One in 20 Ontario children and youth have attention deficit hyperactivity disorder and many are prescribed antipsychotic drugs, despite having no other mental health diagnoses, researchers have found.
A study by the Institute for Clinical Evaluative Sciences found almost 12 per cent of kids and youth with attention deficit hyperactivity disorder, or ADHD, were prescribed antipsychotics like Risperdal, Zyprexa and Seroquel.
"When we looked at the information on the children and youth with ADHD who were prescribed antipsychotics, a very, very small number of them had a condition where you would expect the use of an antipsychotic – conditions such as bipolar disorder or schizophrenia," said senior author Dr. Paul Kurdyak, head of the mental health and addictions program at ICES.
As its name suggests, ADHD causes such symptoms as difficulty concentrating on tasks and restlessness, which can have major implications for school achievement, no matter a young person's intellectual capabilities, Kurdyak said.
To conduct the study, published Wednesday in the Canadian Journal of Psychiatry, researchers took a random sample of health records for 10,000 Ontarians aged one to 24 and examined data relating to ADHD and other diagnoses, prescribed medications and health services utilized.
They found about five per cent – or 536 – of the children and youth had a diagnosis of ADHD. Males are two to three times more likely than females to be diagnosed with ADHD.
About 70 per cent of the young people with ADHD were being treated with drugs like Ritalin and Adderall, which are considered standard, first-line therapy for the common condition. About 20 per cent had also been prescribed antidepressants, "which isn't terribly surprising because depression and anxiety commonly co-occur with ADHD," Kurdyak said.
"But the surprising finding to us was the 12 per cent of kids with ADHD who were prescribed an antipsychotic," he said, explaining that the medications have a sedating effect, which could help reduce disruptive behaviour.
However, these drugs can have adverse effects, such as causing significant weight gain. One study found kids gained almost 19 pounds on average after 10 weeks on the drugs – and the risk of developing pre-diabetes or diabetes.
"We don't know why these children and youth with ADHD are on antipsychotics, but there is a risk associated with early antipsychotic exposure, so we need to know more about why they are being used, so that the benefits can be weighed against the risks."
Mark Henick, national director of strategic initiatives at the Canadian Mental Health Association, said it's known that some doctors prescribe antipsychotic medications for ADHD, and he's concerned about the high level of use in young people with the disorder.
"They're not indicated for ADHD and there's not a lot of evidence that they work for ADHD," he said Wednesday. "In fact, there's good evidence that they could be harmful."
The ICES study shows that people who go to a psychiatrist for treatment are more likely to be prescribed an antipsychotic, noted Henick, who was not involved in the research. "But it's often not appropriate in these kinds of cases, where we know psychotherapy is quite effective for ADHD."
However, he said it can be difficult for many families to arrange psychotherapy for a child with ADHD. Psychiatrists' services are covered by provincial health insurance, but they often have long wait lists as a result. Psychologists and other psychotherapists are typically far more accessible, but their services are not covered and must be paid for out of pocket.
"So you'd be looking at anywhere from $100, $150, $200, $250 an hour for psychotherapy for ADHD – and most families can't afford that."
Kurdyak said children and youth who experience continued ADHD-related behavioural issues that are making school and home life difficult need to have an integrated therapeutic plan beyond medications.
"You'd certainly want a child in that situation to have access to behavioural therapies that provide children and their families with coping skills so that they can manage their behaviours," he said.
"We would like to see situations where kids, who are more complex,
that the treatment they receive is comprehensive and aligned with their need
and not simply the addition of an antipsychotic with all its risks."
By Sheryl Ubelacker
19 January 2017
A more holistic approach to health promotion in schools could lead to empowered youth according to a study by a Massey University academic.
School of Public Health lecturer Dr Eva Neely spent a year at an urban secondary school for girls, observing and interviewing students and teachers about how they use food in everyday life, to better understand the social meaning of food amongst young people.
Dr Neely says she was dissatisfied when reading literature about young people’s nutrition, which she says was often narrow and negative.
“Young people are always put in a bad light, because they don’t adhere to the right fruit and vegetable levels, and they are deemed a big risk to our future health. I always felt it was really undermining, and very narrow, and it didn’t really take into account the whole picture,” Dr Neely says.
