates. Christopher demands constant attention. When he doesn’t get it, he throws up.

"He went after a babysitter with a knife one time," Marykaye tells Ivanhoe. "He repeatedly has dreams that he’ll tell you are very vivid about dismembering family members."

Christopher has a severe case of conduct disorder, according to educational psychologist Bunni Tobias, Ph.D.

"The belief systems -- the thinking -- are absolutely irrational. When they say, ‘I’m going to kill you,’ they have a plan," Tobias, who is known as Dr. Bunni, tells Ivanhoe.

According to her, a kid who’s simply acting out, acts first. Thinks later. He crosses the line when behavior becomes calculated and pre-meditated. He’s deceitful and vindictive. He kicks, bites, and punches to get his way. Tantrums range from 30 minutes to four hours. He shows no remorse.

If the mood swings from extreme anger or sadness to extreme silliness, it could be bipolar disorder. Psychiatrist Demitri Papolos, M.D., says symptoms are often present at birth.

"[Warning signs can be seen in] bright-eyed babies of the nursery, oversensitive, over-reactive to sensory stimuli, easily aroused," says Dr. Papolos, of Albert Einstein College of Medicine in New York.

Warning signs, however, aren’t always loud and angry like Christopher’s were. Naz Zareh was 16 when she went to Dr. Bunni for help. She was severely depressed.

"Yeah, yeah there was a lot of times when that happened and I did, I did give up, you know," says Naz. The signs were there by second grade -- class disruptions, bad grades, loss of friends.

Naz’s father, Kali, says, "She would be so tired and frustrated she wouldn’t want to deal with me or her sister even."

Knowing what triggers an episode in kids with behavior disorders is key. Those triggers can include interruptions in routine, a poor diet, less than six hours of sleep, or an unstable home environment. The word 'no' can also be a trigger.

Unconditional love from dad and therapy finally gave Naz her confidence back -- and her smile.

It’s normal for kids to get angry, sad, or anxious. But doctors say if it is persistent and interrupts a child’s normal activities, like sleeping, attending school, or making friends, it’s time to get help.


If you would like more information, please contact:

Bunni Tobias, Ph.D.
The Kid’s Detective
P.O. Box 1658
Lake Forest, CA 92609
(888) 372-8664
http://www.drbunni.com

Kim Craft
Echo Media Group
12711 Newport Avenue Suite H
Tustin, CA 92780
(714) 573-0842
kim@echomediapr.com

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 4:59 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 12, 2003


What’s Wrong with my Child?
Part 2 of 3: ADHD or Bipolar?



(Ivanhoe Broadcast News) -- As many as 2 million American children are diagnosed with ADHD and are treated with one of a number of approved stimulants to treat the condition. Now, doctors and parents are finding that many of these children really have another condition -- one that calls for a very different treatment.

When Jonathan Latteri was 18 months old, Donna Latteri knew something was wrong. "He started having night terrors. He would be screaming for me and I would be right there for him and he wouldn’t recognize me," Donna tells Ivanhoe.

Life went to pieces for Judith Lederman when her son Eric was 5. She says, "He came to me at four in the morning banging a tambourine at one point."

For Susan Montanile and Charlie, life started spinning out of control when he was 2-and-a-half years old. "Somebody would come over and he wouldn’t just throw a fit in the room, he’d go to another room and cause a big commotion," Susan says.

{All three children were diagnosed as ADHD and put on Ritalin. All three reacted in ways no one expected.


Judith says, "Eric was] running around without clothes in 30-degree weather, outside."

"[Jonathan] wasn’t getting better, he was getting worse," says Donna.

Susan says, "They thought [Charlie] might have been a danger to himself or to others."


It turned out the boys did not have ADHD. They had bi-polar disorder. Child psychiatrist Demitri Papolos, M.D., says the wrong treatment has serious consequences in 70 percent of bipolar kids.

"Many of them became violent, extremely aggressive, oppositional. A certain percentage become psychotic and require hospitalization," Dr. Papolos, of Albert Einstein College of Medicine in New York, tells Ivanhoe.

Bipolar patients experience depression. But when they take Ritalin, they endure depression and mania at the same time.

"That is the period of time when most people actually have the energy to kill themselves and the motivation to do that," says Dr. Papolos.

One way to avoid misdiagnosis is to know the differences. ADHD is constant. Bipolar comes and goes. According to pediatric psychiatrist Paramjit Joshi, M.D., children with ADHD often struggle to get up in the morning. Bipolar kids wake early. ADHD kids are confrontational. Bipolar are often withdrawn. Dr. Papolos, on the other hand, says ADHD kids wake early and bipolar kids struggle to get up in the morning. He also says it's bipolar kids who are confrontational.

A family history almost always goes along with bipolar. Dr. Joshi, of Children’s National Medical Center in Washington, says, "When I have what I call a squeaky clean family history for bipolar disorder and you have a youngster who may have some of the symptoms of bipolar disorder, I am somewhat suspicious and I take my time to really figure out what may be going on."

Dr. Joshi stresses taking a history at what she calls ground level. "You really have to ask about each person in the family, and take your time," she says.

Even when bipolar is diagnosed correctly, the condition can still be frustrating.

Nine-year-old Charlie Crow says, "Sometimes nothing happens, sometimes things happen, I’m not sure what’s going to happen."

But with the right medications, kids can go back to being kids. "It helps me control myself and deal with my temper a lot better than normal," says 11-year-old Jonathan Kistle, and that makes life easier for everyone.

Dr. Papolos and Dr. Joshi agree that the problem is that most child psychiatrists practicing today were trained at a time when bipolar disorder was thought to only affect adults.


If you would like more information, please contact:

Janice Papolos
Juvenile Bipolar Research Foundation
info@bipolarchild.com
http://www.bipolarchild.com

Paramjit Joshi, M.D.
Children’s National Medical Center
(202) 884-3932
pjoshi@cnmc.org

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 5:05 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 12, 2003


What’s Wrong With My Child?

Part 3 of 3: Helping Children Help Themselves



(Ivanhoe Broadcast News) -- According to a recent report by the Surgeon General, about 20 percent of children between ages 9 and 17 in the United States have diagnosable mental disorders -- more than the number of children who are overweight.

Here are two programs helping kids regain control of their lives.

Ten-year-old Santee Bradford's third grade report card was an early sign of a deeper problem. "I was being bad in school, getting bad grades," he tells Ivanhoe.

Santee is bipolar. Last year, he was nearly kicked out of his after-school program for violent tirades. His mother, Consuelo, says, "He would do things and not really remember doing them, and that was really frightening."

Searching for answers, his mom sought help from a mental health project in San Francisco called Family Mosaic. The program reduces hospitalizations as much as 55 percent. It also decreases out-of-home placements as much as 70 percent, and crimes committed by nearly 90 percent.

Family Mosaic Project Executive Director Roban San Miguel says, "What we could really do is be able to decrease the dependence on institutionalization, really help empower the families, and keep their children at home in the community."

Individualized plans include everything from family therapy, sports programs, tutors, music lessons and mentors like Bobby. He meets with Santee up to 10 hours a week.

The Nurse Family Partnership is another mental health program, but it helps children before they’re even born. It educates low-income single women about behaviors during pregnancy that are harmful to their children.

