Continuum Wellness News » ADD

U.S. Children Overmedicated

continuum wellness — Tue, 30 Sep 2008 04:39:52 +0000

American children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease than European children are, a new study finds.

Differences in regulatory practices and cultural beliefs about the benefit of medication for emotional and behavioral problems may explain this dramatic difference, the U.S. researchers added.

“There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe,” according to lead researcher Julie Zito.

The report was published in the Sept. 24 online edition of Child and Adolescent Psychiatry and Mental Health.

Antidepressant medications Prozac, Ritalin and stimulant usage were compared in the United States, the Netherlands and Germany,

The researchers found that the annual prevalence of psychotropic medications among children in the United States was significantly greater than in either the Netherlands or Germany. In the United States, 6.7 percent of children were taking these drugs, compared with 2.9 percent in the Netherlands and 2 percent in Germany.

In addition, use of antidepressants and stimulants was three or more times higher in the United States than in the Netherlands or Germany, and use of antipsychotic drugs was 1.5 to 2.2 times greater in the United States than in either of the other countries.

The difference in the use of these drugs may be partly due to differences in diagnosis systems. For example, in the United States, there are more diagnoses of bipolar disease among children and adolescents than there are in Europe, the researchers noted.

Many children in the United States are taking two or more psychotropic drugs in a single year.

(article here)

ADHD and Heart Screening, Update

continuum wellness — Thu, 31 Jul 2008 05:02:18 +0000

Apparently the experts are at odds with one another, but have come to some agreement regarding assessing the risk of future heart problems developing in children who take stimulant drugs.

Pediatricians don’t consider it necessary for heart screenings for children prescribed stimulant drugs. The American Heart Association initially recommended heart screening for children taking stimulant drugs. The current position is it not mandatory, but considering the number of children who have sudden cardiac death it may be useful to at least have the heart screen performed. The AHA has released an update clarifying their position, here. Basically an ECG screening is not considered mandatory.
U.S. News reported on this topic here
Following is the statement: of the American Heart Association
May 16, 2008

This statement replaces the April 21 news release

Endorsed by the American Academy of Child and Adolescent Psychiatry, the American College of Cardiology, Children and Adults with Attention-Deficit/Hyperactivity Disorder, the National Initiative for Children’s Healthcare Quality and the Society for Developmental and Behavioral Pediatrics

The American Heart Association released on April 21, 2008 a statement about cardiovascular evaluation and monitoring of children receiving drugs for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). As a result of language in the news release and the statement as published, there have been conflicting interpretations of the recommendations regarding the use of an electrocardiogram (ECG) in assessing children with ADHD who may need treatment with medications. The purpose of this joint advisory of the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) is to clarify the recommendations.

• The scientific statement included a review of data that show children with heart conditions have a higher incidence of ADHD.

• Because certain heart conditions in children may be difficult (even, in some cases, impossible) to detect, the AAP and AHA feel that it is prudent to carefully assess children for heart conditions who need to receive treatment with drugs for ADHD.

• Obtaining a patient and family health history and doing a physical exam focused on cardiovascular disease risk factors (Class I recommendations in the statement) are recommended by the AAP and AHA for assessing patients before treatment with drugs for ADHD.

• Acquiring an ECG is a Class IIa recommendation. This means that it is reasonable for a physician to consider obtaining an ECG as part of the evaluation of children being considered for stimulant drug therapy, but this should be at the physician’s judgment, and it is not mandatory to obtain one.

• Treatment of a patient with ADHD should not be withheld because an ECG is not done. The child’s physician is the best person to make the assessment about whether there is a need for an ECG.

• Medications that treat ADHD have not been shown to cause heart conditions nor have they been demonstrated to cause sudden cardiac death. However, some of these medications can increase or decrease heart rate and blood pressure. While these side effects are not usually considered dangerous, they should be monitored in children with heart conditions as the physician feels necessary.

The statement has been revised to clarify the language and to assure that the intent is clear to all readers. This is available at:
http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189473

The correction notice is at:
http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.107.189473/DC1.

This clarification has been endorsed by the American Academy of Child and Adolescent Psychiatry, the American College of Cardiology, Children and Adults with Attention-Deficit/Hyperactivity Disorder, the National Initiative for Children’s Healthcare Quality and the Society for Developmental and Behavioral Pediatrics.

Warning for Children on ADHD Medication – Get a Heart Checkup

continuum wellness — Thu, 24 Apr 2008 01:48:04 +0000

The article below is from the American Heart Association. While there is a place for modern medicine, it seems practically every day there is a warning or a recall over drug safety or a therapeutic approach gone sour.
It seems evident that there should be options for those who want to explore and use them, and yes I am referring to homeopathic medicine or other holistic approaches. Why should the public be subjected to these scenarios? Read the article below.

Children with ADHD should get heart tests before treatment with stimulant drugs

Statement highlights:
• The side effects of stimulant drugs, like those used to treat ADHD are usually insignificant, but are important to monitor for children with ADHD and certain heart conditions.
• Children diagnosed with ADHD should receive an electrocardiogram (ECG) to rule out heart abnormalities before beginning treatment with stimulant drugs.
• Children currently taking stimulant drugs who did not have an ECG prior to treatment should get an ECG.