“Our strong focus on this physical health lifestyle approach really impacts on health holistically. I think a much better focus for looking at health in any population is a more holistic picture, looking at physical, mental and social health and how these aspects affect each other and how we can approach health promotion from more of an empowerment-based approach.”
Dr Neely says her personal interest in nutrition clashed with existing research, and she wanted to know more about the meaning of food for social health. “It’s not up to individuals always to make the right health choices, and not everyone can.”
Over a year, Dr Neely watched and spoke to teachers and 16-18 year-old students (Year 13), exploring the students’ everyday food practices including routines, rituals and habits. “The purpose of my paper is to fill the knowledge gap exploring how food rituals act as vehicles for young people to establish, maintain, and strengthen social relationships.”
While fully immersed at the school, attending three to five days a week, Dr Neely was able to observe the students’ eating habits and decision-making. They discussed “typical things you would think 16-year-olds are interested in, from boys, to things going on at school to other girls and other groups,” Dr Neely says.
“Relationships would seem to me to be one of the main things that matter to young people - where they stand, who are their friends - because they seem to be their primary support people during that quite vulnerable period. Those emerged as key things in their talk. Food emerged in these practices as something quite noticeable sometimes. For example, if people were in a mood or having a fight, they didn’t offer that person food as part of the group when offering food around.”
The findings include three food rituals highlighted as significant for young people in managing their social relationships. “Food rituals were used to build, maintain and regulate relationships. Gifting food was quite a big thing. There were often girls that had made cupcakes to bring and share with others or they made something for someone’s birthday. These were all really engrained practices linked to their relationships.
“The act of going for a walk to get lunch encouraged social interaction and was a means for young people to integrate into a new group, and ritualised food sharing involved negotiating friendship boundaries.”
Dr Neely says further research exploring how young people use food
rituals in their everyday lives to manage social relationships is needed.
“A focus on social relationships in settings such as schools could broaden the scope of nutrition promotion to promote health in physical, mental, and social dimensions, and have wide-reaching implications for school health promotion.”
Fostering social relationships through food rituals in a New Zealand school was co-authored by Dr Eva Neely and Dr Mat Walton from the School of Public Health, and Professor Christine Stephens from the School of Psychology, and can be read here.
17 January 2017
Growing up in poverty exposes children to greater levels of stress, which can lead to psychological problems later in life, a new study suggests.
Researchers at Cornell University reported that kids who grow up poor are more likely to have reduced short-term spatial memory. The study also reported that such kids seem to be more prone to antisocial and aggressive behavior, such as bullying.
Poor children are also more likely than kids from middle-income homes to feel powerless, the study authors suggested.
Of course, the findings don’t mean that all children growing up in poverty will have these problems, only that the risk is higher, the researchers said.
“What this means is, if you’re born poor, you’re on a trajectory to have more of these kinds of psychological problems,” study author Gary Evans, a professor of environmental and developmental psychology, said in a university news release.
The researchers said the negative psychological effects of growing up in poverty may stem from stress.
“With poverty, you’re exposed to lots of stress. Everybody has stress, but low-income families, low-income children, have a lot more of it,” Evans said. “And the parents are also under a lot of stress. So, for kids, there is a cumulative risk exposure.”
For the study, the researchers monitored 341 children and young adults for 15 years. The participants were evaluated at four intervals: age 9, 13, 17 and 24.
The young people’s short-term spatial memory was tested by asking the older participants to correctly repeat a series of complex sequences of lights and sounds by pressing four colored pads in a certain order.
Those who grew up in poverty were not able to perform this task as well as those from middle-income backgrounds.
“This is an important result because the ability to retain information in short-term memory is fundamental to a host of basic cognitive skills, including language and achievement,” the study authors wrote.
The study participants were also asked to solve an impossible puzzle to assess their sense of helplessness. The adults who grew up poor gave up 8 percent more quickly than those who weren’t impoverished as children. The adults who grew up in poverty were also more likely to agree with statements, such as, “I argue a lot” and “I am too impatient,” than those who didn’t.
The study also found that adults who grew up poor had higher levels of chronic physical stress throughout childhood that lingered into adulthood.