"Children who are exposed to alcohol and tobacco are at significantly elevated risk for behavioral problems when they’re in school and crime and delinquency once they’ve become adolescents," says David Olds, Ph.D., professor of pediatrics at University of Colorado Health Sciences Center in Denver.

Nurses do home-visits for about two years. That intervention has resulted in nearly 80-percent fewer cases of child abuse and neglect, fewer months on welfare, and fewer arrests among moms in the program.

The benefits don’t stop there. Fifteen years later, there are nearly 70 percent fewer convictions among kids in the program, fewer sexual partners, less tobacco and alcohol use and 54-percent fewer arrests.

Jamie Mason says she needs her nurse. "I’m a single mom, and right now I don’t have an education. I think I’ve dealt with things in a healthier manner than I would have without her." She says, "It’s so easy to be selfish when you’re a single mom, and I’ve been selfish. I’m not perfect."

But perfection isn’t the goal -- the goal is to keep kids from going through what Santee has. And he’s one of the lucky ones. "It took some time, a lot of hard work, a lot of tears, a lot of prayers," says his mother Consuelo.

It’s paid off. Santee is no longer on medication and he just won student of the year -- from the very after-school program that nearly kicked him out.

The Family Mosaic Project is limited to San Francisco residents. The Nurse Family Partnership program is now available in 246 counties across 22 states.

If you would like more information, please contact:

Rochelle Frank
Family Mosaic Project
1309 Evans Ave.
San Francisco, CA 94124
(415) 206-7645

David Olds, Ph.D.
Prevention Research for Family and Child Health
1825 Marion St.
Denver, CO 80218
(303) 864-5205

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 5:18 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 19, 2003


What's Wrong with my Child?
ADHD or Bipolar?

Full-Length Doctor's Interview


In this full-length interview, Demitri Papolos, M.D.,
explains the symptoms of bipolar disorder in children.


Ivanhoe Broadcast News Transcript with
Demitri Papolos, M.D., Psychiatrist,
Associate Professor of Psychology, Albert Einstein College of Medicine,
Director of Research, Juvenile Bipolar Research Foundation



After watching these children, what is the difference between bipolar disorder in children and bipolar disorder in adults?

Dr. Papolos: In adults, the presentation of the illness is one where you see rather long durations of cycles of mood, so the mania with the hypomania will last for a week or sometimes months. The presentation, the picture of the mood state, is one of, in adults, typically elation or irritability. There’s usually a tremendous amount of energy, a great deal of anxiety, often agitation, the speech is pressured, it brooks not interruption. The pattern of the cycling, usually for the most part, is mania or hypomania, followed by a period of depression and the depressive episodes are, typically for adults, a depressed mood, sadness, melancholia, and sometimes irritability. They have problems concentrating. They feel worthless. There’s a change in sleep cycle. Often, there’s a sleeping too long and there’s a change in appetite or cravings for carbohydrates or sweets. Suicidal ideation is also not unusual. There’s a withdrawal from the world and an isolation. Often, one of the principle symptoms is a loss of interest in things that would ordinarily give them interest. In children on the other hand, while many of the symptoms and behaviors are similar, the mood swings are typically much more rapid. They will cycle within the day, often multiple times, and apparently for about 80 percent of them, there is a very regular 24-hour cycle that is noticeable. In the morning, they wake up as if they are waking up out of some hibernated state. They are very hard to get going. The parents will describe them as needing to put them on roller skates to get them moving. There’s a difficulty initiating movement. They’re irritable, and if you ask them to do anything, they’ll bite your head off. As the day goes on, they get more energy, they’re more active, and often they’ll get through the school day and then around four o’clock in the afternoon, the rocket thrusters go off. There is a tremendous amount of energy. The moods become either incredibly irritable or elated, silly, goofy, and regressed.

Those are the typical ways in children that the manic or hypomanic state presents. It’s not that way in adults. Then, as the evening goes on, there is more intense activity -- jumping up on beds, provoking their siblings, and then difficulty settling at night and getting to sleep. So, in terms of the mood a swing, that is a common presentation for children whereas in adults, the mood swings are, from one pole to another, are usually much more longer lasting.

That’s a big problem currently in terms of diagnosis and recognition of early onset bipolar disorder because the current manual that psychiatrists, psychologists, mental health professionals use around the country to make the diagnosis is the DSM-IV. The DSM-IV does not distinguish between adult- and childhood-onset bipolar disorder. So, there is a duration requirement typically for making the diagnosis, and of course, most of these kids don’t meet that criteria. They don’t have cycles of longer than a week, so a very, very large percentage of children who are held to that standard and who do have bipolar disorder are not diagnosed. They’re often diagnosed with other conditions that are much more commonly recognized like obsessive/compulsive disorder, major depression, certain anxiety disorders, separation anxiety disorder, because those conditions go hand in hand with bipolar disorder. The problem with that is that most of the, and also attention deficit disorder is another common set of symptoms that overlap with bipolar disorder, and so many, many of these children are originally diagnosed with that condition. The significant problem with that is that most of these conditions are treated with medications that make the course of bipolar disorder worse. So, typically children, parents, who bring their children to me have had their children exposed to multiple trials of stimulants and anti-depressants and the course of their illness has worsened over time. That’s a big, big problem. In many ways, it’s a national mental health problem because so many of these children are being diagnosed with these other conditions where the symptoms are really part of the disorder but not necessarily independent of the bipolar disorder.


I have parents telling me the doctor said it's ADD or ADHD and put them on Ritalin. Then the child ended up hospitalized. How common is it that something like that happens?

Dr. Papolos: Well, we just finished a retrospective study on about almost 200 children looking at both the effect of antidepressants and stimulants on the course of illness. In the study we did, about 70 percent of the kids had significant adverse responses. Many of them became violent, extremely aggressive, and oppositional. A certain percentage become psychotic and require hospitalization. Others can become suicidal. In many, many of these kids, it throws them into what’s called a mixed state. A mixed state is basically where you have symptoms of both poles at the same time, and it is incredibly agitating. It is the period of time when most people, adults with bipolar disorder, actually do have the energy to kill themselves and the motivation to do that. So, it’s a very, very important message to get across to clinicians, many of whom are pediatricians who are prescribing for these children because there are way too few child psychiatrists around the country to really see and treat all of them. So, that is something that is of real significance.


When you say they are experiencing both poles at the same time, what does that mean?

Dr. Papolos: They’ll have symptoms of mania or hypomania and they’ll have symptoms of depression at the same time. So, for example, they may feel that they’re worthless and that everybody hates them, and they’ll have no interest in doing anything and feel isolated. At the same time, they’ll have this tremendous energy that comes with mania or hypomania. But, typically when you’re depressed, you don’t have much energy. You’re slowed down. There’s a fatigue, so there’s no capacity really to act on an impulse that you might have that is to hurt yourself, whereas in a mixed state, you have a combination of the sense of worthlessness and sense of isolation and a sense that there’s no future pleasure that’s going to come into your life and you have this agitation and energy.


You mentioned pediatricians need to be aware of it, but what about parents? What is a parent who might have a bipolar child need to know when they do get this diagnosis of ADD or OCD or Oppositional Defiance?