View the statement here

DALLAS, April 21 – Children with attention deficit hyperactivity disorder (ADHD) should get careful cardiac evaluation and monitoring – including an electrocardiogram (ECG) – before starting treatment with stimulant drugs, a new American Heart Association statement recommends.

The scientific statement on Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs is published online in Circulation: Journal of the American Heart Association.

In 1999, concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants, but including stimulants, prompted an American Heart Association Scientific Statement: Cardiovascular Monitoring of Children and Adolescents Receiving Psychotropic Drugs. However, no specific cardiovascular monitoring was recommended for the use of stimulant medications. Warnings from the U. S. Food and Drug Administration (FDA) about stimulant medications and public concern for the safety of using them have prompted the current statement.

Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. These side effects are insignificant for most children with ADHD; however, they’re an important consideration for children who have a heart condition. Certain heart conditions increase the risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes erratic and doesn’t pump blood through the body.

Doctors usually use a physical exam and the patient and family history to detect the risk for or presence of health problems before beginning new treatments, including prescribing medication. But some of the cardiac conditions associated with SCD may not be noticed in a routine physical exam. Many of these conditions are subtle and do not result in symptoms or have symptoms that are vague such as palpitations, fainting or chest pain.

That’s why the statement writing group recommends adding an ECG to pre-treatment evaluations for children with ADHD. An ECG measures the heart’s electrical activity and can often identify heart rhythm abnormalities such as those that can lead to sudden cardiac death.

“After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death,” said Victoria L. Vetter, M.D., head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.

If heart problems are suspected after the evaluation, children should be referred to a pediatric cardiologist. Once stimulant treatment begins, children should have their heart health monitored periodically, with a blood pressure check within one to three months, then again at routine follow-ups every six to 12 months.

“Children can have undiagnosed heart conditions without showing symptoms,” Vetter said. “Furthermore, a child’s body changes constantly, with some conditions not appearing until adolescence.”

If the initial ECG was taken before age 12 years, it may be useful to do a repeat ECG after the child is over age 12 years, the statement says.

Widespread use of ECGs to detect heart abnormalities, including screenings for competitive athletes, is not routinely recommended by the American Heart Association. However, the writing group found using ECG screening in this specific population of children prescribed ADHD medication is medically indicated and reasonably priced. That said, however, lack of an ECG shouldn’t mean that kids who need ADHD treatment can’t get it.

“While we feel that an ECG is reasonable and helpful as a tool to identify children with cardiac conditions that can lead to SCD, if, in the view of their physician, a child requires immediate treatment with stimulant medications, this recommendation is not meant to keep them from getting that treatment,” said Vetter, who added that some children may not have access to a pediatric cardiologist who can evaluate an ECG or perform a cardiology consultation.

In 2003, an estimated 2.5 million children took medication for ADHD. Surveys indicate that ADHD affects an estimated 4 percent to 12 percent of all school-aged children in the United States, and it appears more common in children with heart conditions. Studies report that, depending on the specific cardiac condition, 33 percent to 42 percent of pediatric cardiac patients have ADHD, Vetter said. The number of undiagnosed children with heart conditions is unknown as routine heart screening is not performed, but Vetter said that a recent pilot study she presented at the American Heart Association’s 2007 Scientific Session indicated that up to 2 percent of healthy school aged children had potentially serious undiagnosed cardiac conditions identified by an ECG.

Data from the FDA showed that between 1999 and 2004, 19 children taking ADHD medications died suddenly and 26 children experienced cardiovascular events such as strokes, cardiac arrests and heart palpitations. Since February 2007, the FDA has required all manufacturers of drug products approved for ADHD treatment to develop Medication Guidelines to alert patients to possible cardiovascular risks.

Future studies are necessary to assess the true risk of SCD in association with stimulant drugs in children and adolescents with and without heart disease, Vetter said. However, studying SCD associated with drugs is difficult because the government’s reporting system is voluntary, which means local data on these types of deaths isn’t always reported nationally.

A registry of SCD events is necessary for further investigating this issue, the writing committee said. Such a registry would allow for a more accurate understanding of SCD, including the true incidence of it and the potential effectiveness of universal ECG testing and pre-participation screening questionnaires.

The statement writing committee said its recommendations are not intended to limit the appropriate use of stimulants in children with ADHD.

“Our intention is to provide the physician with some tools to help identify heart conditions in children with ADHD, and help them make decisions about the use of stimulant medications and the follow-up of children who take them,” Vetter said. “The goal is to allow treatment of ADHD, while attempting to lower the cardiac risk of these products in susceptible children.”

The writing committee also includes: Josephine Elia, M.D.; Christopher Erickson, M.D.; Stuart Berger, M.D.; Nathan Blum, M.D.; Karen Uzark, R.N., Ph.D.; and Catherine L. Webb, M.D.