The study’s findings may have broad implications since children who grow up poor tend to remain poor as adults, Evans noted. About 40 percent of sons have incomes similar to their fathers, the researchers said.
“People walk around with this idea in their head that if you work hard, play by the rules, you can get ahead,” Evans said. “And that’s just a myth. It’s just not true.”
To prevent these psychological problems, poor children likely need help early in life. “If you don’t intervene early, it’s going to be really difficult and is going to cost a lot to intervene later,” he contended.
Evans said one possible way to reduce poor children’s exposure to stress and reduce their risk for psychological problems may be to boost their family’s income. One way to do that would be to create a safety net for poor families with children, similar to Social Security’s supplemental income for the elderly and disabled, he said.
“It’s not true you can’t do anything about poverty. It’s just whether there’s the political will, and are people willing to reframe the problem, instead of blaming the person who is poor and even more preposterous blaming their children,” he said.
“This is a societal issue, and if we decide to reallocate resources like we did with the elderly and Social Security, we could change the kind of data this study is showing,” he said.
“Could we get rid of poverty? Probably not,” Evans said. “But I think we could change it dramatically.”
The study was published recently in the Proceedings of the National Academic of Sciences.
By Mary Elizabeth Dallas
10 January 2017
Children who have been admitted to a juvenile detention center often struggle with a range of issues years after being detained, according to results from a study published in JAMA Pediatrics.
The longitudinal study affords a rare look at how youth who experienced juvenile detention fared in terms of eight positive outcomes five and 12 years after detention.
The eight domains included the following: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility.
A team of researchers from Northwestern University tracked more than 1,800 youth who were admitted to the Cook County Detention Center in Chicago from 1995 to 1998. The average of youth of these youth was about 15 years old.
In interviews both five and 12 years after detainment, the study attempted to determine if these youth had attained age-appropriate psychosocial outcomes in the years after detention, and how much these outcomes varied by race and sex.
According to analysis, only 21.9 percent of males and 54.7 percent of females had attained positive outcomes in the eight domains. Of all groups surveyed, African Americans were the least likely to achieve positive outcomes in the years after detention.
Robert Sampson, the Harvard sociologist who has written about both life-long trajectories of delinquent youth and spatial inequality in Chicago, wrote an editorial comment on the study in the same issue of JAMA Pediatrics. The long-term consequences of detention for delinquent youth, or “the juvenile equivalent of re-entry among ex-prisoners,” remains a topic of little research, according to Sampson.
“Juvenile detention has operated in the shadow of adult incarceration,” Sampson wrote.
In their study, the Northwestern researchers say that longitudinal studies of youth incarcerated in juvenile facilities have generally focused on recidivism, rather than on how youth adjust to life after returning to their communities. They argue that pediatric health care professionals have a role to play in promoting psychosocial health among these youth.
“To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community,” the researchers wrote.
By Jeremy Loudenback
4 January 2017
We live in a culture that celebrates individualism and self-reliance, and yet we humans are an exquisitely social species, thriving in good company and suffering in isolation. More than anything else, our intimate relationships, or lack thereof, shape and define our lives.
While there have been many schools of thought to help us understand what strains and maintains human bonds, from Freudian to Gestalt, one of the most rigorously studied may be the least known to the public. It’s called attachment theory, and there’s growing consensus about its capacity to explain and improve how we function in relationships.
Conceived more than 50 years ago by the British psychoanalyst John Bowlby and scientifically validated by an American developmental psychologist, Mary S. Ainsworth, attachment theory is now having a breakout moment, applied everywhere from inner-city preschools to executive coaching programs. Experts in the fields of psychology, neuroscience, sociology and education say the theory’s underlying assumption – that the quality of our early attachments profoundly influences how we behave as adults – has special resonance in an era when people seem more attached to their smartphones than to one another
By the end of our first year, we have stamped on our baby brains a pretty indelible template of how we think relationships work, based on how our parents or other primary caregivers treat us. From an evolutionary standpoint, this makes sense, because we need to figure out early on how to survive in our immediate environment.
“If you’re securely attached, that’s great, because you have the expectation that if you are distressed you will be able to turn to someone for help and feel you can be there for others,” said Miriam Steele, the co-director of the Center for Attachment Research at the New School for Social Research in New York.