Dr. Papolos: You’re right. All too often, parents go into a situation and expect that the professional is going to be able to make the right diagnosis and prescribe the right medication. I think it’s important for parents to realize that until around 1995, there was very, very little that was written about this condition in childhood. There were a handful of anecdotal reports, no real clinical studies, and the prevailing view in psychiatry was that bipolar disorder did not occur before puberty. The same thing is true of depression 15 years ago. Children were not thought to be able to have a major depression until they reached puberty, and even then, it was considered to be a rare phenomenon. So, the training of most child psychiatrists who are practicing today excluded the training in the diagnosis and treatment of this condition, and it is still controversial. So, parents need to know that before they go seeking professional help. One of the things we advise parents to do, if there’s a family history and they see their child is manifesting some of the symptoms like the ones that I talked about, is that they go to our Website and take a look at the inventory that we’ve developed that will help them to determine whether it's reasonable to go ahead and get a consultation, looking to see if their child has bipolar disorder. If they suspect that, then they need to carefully interview the physician who they are going to for consultation and begin with the question, "Do you believe that bipolar disorder exists in childhood?" If the answer is yes, then, "How many children have you diagnosed, and how have you treated it?" We have a section in the book that actually gives parents an idea of the questions they could ask of a physician that they go to to help them determine whether that’s the right direction to go in. So, that’s something that I think would be worthwhile to take a look at before you went about that kind of inquiry.


Clearly it is happening in children before puberty, so how young are you seeing it develop now?

Dr. Papolos: Based on retrospective accounts from parents, typically the earliest that I’ve actually seen and diagnosed a child is about age 4 or 5. That’s only where you really see the primary manifestations of the condition and where there’s a strong family history, but retrospectively, what we find is there are a lot of early antecedent symptoms that are rather typical and that precede the onset of the full picture. So, you may diagnose a child and they may sort of fully declare themselves at age 6, but when you’ve got a history of going back, you’ll hear about very, very specific symptoms that are characteristic, not of all of them, but commonly observed. We’ve had one mother who described her child in utero as a ninja baby, so much movement and an inhibition of the motor system that she knew there was something different about this child from the very beginning. And, the temperamental features that children have even as early as infancy, often there are the bright-eyed babies of the nursery, oversensitive, overreactive to sensory stimuli, easily aroused, crying, whining, irritable, hard to settle. They often don’t settle into a regular sleep pattern, until long after it would be expected. So, there is some problem clearly with the arousal system. They are unable to modulate sensory input as it’s coming in, and they also have difficulty regulating their own moods and emotions.

I probably should say something that I’d neglected when you asked me the question about the difference between adult and child bipolar and I didn’t talk about the aggression. Another major difference between adults and children with bipolar disorder is that children typically have very, very oppositional, domineering, overbearing, and aggressive behaviors. Now, it's not unusual to see the overbearing, willful, stubborn, persistent behaviors, but it's not as common to see four-hour rages and tantrums that occur over the drop of a hat or particularly when a parent says no or deprives them of something that they want, whether it’s a toy or something that they want to do. If a routine is interrupted, something that’s expectable, that could be one trigger and provoke a rage. This is something that seems to be characteristic of many of these children.


It used to be that children were not diagnosed with this, and now clearly they are. Is it becoming an increasing problem or diagnosis in children? What do you attribute that to?

Dr. Papolos: It’s hard to know because there really have yet to be any general population studies of bipolar disorders. All of the studies that have been sponsored by the National Institutes of Mental Health over the years and for childhood psychiatric disorders pretty much excluded the diagnosis of bipolar disorder. There’s only one study in adolescence that was done and they looked at a group of about 1,700 high school students. In the children who would be diagnosed, let’s say, according to the way they actually do present, which are these shorter cycles, upwards to 9 percent of the population might be considered to have the illness, whereas if you look at the brief duration criteria, it's more like 1 percent of the population. So, that’s been shown in adult studies more recently that depending on the criteria you use to make the diagnosis, you’ll increase the size or decrease it, which makes sense. So, that’s in adolescence.

We really have no such studies in children, so there’s no way really of objectively answering the question. Clearly, because of the fact that there has been much more attention, national attention, that’s been brought to this diagnosis over the last two or three years, it's becoming more acceptable to make the diagnosis, whereas before, most of these children were diagnosed as having oppositional defiant disorder or attention deficit disorder or some of the psychiatric diagnosis. So the rates, because of that, are obviously becoming higher simply because it's more recognized. Whether there’s been an increase, an actual increase, in children of this diagnosis is a matter of debate at this point. There is evidence from studies that have been done by the National Institute of Mental Health or sponsored by the National Institute of Mental Health, in the general population, looking at the onset of mood disorders that includes bipolar disorder and depression since 1949. What’s been reported, is that within the generations, beginning in 1949 through the present, there are higher rates of mood disorders in the general population and the onsets are earlier and earlier with each generation. So, this may be some phenomenon that’s going on that has some potential genetic or environmental factors may be involved that are leading to earlier and earlier onset of these conditions.


We talked about children who are bipolar and are treated as if they’re ADD or ADHD have obviously been treated wrong and have been given the stimulants or antidepressants. How do you treat a child with bipolar disorder? What kinds of medications do they need to be taking?

Dr. Papolos: Let me start by saying there really are only a handful of studies, double-blind, controlled studies, that would allow us to conclude objectively what medications would be best used to treat the condition. So, in the interim, clinicians who are faced with having to choose some way of treating these kids rely primarily on adult studies, and so the same medications that are being used on adults to treat bipolar disorder are being used in children. Those include lithium, which is the gold standard, and also medications that were primarily first developed and used to treat seizure disorders. In fact, most of the mood stabilizers that are used to treat bipolar disorder in adults and children are anti-convulsants, anti-seizure medications. The other class of medication that’s most commonly used are major tranquilizers or anti-psychotic medications, and often, children need to be on more than one mood stabilizer and often major tranquilizers as well to achieve some kind of stability through the illness.


What are some of the triggers that you see in children that set off these various episodes, whether it be mania, depression or whatever?

Dr. Papolos: There are a number of triggers that can increase the cycling and also increase the frequency of rages. There are a number of factors for both the cycling and for the rages. Certainly, seasonal change in a major precipitant. Studies in adults have shown that the spring and fall are peak times for both mania and depression; usually in the spring, there’s a rather significant increase in hospitalizations for mania primarily, but also depression, and the reverse in the fall. Very large peaks for depression and hypomania or mania, there’s a lower peak at that point. Also, at both times, the rates of suicide and suicide attempts are sky-high, so there’s a definite seasonal variation in the condition. Other triggers that you see are sleep deprivation. Sleep appears to be a primary modulator of cycling and typically, if a child gets less than six hours of sleep, often the next day paradoxically, they’re not less tired, but they’re more active and the reverse is true for depression. The longer they sleep, the more likely they are to be in a depressed mood and have low energy following that. So, it's quite different than you might imagine. In terms of the rages, the typical triggers are a parent saying no, depriving the child of something, whether it's telling them they can’t have a toy they want can set off an enormous burst of anger that can last for sometimes half an hour or even four hours, and thwarting some agenda that some child has. If he has in his mind that he wants to go and do something and you get in his way, it’s kind of like waving a red flag in front of a bull. So, those are the kinds of things we often advise parents to try to avoid, particularly the word no. There are other ways of telling a child they can’t do something and that definitely is a provocation. It's almost like you’re turning on something very primitive that gets reflexively expressed by the tone of voice in the statement.