###

NR08-1058 (CIRC/Vetter)

The American Heart Association/American Stroke Association receives funding primarily from individuals. In addition, foundations and corporations – including pharmaceutical, device manufacturers and other companies – make donations and fund specific American Heart Association/American Stroke Association programs and events. Revenues from pharmaceutical and device corporations are disclosed at www.americanheart.org.

Diet Change May Help Hyperactive Children

continuum wellness — Wed, 27 Feb 2008 19:55:55 +0000

by Nina Larson

STAVANGER, Norway (AFP) – Tears streak Rita’s cheek as she recalls what it was like trying to figure out what was wrong with her son more than a decade ago, but she breaks into a smile when she explains how changing his diet made all the difference.

“I could tell something was wrong with him as soon as he began eating solids as a baby. It was if the food was draining him,” says Rita, 50, describing how her son Christoffer had yoyoed between passive and hyperactive behaviour until she had removed several staples from his diet including milk and grains.

Christoffer, today a normally developed 14-year-old, is one of 23 children suffering from hyperactive disorders who were put on milk-free diets in 1996-1997 and whose development has been tracked ever since by a small group of educators and researchers in the southwestern Norwegian town of Stavanger.

The group set out to prove a theory by Oslo-based scientist Karl Ludvig Reichelt that a metabolic disorder making it difficult to break down certain proteins, including casein (the protein in milk that makes it possible to make cheese), could cause mental problems like Attention Deficit Hyperactivity Disorder (ADHD).

“One of the kids I worked with started on the diet on Wednesday and by the weekend his parents said they saw a huge positive change in his behaviour,” says special educator Magne Noedland, who helped spearhead the diet project.

All 23 children, who were between four and 11 years old when the project started, were suspected of having ADHD and had been shown to have abnormal levels of peptides in their urine.

The accumulation of peptides, which are short compounds containing two or more amino acids, is an indication that the enzyme needed to fully break down certain proteins is inhibited or missing, and can have an opium-like effect on the brain, according to Reichelt.

Much international research has been done linking such protein disorders to cases of autism and schizophrenia, and a growing number of studies also hint that some cases of ADHD are connected with the digestive problem.

There is however a lot of scepticism to the theory in medical circles, with many doctors believing medication like Ritalin is the best way to treat the condition.

Noedland acknowledges the Stavanger project does not meet all scientific standards, claiming the main problem is the lack of comprehensive studies on how many ADHD children suffer from peptide abnormalities.

“There is no reason to put everyone with ADHD on a diet if only 10 percent of them have protein imbalances,” he says.

The children in the Stavanger project all followed a strict casein-free diet the first year, and the results were overwhelmingly positive, Noedland says, pointing out that 22 of the 23 families reported clear improvements in their child’s behaviour and attention-span.

A number of the children have since stopped following the diet for different reasons and some were put on medication, but after eight years six were still strictly avoiding all milk products and several had also cut out gluten, which is found in wheat, rye, barley and to some extent oats.

“We see a clear difference between those who stopped and those who stayed on the diet,” Noedland says.

“Seeing these kids going from one day not being able to learn a thing to the next day being receptive; as a teacher that’s a wonderful feeling,” says Kristine Fosse, one of the educators involved in the project.

To illustrate her point, Fosse pulls out a writing test by a six-year-old boy who took part in the project.

The boy was asked to write his numbers after involuntarily breaking his diet and ingesting milk on September 22, 1996. The result was a confused and jumbled mess of squiggly lines. Just two days later, again strictly steering clear of casein, he repeated the exercise, this time writing four clearly legible numbers in an even line.

“It’s incredible. We’ve seen intelligence tests that had gone steadily down suddenly turn around and go back up” after a change of diet, says Ann-Mari Knivsberg, who covers the research end of the Stavanger project.

One of the children who still avoids milk and gluten, 17-year-old Sigbjoern, says any lapse in his diet affects his performance in school.

“I can tell right away when I’ve eaten something I shouldn’t. It’s really hard to concentrate. I’m always careful before tests,” he says, taking a big bite of gluten and milk-free carrot cake.

Considered a hyperactive problem child with retarded development in nursery school, Sigbjoern today ranks among the best students in his class.

“He had a slow start and a lot of trouble learning to begin with, but by secondary school he was really doing well,” says Sigbjoern’s mother Grete, 52.

Both Grete and Rita asked that their families’ last names not be used for fear of stigmatisation.

“It is considered shameful to have ADHD,” Grete says. “When they’re on a diet they’re just like everyone else. Just look at them. We have two normal, great kids. I’m eternally grateful that Sigbjoern was included in the project.”

Hundreds of other Norwegian children with ADHD, mainly in and around Stavanger, have in recent years been put on milk-free diets to help deal with their condition, but Fosse complains many doctors don’t inform parents of the option.

“We want to get the word out that this can be an alternative. Parents have to do a lot of searching before they get this information,” she says.

“The scepticism is infuriating. I’m glad I have a good education and can stand up for myself when I meet doctors who ridicule what I’m doing,” says Grete, putting her arm around Sigbjoern’s shoulder.

“I mean, as a parent, wouldn’t you want to at least try switching your child’s diet before medicating him?”