It’s not so great if you are one of the 40 percent to 50 percent of babies who, a meta-analysis of research indicates, are insecurely attached because their early experiences were suboptimal (their caregivers were distracted, overbearing, dismissive, unreliable, absent or perhaps threatening). “Then you have to earn your security,” Dr. Steele said, by later forming secure attachments that help you override your flawed internal working model.
Given that the divorce rate is also 40 percent to 50 percent, it would seem that this is not an easy task. Indeed, researchers said, people who have insecure attachment models tend to be drawn to those who fit their expectations, even if they are treated badly. They may subconsciously act in ways that elicit insensitive, unreliable or abusive behavior, whatever is most familiar. Or they may flee secure attachments because they feel unfamiliar.
“Our attachment system preferentially sees things according to what has happened in the past,” said Dr. Amir Levine, a psychiatrist at Columbia University and the co-author of the book “Attached,” which explores how attachment behaviors affect the neurochemistry of the brain. “It’s kind of like searching in Google where it fills in based on what you searched before.”
But again, history is not necessarily destiny. Intervention programs at the New School and the University of Delaware are having marked success helping at-risk groups like teenage mothers change their attachment behaviors (often passed down through generations) and establish more secure relationships. Another attachment-based intervention strategy called Circle of Security, which has 19,000 trained facilitators in 20 countries, has also proved effective.
What these protocols have in common is promoting participants’ awareness of their attachment style, and their related sabotaging behaviors, as well as training on how to balance vulnerability and autonomy in relationships.
One reason attachment theory has “gained so much traction lately is its ideas and observations are so resonant with our daily lives,” said Kenneth Levy, an associate professor of psychology at Pennsylvania State University who researches attachment-oriented psychotherapy.
Indeed, if you look at the classic categories of attachment styles – secure; insecure anxious; insecure avoidant; and insecure disorganized – it’s pretty easy to figure out which one applies to you and others in your life. The categories stem from tens of thousands of observations of babies and toddlers whose caregivers leave them briefly, either alone or with a stranger, and then return, a test known as the “strange situation.” The labels can also apply to how adults behave toward loved ones in times of stress.
Secure children get upset when their caregivers leave, and run toward them with outstretched arms when they return. They fold into the caregiver and are quickly soothed. A securely attached adult similarly goes to a loved one for comfort and support when they, say, are passed over for a promotion at work or feel vulnerable or hurt. They are also eager to reciprocate when the tables are turned.
Children high on the insecure anxious end of the spectrum get upset when caregivers leave and may go to them when they return. But these children aren’t easily soothed, usually because the caregiver has proved to be an unreliable source of comfort in the past. They may kick and arch their back as if they are angry. As adults, they tend to obsess about their relationships and may be overly dramatic in order to get attention. They may hound romantic interests instead of taking it slow.
Insecure avoidant children don’t register distress when their caregivers leave (although their stress hormones and heart rate may be sky high) and they don’t show much interest when caregivers return, because they are used to being ignored or rebuffed. Alternatively, a parent may have smothered them with too much attention. Insecure avoidant adults tend to have trouble with intimacy and are more likely to leave relationships, particularly if they are going well. They may not return calls and resist talking about their feelings.
Finally, insecure disorganized children and adults display both anxious and avoidant behaviors in an illogical and erratic manner. This behavior is usually the lingering result of situations where a childhood caregiver was threatening or abusive.
Tools to determine your dominant attachment style include the Adult Attachment Interview, which is meant to be administered by a clinician, or self-report questionnaires like the Attachment Styles and Close Relationships Survey. But critics said their accuracy depends on the skill and training of the interviewer in the case of the former and the self-awareness of the test taker in the latter, which perhaps explains why you can take both tests and end up in different categories.
“It can also be possible that people should be viewed as along a continuum in all categories,” said Glenn I. Roisman, the director of the Relationships Research Lab at the University of Minnesota in Minneapolis.
"It’s worth noting that just as people in the insecure categories can become more secure when they form close relationships with secure people, secure people can become less so if paired with people who are insecure. You need social context to sustain your sense of security,” said Peter Fonagy, a professor of psychoanalysis at University College London.