When does it cross the line that a parent should be concerned that maybe there is something else going on when they say no and their child gets upset? When is it possible mania, as opposed to a child being a child and not wanting to have something taken away from them?

Dr. Papolos: I think the best way of understanding this is that the responses, the mood states, the anger, the aggression, the increase in sexual behavior, which we didn’t mention, all of these things are normal, human behaviors. Children will get silly, goofy and giddy. Children will get angry. Children will explode. It’s the intensity of these responses and the fact that they are poorly modulated, that they go on and on and on. That’s really the characteristic. It’s the lack of the capacity to modulate emotion, drives, and the expression of feeling.


Do you have any research showing whether it is more prevalent in males or females?

Dr. Papolos: As I said, there aren’t any epidemiological studies so we can’t really say, but from the clinical reports and the studies that have been done, the small-scale studies that are being reported in the literature, if you look at the male/female ratio, it is heavily weighted towards males. On the other hand, most childhood psychiatric disorders apparently are heavily weighted towards males. The same could be said about attention deficit disorder. Now, why that is is a different question. I don’t think we have the answer for that, but it may very well be that particularly with bipolar disorder, that boys may have a greater capacity to express aggression and that is often the primary symptom that brings a child to the attention of a mental health professional. It gets them kicked out of school, suspended, and poses a lot of behavioral problems.


I just want to elaborate because this is the third time the hypersexuality has been sort of referenced but then kind of stopped. I was just wondering if you could sort of give me the laundry list of what other symptoms go along with bipolar disorder in children that parents might not be aware of, the more unique ones.

Dr. Papolos: I’m not sure. I would say that hypersexuality is unique. I think it's probably less discussed, and I think that’s really in general, in terms of psychiatric interviews, I think it’s an area for whatever reason that isn’t one that’s of direct inquiry. Particularly for children, where the expectation is that children are really not sexually mature and there’s not that kind of curiosity and interest. With kids with bipolar disorder, it’s as if the program that was intended to be released in adolescence and puberty is manifest much early. Not in all children with bipolar disorder, but certainly in a fairly sizable percentage. Typically, what you see when you see hypersexuality is there’s a much greater interest in genitalia. They will often be touching, either directly or surreptitiously, their mother’s breasts. They’re very interested in if they see it in pornography and essentially public displays, running around naked in the house, often when they’re in a silly, giddy, hypomanic state. So yes, that is a symptom. Again, it's aggression and sexuality are both primary drives in human beings and just like aggression, sexuality is poorly regulated in these kids.


Going back to what’s normal, what’s not normal, and this may be reiterating what we’ve already talked about, for example, separation anxiety. At what point does a parent need to be concerned that this isn’t just separation anxiety and the child misses his mother?

Dr. Papolos: I think again children with bipolar disorder, for those who experience separation anxiety, it is usually extreme. I can site some examples that might give you a better idea. We had one child who was so anxious when the mother would leave the room, it wasn’t just at school, but he demanded that mother carry a walkie-talkie around and he would of course have one in the household so that he had immediate access to her and knew where she was at any time. So, it’s the extreme. It’s normal for children going off to school for the first time to have separation anxiety, and there’s a spectrum of degree. Sometimes it takes two or three weeks; sometimes it takes a couple of days for a child to be able to separate from a mother and that’s normal, but this is a kind of separation anxiety that is prolonged, consistent, and continues for months. Many, many children with bipolar disorder persist in having some form of separation anxiety, and it is in fact also an issue with adults, so it continues as a persistent feature of the personality, well beyond the time that you would expect that it wouldn’t be an issue.


When does aggression go beyond just normal childhood frustration?

Dr. Papolos: When children with bipolar disorder go into rages, it's really unmistakable. One of the things parents will say over and over again is they get this look in their eyes; it’s almost like a feral look, like an animalistic expression where they completely lose control of their impulses. The temper tantrums, or rages as they’re called, can last anywhere from half an hour to four hours, so again, it's an extreme and protracted period of anger and aggression and they can often be profane, violent throwing things, quite abusive often directed mostly at the mother. If you saw one of these rages, it would be unmistakable. You wouldn’t confuse it with an ordinary temper tantrum.


What are some other mental illnesses that perhaps are increasing among today’s youth that we didn’t think affected kids before?

Dr. Papolos: We know that there is some evidence that autistic spectrum disorders are more on the rise. Whether there’s objective epidemiological evidence to support that, I can’t say for sure. I think it’s somewhat controversial, but certainly it would appear that mood disorders, whether they’re more commonly diagnosed because they’re more easily recognized now is a question mark.


Do you think is it because these illnesses are affecting more children or are being better diagnosed?

Dr. Papolos: I think in general, the answer is that it’s hard to tell. I think since there’s no really basis for comparison, we don’t have epidemiological studies that go back with the diagnosis. We really don’t have general population studies that can make those kinds of comparison since a number of the major child psychiatric disorders are the criteria have been rather recently developed, I mean, over the last decade. So I don’t think there’s a long enough perspective looking back to be able to say that with any confidence. I think in terms of the treatment of these conditions, the advent of psychotropic medications, particularly over the last decade, they’re use in children has grown logarithmically. There are certainly recent studies that have been done that have looked at this particular phenomenon. A number of prescriptions for stimulants and for antidepressants have skyrocketed. There is a considerable concern, at least on my part and other clinicians who treat children with bipolar disorder, that because of the adverse effects on the course of illness that particularly antidepressants and stimulants may cause, that we are seeing earlier and earlier onsets in children that are vulnerable to have the condition. That is, to say the children that carry the genetic traits that are vulnerable and that are being induced at ages that are earlier than might be the case, and that’s certainly a concern. Again, there is not sufficient data to support that idea, but from the clinical point of view, it's something that we’re all concerned about.


With all that being said, what in your opinion needs to be done to improve the field of mental illness in children? Where does more focus need to be placed?

Dr. Papolos: I guess there are a couple of areas. First of all, we need to clarify the diagnosis and, I think, recognize that the condition presents quite differently in childhood and to reorganize the way that we define it. The other thing that I think is needed pretty desperately is general population studies that identify the rates of the condition of all of the childhood conditions and right now though, even if we were to have the most accurate diagnostic criteria and clear treatments for the condition, neither of which do we have, we still don’t have anywhere near the number of trained physicians who can diagnose and treat children for a multitude of major psychiatric conditions. There are, I think, only 6,500 child psychiatrists in the country where some states in the union have one or two child psychiatrists. Most of them are concentrated in the metropolitan areas, so it's very clear that it is going to be incumbent on pediatricians who are often the physicians of first contact to begin to learn more and more about behavioral disorders in childhood and become more competent at introducing and treating them with medications.


Is there anything else that you want to add?