He added that having secure attachments is not about being a perfect parent or partner but about maintaining communication to repair the inevitable rifts that occur. In the daily battering of any relationship, Dr. Fonagy said, “if free flow of communication is impaired, the relationship is, too.”
By Kate Murphy
7 January 2017
Kate Murphy is a journalist in Houston who writes frequently for The New York Times.
Parents and nonparents alike feel better about corporal punishment when it's called 'spanking' rather than 'hitting' or 'beating,' according to a new study by researchers at Southern Methodist University, Dallas.
Study participants judged identical acts of a child's misbehavior and the
corporal punishment that followed it, but rated the discipline as better or
worse simply depending on the verb used to describe it.
Discipline acts referred to as spank and swat were ranked as more effective and acceptable than those referred to as slap, hit or beat.
The findings of the study indicate that people buffer negative views of corporal punishment by calling it by a more culturally acceptable label, said psychologist Alan Brown, psychology professor at SMU and lead author on the research.
"Our findings suggest that the way child-discipline is described may alter the action's implied intensity or physical harm, and its consequences such as emotional upset," Brown said. "Calling a response to misbehavior a 'swat' may imply higher prevalence of that response as well as make it seem more justifiable and valid – even if the actual punishment is the same as an act described more harshly."
Participants in the study rated the acts after reading and responding to hypothetical scenarios in which a mom disciplined her misbehaving son. Spank rated highest for commonness, acceptability and effectiveness, while beat ranked the worst, he said.
"The labels that we give to our experiences can have a moderate to profound influence on how we interpret and remember these events," Brown said. "We found that altering the verb used to describe an act of corporal punishment can change perception of its effectiveness and acceptance of it."
One implication of the study is that public health interventions to eliminate corporal punishment should focus on changing the semantics of discipline to reduce or prevent violence, say the authors. They cite UNICEF's 2014 recommendation that "There is a need to eliminate words which maintain 'social norms that hide violence in plain sight.'"
The psychologists endorse replacing the verb spank with the verb assault, as suggested by other researchers in the field, which they say could change the perception of spanking and reduce its use.
Labels can buffer how actions are perceived
Research consistently has found that corporal punishment does emotional and developmental harm to children and fails to improve a child's behavior over the long run.
"Our belief is that it is never okay to discipline a child by striking them, and that various terms commonly used to describe such actions can buffer how these actions are perceived," Brown said. "Our research demonstrated that ratings of how common, acceptable and effective an act of corporal punishment appears to be is significantly influenced by the word used to describe it."
Co-author on the study was psychologist George Holden, a noted expert on parenting, discipline and family violence and co-author on the research and a professor in the SMU Department of Psychology.
The findings were reported in the article "Spank, Slap, or Hit? How Labels Alter Perceptions of Child Discipline" published in the journal Psychology of Violence.
The other co-author on the research was Rose Ashraf, a graduate student in SMU's Department of Psychology.
Holden is a founding steering committee member and current president of the U.S. Alliance to End the Hitting of Children.
Study examined how different terms influence perceptions and actions
Participants were 191 nonparents and 481 parents.
The discipline scenarios were between a mom and her 5-year-old son. The mom and son varied with each scenario, which described a boy in eight acts of misbehavior: aggression, stealing, ignoring requests, deception, teasing, property destruction, animal cruelty and lying.
Study participants read each vignette of misbehavior, and the subsequent description of the mom's response using a term commonly reflecting corporal punishment: spank, slap, swat, hit and beat.
The authors selected the labels from the most commonly used terms in the research literature for corporal punishment in American culture.
The hypothetical scenarios were brief and left context and details such as the seriousness of the transgression or the intentions of the misbehaving child to the respondents' imaginations.
For example: "John continues to hit his sibling after his mother has asked him to stop. John's mother ______ him." The participants then rated the mother's response on how common it was, how acceptable it was and how effective it was.
The purpose was to examine how differences in the terms influence perceptions of parental discipline, the authors said.
"Our study highlights the role of language in legitimizing violent parental behavior," according to the authors in their article. "Altering the verb used to describe the same act of corporal punishment can have a substantial impact on how that parental response is evaluated, with some terms having a relative tempering effect (spank, swat) compared with others (hit, slap, beat)."
January 4, 2017