Dr. Papolos: If you’re looking for an ADHD statement, I think we’d want to amplify that. It’s very common for children who go on who go on to be diagnosed with bipolar disorder to first be diagnosed with attention deficit disorder. The reason for that is there are at least four or five overlapping symptoms, and because there has been a myth that bipolar disorder does not exist in childhood and attention deficit disorder is so commonly recognized and diagnosed, when a child presents with hyperactivity, pressured speech, problems with attention, distractibility, all of these symptoms are common for both conditions, so typically a clinician will recognize them and diagnose them as attention deficit disorder. In our recent studies, we’ve found that really when you look at specific features of attention deficit, or that is you measure attention and impulsivity, really only about 12 percent to 15 percent of children with bipolar disorder also have attention deficit disorder, so there are co-occurring in a certain percentage of children, but in a very, very large number of children who have bipolar disorder, are first diagnosed with attention deficit disorder and that creates an enormous problem because medications that are typically used to treat attention deficit disorder typically cause adverse effects and often cause an adverse reaction in children that have bipolar disorder.

END OF INTERVIEW



If you would like more information, please contact:

Janice Papolos
Juvenile Bipolar Research Foundation
info@bipolarchild.com
http://www.bipolarchild.com

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 5:39 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported March 16, 2005


ADD/ADHD 2005 Executive Summary:
Diagnosis, Traits and Treatment


(Ivanhoe Newswire) -- In its most commonly diagnosed form, attention-deficit disorder is accompanied by hyperactivity and is sometimes called attention-deficit hyperactivity disorder. The symptoms usually begin before age 7. It is a serious and persistent disorder, however research indicates children with ADD can be helped.

If you would like a copy of any of the articles referenced below, just send me an email and I will gladly send it to you. Of course, if you wish, I will post the particular article here, as well.

While there is no single test for ADD, an accurate diagnosis can be made by combining observations, tests, and other measurements gathered from parents, teachers, psychologists, physicians, and the child. However, it can easily be misdiagnosed. Often times very young children show characteristics of ADD, but are normal behaviors for their age. As well, other conditions can often be mistaken for ADD.

ADD is not limited to children, although for years it was assumed to be a childhood disorder. It is now known that many children with ADD do not grow out of it as they age.

Articles:

Diagnosis

Learning Disabilities may be Vision Problems
Researchers from Northeastern University in Tahlequah, Okla., say many children are diagnosed with learning disabilities and attention-deficit disorders when their inability to learn may be an undetected and untreated vision problem.


ADD: Alternatives to Medication
While Ritalin is effective for a large percentage of children, there's a group who react negatively. They have some other medical condition or educational learning problem going on that needs to be evaluated. One doctor says an estimated 80 percent to 90 percent of children she sees have nutritional deficiencies or allergies that cause behavioral problems.


ADHD Children Have Other Disorders
Children with ADHD are more likely to have other behavioral disorders and may be prescribed incorrect medications, this study reports.


Misdiagnosis of ADHD Leads to Depression
This study shows the misdiagnosis of ADHD combined with prescription drug use in children may lead to depression in adulthood.


Sleep Problems in Children Appear as ADHD
Children who struggle with sleep disorders often appear sleepy and inattentive during the daytime. This study shows symptoms in 5-year-olds are suggestive of ADHD, but doctors say there is now an increasing understanding of obstructive sleep-disordered breathing. It’s estimated to affect 2 percent to 3 percent of children.


Traits

ADHD Kids Have Smaller Brains
According to this study, children with ADHD have smaller brain volumes than children without ADHD. The study also found that medication used to treat ADHD does not contribute to brain development in ADHD children.


Brain Abnormalities and ADHD
Another study shows children with ADHD have specific brain abnormalities.


Children With ADHD Have Different Brains
This study shows children with ADHD have certain anatomical brain abnormalities, and medications may help normalize them. Researchers found ADHD children who had taken medication for an average of 2.5 years exhibited more normalized fiber pathways of several brain areas.


ADHD and Later Substance Abuse
It seems there are several important factors predicting which children with ADHD will go on to deal with substance abuse.


Study Assesses Incidence of ADHD
Health officials estimate the prevalence is anywhere from 1 percent to 20 percent of school-aged children. The true incidence of the condition remains in dispute, and many are concerned some children may be receiving drug treatment for the condition when they don't really need it.


ADHD in Adults
The condition often goes undiagnosed in girls -- then continues into adulthood. Now doctors realize that women have been suffering -- undiagnosed -- with it for years.


Pediatric psychiatrist Paramjit Joshi, M.D., of Children’s National Medical Center in Washington, says there are some specific differences to look for in children when diagnosing ADHD or bipolar.


Treatment

Drug-Free Help for ADD
Here is one way kids can control their emotions without drugs. It involves brain mapping, and with the help of a listening tool and graphics, the child can see and hear his brainwaves and learns how to increase his own brain activity.


21st-Century Mom
A medical diagnosis and treatment are often the first options for these children -- choices not every parent is comfortable with. One mom found a different approach … the help of a tutor, lifestyle changes, and trading junk food for a healthy diet and television for music.


Non-Stimulant for ADHD: Strattera (atomoxetine)
It lasts 24 hours, and it’s not a stimulant. One doctor says it helps kids who don’t benefit from stimulants -- especially those who are anxious, have tics, or who have trouble sleeping.


Iron Supplements may Help Kids With ADHD
Researchers found children with ADHD had significantly lower blood levels of iron than kids without the condition.


Addressing Adult ADHD
If you had ADD or ADHD as a child, there’s a good chance you may still suffer its effects. Here's a treatment that works for the adult population.


Drug Effective for ADHD
New research shows the drug atomoxetine is an effective treatment for children with ADHD.


Treating Tics and ADHD
Research outlines an effective drug therapy for children who have ADHD as well as chronic tic disorders. Doctors found the combination of Ritalin and clonidine was more effective than either drug alone.


Help for ADHD
Doctors may have another option to treat children with ADHD. A study in Archives of General Psychiatry shows the drug desipramine reduces symptoms in children with chronic tic disorder and ADHD.


Help for Adult ADHD
Results of the study show adults with ADHD who are treated with amphetamines experience fewer symptoms associated with their disorder.


ADHD? Get Outside!
This study shows children with ADHD can reduce their number of symptoms simply by enjoying nature.


Once-a-Day Dose for ADHD
One study shows a once-a-day dose of MPH MR (Metadate CD) may be effective at controlling behavior.


Zinc for ADHD?
Zinc supplements may increase the effectiveness of stimulants for children with ADHD, according to researchers from Iran.


ADHD Help in a Patch
Here is one way to treat ADHD that ends those trips to the nurse's office and questions from classmates: a patch. It may be the same chemical but the patch seems to have a big advantage over pills.


Sale of Adderall Suspended in Canada
The Canadian regulatory agency Health Canada has suspended sales of the drug Adderall XR. Adderall XR is a controlled-release amphetamine used to treat patients with attention-deficit hyperactivity disorder.


ADHD from too Much TV
Parents who want to guard against the development of ADHD in their children might want to turn off the television.


ADHD and Drug Abuse
Research shows children who take stimulants for ADHD are no more likely to use illegal drugs as teens or adults than children who are not treated for ADHD.


Childhood Injuries and Behavioral Disorders
Children and adolescents with ADHD, or other behavioral problems, are more likely to suffer injuries, a new study shows in this month's Pediatrics.

END


Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 5:45 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 1, 2003
Note: Dr. Papolos has written a book entitled, The Bipolar Child


What’s Wrong with my Child?
ADHD or Bipolar?

Questions to Ask Your Child's Doctor




According to Demitri Papolos, M.D., these are some questions to ask your doctor that will tell you if he will look for bipolar disorder in your child.

1. Do you strictly adhere to DSV-IV criteria? (According to Dr. Papolos most children cannot be diagnosed according to current diagnostic criteria.)

2. Are you aware of the clinical studies done by Drs. Barbara Geller and Joseph Biederman describing the nature of children's bipolar symptoms and how it differs from adult bipolar disorder? (The duration of cycling is much shorter in children.)

3. What is your view about the existence of comorbid conditions like ADHD, oppositional defiant disorder, and anxiety disorders with bipolar disorder? (Look for a doctor who views the treatment and stabilization of bipolar disorder as the primary initial goal.)

4. Ask how experienced the doctor is in using mood stabilizers.

5. How often does he/she prescribe lithium, Depakote, Tegretol, or Neurotin.

The doctor should encourage the parents to chart the child's illness and course of treatment.


If you would like more information, please contact:

Janice Papolos
Juvenile Bipolar Research Foundation
info@bipolarchild.com
http://www.bipolarchild.com

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 6:03 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 1, 2003


What’s Wrong with my Child?
ADHD or Bipolar?
ADHD Indicators vs. Bipolar Indicators


Pediatric psychiatrist Paramjit Joshi, M.D., of Children’s National Medical Center in Washington, says there are some specific differences to look for in children when diagnosing ADHD or bipolar.


ADHDBIPOLAR
Signs must begin in childhoodSigns can show up in childhood or later
Symptoms are constantExtreme behavior comes and goes
Struggles to awaken in the morningAwakens early
Likes to be the center of attentionWithdrawn
Can have family historyFamily history almost always exists



If you would like more information, please contact:

Paramjit Joshi, M.D.
Children’s National Medical Center
(202) 884-3932
pjoshi@cnmc.org

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 6:05 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 1, 2003


What's Wrong with my Child?
Mental Health in Kids

Places to go for Help


Janice Papolos
Juvenile Bipolar Research Foundation
info@bipolarchild.com
http://www.bipolarchild.com

Bunni Tobias, Ph.D.
The Kid’s Detective
P.O. Box 1658
Lake Forest, CA 92609
(888) 372-8664
drbunni@drbunni.com
http://www.drbunni.com

Paramjit Joshi, M.D.
Children’s National Medical Center
(202) 884-3932
pjoshi@cnmc.org

Anxiety Disorders Association of America
http://www.adaa.org

Anxiety and Stress Disorders Clinic
Ohio State University
http://anxiety.psy.ohio-state.edu

National Center for PTSD
http://www.ncptsd.org/

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/

About our Kids
http://www.aboutourkids.org/

National Attention Deficit Disorder Association
http://www.add.org/

Bipolar Disorders Information Center
http://www.mhsource.com/bipolar/index.html

National Institute of Mental Health
http://www.nimh.nih.gov/

Columbia University’s Department of Psychiatry
http://cpmcnet.columbia.edu/dept/pi/psychres/psychfront-gd.html

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 6:52 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported March 3, 2003


What's Wrong with my Child?
Mental Health in Kids

Ivanhoe.com White Paper


By Mildred Leinweber Dawson, Ivanhoe Health Correspondent


(Ivanhoe Newswire) -- Mentally healthy children develop the cognitive and emotional skills they need to function within their families and communities and later to contribute to society as adults. In contrast, mentally ill children display abnormalities in their cognition (thinking), emotions or moods, and in complex behaviors such as social interactions or in planning.

"Parents are usually the first to recognize that their child may need special help," says Eve Moscicki, Sc.D., M.P.H., acting associate director for child and adolescent research at the National Institute of Mental Health. However, the nature of normal development in children complicates a parent's task in recognizing that their child's problematic behavior warrants professional attention. Behaviors that are to be fully expected within one age range can be symptoms of mental illness within a later age range. For instance, an infant's display of separation anxiety is entirely normal, but if a 5- or 6-year-old was to cry and cling to his mother when left with someone he knew well, his actions could indicate the presence of an emotional disorder. Likewise, a certain amount of hitting and pushing is normal for preschoolers but could signal the presence of a significant emotional disorder in a 9-year-old. Parents who understand the normal stages through which children pass are best equipped to recognize when their child's behavior falls well outside of the normal range.

Complicating the issue, though, is the fact that mental illness still bears a significant stigma for many people. This factor can cause some parents to dismiss signs of serious trouble displayed by their children. Parents may say of an excessively clingy daughter, "She'll outgrow it" or "He's a total boy" of an excessively aggressive son. Such attitudes can cost the child (and the family as a whole) the benefits of early intervention. "The earlier you intervene, the better opportunity you have to change a potentially negative course of development," says Moscicki. The need for public education about the value of early treatment is critical. "There is often an enormous gap between the time that parents see a problem and [a professional] seeing that child," Moscicki says. She urges parents "to get that child into treatment as early as possible. Mental health is a part of overall health. You can't just ignore it."

In 1999, the U.S. Surgeon General issued a massive report on mental health that child and adolescent psychiatrists accept as the most authoritative document on the subject. Unless otherwise noted, it is the source of most of the facts stated in this Special Report. It cited a major study that "estimated that almost 21 percent of U.S. children ages 9 to 17 had a diagnosable mental disorder associated with at least minimum impairment. When diagnostic criteria required the presence of significant functional impairment, estimates dropped to 11 percent. Finally, when extreme functional impairment is the criterion, the estimates dropped to 5 percent."

However, the Surgeon General states currently, "Most children in need of mental health services do not get them." Credible studies in the 1990s showed "a high proportion of young people with a diagnosable mental disorder do not receive any mental health services at all." This reflects a lack of progress since the 1980s when "70 percent of children and adolescents in need of treatment" did not receive it. The Surgeon General says, "The most likely reasons for [such] underutilization [of mental health services] relate to the perceptions that treatments are not relevant or are too demanding or that stigma is associated with mental health services; the reluctance of parents and children to seek treatment; dissatisfaction with services; and the cost of treatment."

A cure is sometimes, but not always, the goal of treatment. James C. MacIntyre, M.D., associate professor of psychiatry at Albany Medical College in Albany, New York, says, "There are no cures for hypertension or diabetes, yet those diseases represent a huge amount of medical care in the United States. We teach people how to live with those diseases."

He explains, "We can also teach them how to live with mental illnesses, for instance to identify triggers when they're starting to be depressed, with the hope they'll go back to their psychiatrist and start their medications again. With other mental illnesses, such as the early stages of an eating problem, you may be able to avert a full blown eating disorder (and potentially save a life) but quick intervention is critical." Triggers a depressed person could learn to watch for might include extreme irritability, sleep difficulties, avoidance of social gatherings, or changes related to eating. Some depressed people avoid eating and lose significant weight; others tend to overeat.

Social trends shape children's mental health. On the personal level, the extent to which adults can create loving, stable homes for children greatly diminishes the risk to those children of many mental illnesses. On the national level, the extent to which our nation becomes a regular target of terrorism may affect the mental health of children vulnerable to anxiety and other mental disorders, or whose stability may be shaken by the loss of parents and other loved ones.


THE MOST COMMON MENTAL ILLNESSES OF CHILDREN


This section lists common mental illnesses among youngsters, along with chief signs and symptoms by which they are diagnosed and common treatments employed. Treatments fall into two categories--psychotherapeutic interventions ("talking therapies" of diverse sorts) and psychopharmacological ones (medications). For most disorders, experts agree, treatment that combines both kinds of interventions work best.

The Surgeon General states, "Most psychotherapies are deemed effective for children and adolescents because they improve more [with them] than with no treatment. Psychotherapies are especially important alternatives for those children who cannot tolerate, or whose parents prefer them not to take, medications.

They are also important for conditions for which there are no medications with well-documented efficiency." Henry Gault, M.D., a child and adolescent psychiatrist with a special interest in school related issues, says many practitioners also incorporate therapies, such as relaxation techniques, meditation, deep breathing and muscle relaxation practices, which can be particularly helpful for anxiety disorders."

Many drug treatments have not been rigorously tested for safety and efficacy in children and this often alarms parents. In some very rare cases, a few children have experienced life-threatening side effects, and some have died of side effects. Nonetheless, Dr. MacIntyre says the majority of these "medications have been used with adults in a careful, rational way for a period of time and people working in child psychiatry have looked closely at them and made a risk-benefit determination. It would be nice to wait for thorough studies but there isn't enough money or subjects [because parents won't volunteer their children.] Although we don't know all the risks, we think that the benefits are much greater than the risks." In medicine, many widely accepted treatments similarly lack solid research support but years of experience support their use.


The disorders, their symptoms and treatments

* Attention-deficit/hyperactivity disorder (ADHD) involves two sets of symptoms; inattention and hyperactivity-impulsivity. ADHD children tend to be highly distractible, careless and fail to follow through on tasks. Symptoms always arise before age 7.

Treatment
Treatment involves support and education of parents and teachers (to teach them behavioral techniques), appropriate school placement and pharmacology. Psychostimulants have been widely studied and proven highly effective for 75 percent to 90 percent of children with ADHD. Possible side effects include insomnia, decreased appetite, and sometimes psychosis. Children who can't tolerate the drugs or parents who won't allow them may choose psychotherapies alone.

In an important development, the first new ADHD drug to be approved in 30 years became available in January 2003. Called tomoxitene, it is not a stimulant; therefore, it is not a controlled substance and there is less risk of misuse. Rather, it is in the same class as the antidepressants.

Despite media reports of overdiagnosis, recent studies find little evidence of this. "Fewer children (2 percent to 3 percent) are being treated for ADHD than suffer from it," says the Surgeon General. Some inappropriate use, however, may reflect careless diagnosis. Moscicki stresses with any mental disorder, including ADHD, "It is extremely important to make sure that you have an accurate diagnosis because if children genuinely need the medication then they will respond to the medication."


* Depressive disorders are the most frequently diagnosed mood disorders in children and adolescents. Depressed children are sad, apathetic and self-critical. Youngsters who suffer from depression are at much greater risk of committing suicide than other youngsters.

Treatment
Several psychosocial interventions hold "great promise" as treatments. Forms of cognitive-behavioral therapy, which can teach children coping skills, especially stand out. Research points to a class of drugs called selective serotonin reuptake inhibitors (SSRIs) as potentially useful.


* Suicide: The rates for suicide among males ages 15 to 19 have tripled since the 1960s; those for females have remained stable. Family discord represents a significant risk factor for children's suicide. Suicidal children feel isolated within their families and expendable. The risk of suicide, as well as of major depression and post-traumatic stress disorder, elevates when a relative or friend commits suicide.

Treatment
"Home-based intervention to reduce suicidal ideation in the child and improve family functioning has been reported to have limited efficacy" for youngsters without concurrent major depression, the Surgeon General reports. "There is a dearth of research on the efficacy of medications for ... preventing suicide."


* Anxiety disorders: The combined prevalence of these disorders is higher than all other mental disorders of children and teenagers. It includes separation anxiety disorder (distress upon parting from a caregiver, normal in babies but a symptom in older children); generalized anxiety disorder (excessive worrying); and social anxiety disorder (persistent fear of embarrassment).

Treatments
The only intervention deemed "well-established" is a psychotherapy called contingency management (attempts to alter behavior through the use of techniques such as positive reinforcement.) Other psychotherapies are deemed "probably efficacious." There are few studies being conducted now on medications for anxiety disorders. SSRIs may provide effective treatment.


* Autism is the most pervasive developmental disorder, marked by a severely reduced ability to engage in, and a lack of interest in, social exchanges.

Treatment
Treatment goals are to promote the child's language and social development, and to minimize behaviors that interfere with the child's functioning and learning. Behavioral treatments have helped to increase communication and appropriate social interactions. One anti-psychotic drug, haloperidol, has been useful and others are under investigation.


* Disruptive disorders include oppositional defiant disorder (children who show consistent hostility towards authority figures) and conduct disorders (marked by antisocial actions such as fighting and vandalism). These seem to be collections of behaviors rather than coherent patterns of mental dysfunction.

Treatment
Psychotherapeutic interventions can help, notably special training for parents. No drugs have been proven to help. They occur more often in urban than in rural youth.


* Substance abuse disorders have shown a sharp resurgence among adolescents since the early 1990s.

Treatment
Several treatment approaches have demonstrated effectiveness; family-oriented ones have proven superior to the others.


* Eating disorders are serious, tend to be chronic, and can be fatal. The three main eating disorders are anorexia nervosa (characterized by low body weight and intense fear of weight gain); bulimia (binge eating followed by compensatory activities such as vomiting); and binge eating disorder (a newly recognized condition that features episodic uncontrolled eating without compensatory activities).

Treatment
Treatments entail psychotherapy and medications, alone or combined.



PREVENTION IS POSSIBLE


Childhood is an important time to prevent mental disorders because many adult mental disorders have related antecedents in childhood. It's logical to intervene early before problems become established and more refractory.

The field of prevention has now developed to the point that reduction of risk, prevention of onset, and early intervention are realistic possibilities. Good research supports the value of improving parenting skills through training to substantially reduce antisocial behavior in children.

Some forms of prevention are so familiar that we overlook them. Vaccinations against measles prevent neurobehavioral complications. Safe sex and maternal screening prevent HIV infection in children, with its neurobehavioral complications. Efforts to curb drinking during pregnancy help prevent fetal alcohol syndrome.


Some research projects have shown great value in preventing mental illness in children:

Project Head Start is most famous. It's been proven to lower enrollment in special education and confer social advantages such as less antisocial behavior and better peer relations.

The Elmira Prenatal/Early Infancy Project is another. It targeted high-risk children of unwed, often poor, teenage mothers. Some teens had supportive nurse-visits that involved teaching them parenting skills, either during pregnancy only or for 24 months postpartum. In a 15-year follow-up study of primarily white families in Elmira, N.Y., findings showed the low-income and unmarried women and their children who had a nurse home visitor for the first two years of the child's life had, in contrast to those in a comparison group:

* 79 percent fewer verified reports of child abuse or neglect

* 31 percent fewer subsequent births

* An average of more than two years greater interval between the birth of the woman's first and second child

* 30 months less receipt of Aid to Families with Dependent Children

* 44 percent fewer maternal behavioral problems due to alcohol and drug abuse

* 69 percent fewer maternal arrests

* 60 percent fewer instances of running away by 15-year-old children

* 56 percent fewer arrests of 15-year-old children

* 56 percent fewer days of alcohol consumption by 15-year-old children

The cost of the program was recovered by the first child's fourth birthday. Substantial savings to government and society were calculated over the children's lifetimes.


TRENDS IN HELPING THE MOST TROUBLED YOUNGSTERS


One important recent trend, according to Moscicki, is a focus upon evidence-based programs and interventions. This means psychosocial interventions are now being held to the same standards previously reserved for the testing of pharmaceuticals. Currently, children and teens with severe mental illnesses are frequently placed in residential treatment centers (RTCs), which operate 24 hours and may resemble group homes. RTCs consume about one-fourth of U.S. spending for children's mental health. In fact, recent well-controlled studies show such RTCs not only fail to help troubled youths but they can also exacerbate their problems.

Recent research also points to the value of avoiding the treatment of severely disturbed youngsters with inpatient hospitalization. Hospitalization, which consumes half the national outlay for children's mental health, creates another highly restrictive and artificial environment.

"When you cut off ties with parents, family, and home [as these approaches do]", says Dr. MacIntyre, "you make it much less likely that the child will eventually be reintegrated" into society.

Substantive research supports alternative approaches such as home-based services to teach parents new skills and therapeutic foster care. The latter is an approach that places troubled youths with specially trained foster parents during the day but lets the youngsters return to their own families at night. Parents with severely disturbed offspring ought to inquire about these newer options before institutionalizing their children.

END



Mildred Leinweber Dawson is an Orlando-based freelance writer, specializing in health and business topics.

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 9:10 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported January 3, 2005

Just drop me an email if you would like me to send you the articles referenced below--or if you want me to post any of them posted here (in full).



Autism 2005 Executive Summary:
Causes and Therapy



(Ivanhoe Newswire) -- As many as 1.5 million Americans -- adults and children -- are thought to have autism today. And that number is on the rise. Based on statistics from the U.S. Department of Education and other governmental agencies, autism is growing at a rate of 10 percent to 17 percent per year.

There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function. Researchers are examining a number of theories as to what causes the abnormalities in brain structure and function, including hereditary, genetics and other medical issues.

Children and adults with autism typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Because the characteristics of autism vary from person to person, there is no one set protocol for treating or helping autistic teens or adults.

While there is no cure for autism, there are treatment and education approaches that may reduce some of the challenges associated with the disability. Intervention may help to lessen disruptive behaviors, and education can teach self-help skills that allow for greater independence.



Causes

New Findings on Autism: Researchers have ruled out a possible connection to autism. A study in the British Medical Journal shows children with autism are no more likely than those without it to have had gastrointestinal problems as infants.


Autism and Vaccines: In recent years, more parents and researchers are suggesting the measles, mumps and rubella (MMR) vaccine causes autism. Now, a study from Denmark suggests there is no correlation between the two.


Vaccine, Autism Link Dismissed: Speculation that vaccines trigger autism is being dismissed by the American Academy of Pediatrics as they continue to encourage parents to vaccinate their children.


Vaccine not Linked to Autism: Many parents have second guessed their decision about vaccinating their child with the measles-mumps-rubella vaccine because of its link to the development of autism. However, this study shows there is no association between the vaccine and autism.


Genetics key to Autism: There has been a great deal of speculation about what causes autism in a child. Some reports suggest vaccines could play a role, but this research disputes this claim. Now a new report points to genetic factors as the main cause.


What Causes Autism? Women who experience complications during pregnancy are more likely to have a child who develops autism, but the complications themselves may not be to blame.


Brain Inflammation Found in Autism: Research shows inflammation in the brain is clearly a characteristic of autism. Researchers from Johns Hopkins University School of Medicine in Baltimore say their findings reinforce the theory that immune activation in the brain is involved in autism, although they are unsure of the extent to which it hurts or helps brain development.


Autism Linked to Language Disorder: Autistic boys with language problems have a lot in common with boys suffering from a language-related disorder known as Specific Language Impairment (SLI). The finding could help doctors better understand autism and how to choose the best treatments for individual components of the condition.


Unraveling Autism: A new study shows people with autism may suffer from deficiencies in a part of their brain responsible for handling spatial memory.



Interventions and Treatments

Coping With Autism: Autism can cause aggression in many people, but there are different therapies to help ease that aggression. Doctors found help in the drug risperidone. Another class of drugs -- anti-seizure medications -- can help too.


Life-Changing Autism Intervention: There are many drugs for the behavioral symptoms that come with autism, but new research shows you may not need them. A drug-free treatment may change lives.


Fragile X/Autism Help: No drugs help the learning problems that come with Fragile X or autism, but one doctor hopes the drug CX516 will change that. It increases activity of specific proteins within brain cells, and it only works when patients are trying to learn.


Antibiotics for Autism: Richard Sandler, M.D., a pediatric gastroenterologist at Rush-Presbyterian St. Luke's Medical Center in Chicago says about 25 percent of children with autism experience chronic diarrhea or constipation. Further research is now underway to determine if, in fact, a bug or toxin is present in autistic patients' intestinal tracts, which could be treated with antibiotics.


The Link Between Autism and Manic Depression: Now doctors at Duke University say there is a link between autism and manic depression. This finding could lead to treatment with antidepressants.


Easing Autistic Aggression: Aggression and behavioral disturbances are often seen in children with the disorder, but a new treatment may have just made life a little easier. In a recent study, children were given the anti-psychotic drug risperidone or a placebo. Nearly 70 percent were much or very much improved after eight weeks compared to just 12 percent in the placebo group.


Identifying Autism: Chinese investigators have come up with a new and better way to identify young children with autism.


Overcoming Autism: A new diagnostic tool is proving that autistics may have strong mental abilities even though they can't communicate.


Help for Autism: A hallmark of the disorder often is a lack of verbal skills. A new technique can now boost those skills.


Autism and Early Brain Growth: Two studies out of the University of Washington School of Medicine in Seattle show children with autism have abnormal brain development during the very early years of life.


Curbing Autistic Aggression: This study is looking for ways to stop the violent behavior associated with autism with the treatment of valproic acid, an anti-seizure medicine.


Electronic Ear: French physician Alfred Tomatis has used listening therapy for 40 years to improve singers' voices. The same therapy is used to help children with speech and hearing problems.


New Approaches to Autism: Researchers in New York are taking a different approach they hope will help more children. Their approach in terms of treating individuals with autism is to break the disorder down into its different symptom domains and then address those different symptom domains with appropriate medication.


Investigating Autism: Autistic children can process simple and complex tones just fine -- it’s sounds associated with human speech that appear to create problems. That’s the finding from a new study out of Finland that measured the ability of autistic and normal children to process different types of sounds.


Siblings Have Special Needs, Too: Learning a child has a developmental disability, such as autism or cerebral palsy, can be a devastating blow for any parent. The special needs of that child often complicate marriages, parenting techniques and sibling relations. There are a few tips any parent can use to successfully navigate through this tough -- but rewarding -- job.


Drug Effective in Autistic Children: A drug that is effective in the treatment of adults with schizophrenia may also be effective for children with autism.

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