Digital media use linked to behavioural problems in children

“We can say with confidence that teens who were exposed to higher levels of digital media were significantly more likely to develop ADHD symptoms in the future” says Professor Adam Leventhal  of the Keck School of Medicine of USC discussing the findings of a study that has now been in the JAMA (Journal of the American Medical Association).  The research assessed young people’s digital media usage any association between occurrence of ADHD symptoms during adolescence and tracked almost 2600 teenagers over a  24-month period.

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The research team’s findings indicate that teens who are heavy users of digital devices are twice as likely as infrequent users to show symptoms of attention-deficit/hyperactivity disorder (ADHD), the study finds. Unlike earlier studies on this topic which were conducted before social media, mobile apps and tablets existed, this study included digital media which Leventhal explains “has increased digital media exposure far beyond what’s been studied before.”

While the researchers acknowledge the study does not show causation there was a significant association between higher frequency of modern digital media use and subsequent symptoms of ADHD over a two-year follow-up. 9.5 percent of the 114 children who used half the digital media platforms frequently and 10.5 percent of the 51 kids who used all 14 platforms frequently showed new ADHD symptoms. By contrast, 4.6 percent of the 495 students who were not frequent users of any digital activity showed ADHD symptoms, approximate to background rates of the disorder in the general population (via Science Daily).

Read the full news article from Science Daily 

Abstract

Importance  Modern digital platforms are easily accessible and intensely stimulating; it is unknown whether frequent use of digital media may be associated with symptoms of attention-deficit/hyperactivity disorder (ADHD).

Objective  To determine whether the frequency of using digital media among 15- and 16-year-olds without significant ADHD symptoms is associated with subsequent occurrence of ADHD symptoms during a 24-month follow-up.

Design, Setting, and Participants  Longitudinal cohort of students in 10 Los Angeles County, California, high schools recruited through convenience sampling. Baseline and 6-, 12-, 18-, and 24-month follow-up surveys were administered from September 2014 (10th grade) to December 2016 (12th grade). Of 4100 eligible students, 3051 10th-graders (74%) were surveyed at the baseline assessment.

Exposures  Self-reported use of 14 different modern digital media activities at a high-frequency rate over the preceding week was defined as many times a day (yes/no) and was summed in a cumulative index (range, 0-14).

Main Outcomes and Measures  Self-rated frequency of 18 ADHD symptoms (never/rare, sometimes, often, very often) in the 6 months preceding the survey. The total numbers of 9 inattentive symptoms (range, 0-9) and 9 hyperactive-impulsive symptoms (range, 0-9) that students rated as experiencing often or very often were calculated. Students who had reported experiencing often or very often 6 or more symptoms in either category were classified as being ADHD symptom-positive.

Results  Among the 2587 adolescents (63% eligible students; 54.4% girls; mean [SD] age 15.5 years [0.5 years]) who did not have significant symptoms of ADHD at baseline, the median follow-up was 22.6 months (interquartile range [IQR], 21.8-23.0, months). The mean (SD) number of baseline digital media activities used at a high-frequency rate was 3.62 (3.30); 1398 students (54.1%) indicated high frequency of checking social media, which was the most common media activity. High-frequency engagement in each additional digital media activity at baseline was associated with a significantly higher odds of having symptoms of ADHD across follow-ups. This association persisted after covariate adjustment. The 495 students who reported no high-frequency media use at baseline had a 4.6% mean rate of having ADHD symptoms across follow-ups vs 9.5% among the 114 who reported 7 high-frequency activities and vs 10.5% among the 51 students who reported 14 high-frequency activities.

Conclusions and Relevance  Among adolescents followed up over 2 years, there was a statistically significant but modest association between higher frequency of digital media use and subsequent symptoms of ADHD. Further research is needed to determine whether this association is causal.

Full reference:

Ra CK, Cho J, Stone MD, et al |Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents| JAMA| 2018| 320| (3)|P.255–263|  doi:10.1001/jama.2018.8931

The article can be requested by Rotherham NHS staff here 

 

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National Patterns of Commonly Prescribed Psychotropic Medications to Young People

A new US study has found that medications prescribed to treat young people with psychiatric disorders such as depression may be under prescribed. The researchers compared prescribing rates with prevalence rates for the most common psychiatric disorders in children (Science Daily).

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The full text article is available here from The Journal of Child and Adolescent Psychopharmacology

The full feature from Science Daily

Full reference:  Sultan, R. S., et al. |National Patterns of Commonly Prescribed Psychotropic Medications to Young People| Journal of Child and Adolescent Psychopharmacology|2018|DOI: 10.1089/cap.2017.0077

 

Is ADHD really a sleep problem?

Around 75 percent of children and adults with attention deficit hyperactivity disorder (ADHD) also have sleep problems, but until now these have been thought to be separate issues | ScienceDaily

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  • In 75% of ADHD patients, the physiological sleep phase — where people show the physiological signs associated with sleep, such as changes in the level of the sleep hormone melatonin, and changes in sleep-related movement — is delayed by 1.5 hours.
  • Core body temperature changes associated with sleep are also delayed (reflecting melatonin changes)
  • Many sleep-related disorders are associated with ADHD, including restless-leg syndrome, sleep apnea, and the circadian rhythm disturbance, the delayed sleep phase syndrome
  • ADHD people often show greater alertness in the evening, which is the opposite of what is found in the general population
  • Many sufferers benefit from taking melatonin in the evening or bright light therapy in the morning, which can help reset the circadian rhythm
  • Recent work has shown that around 70% of adult ADHD sufferers show an oversensitivity of the eyes to light, leading many to wear sunglasses for long periods during the day — which may reinforce the problems associated with a ‘circadian shift’.
  • Chronic late sleep leads to a chronic sleep debt, associated with obesity, diabetes, cardiovascular disease and cancer. This cascade of negative health consequences may in part be preventable by resetting the sleep rhythm.

Read the overview via ScienceDaily here

Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder

A Process Map and Proposed Model to Overcoming Barriers to Care | Journal of Pediatric Psychology

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Objective: To provide a topical review of the personal vulnerabilities and systemic barriers facing transitional age young adults with attention-deficit hyperactivity disorder (ADHD), followed by a proposed model for overcoming those barriers.

Methods: Drawing from a growing, but limited, literature on the topic, we outline a process map for identifying and troubleshooting barriers to care in this at-risk population.

Results: Young adults with ADHD frequently lack the organizational skills, time management, prioritization, and persistence to manage their health care at an expected level of adult independence. These difficulties are compounded by a health-care system that has less time or fewer resources for supporting young adult patients.

Conclusions: Recommendations for easing the transition from pediatric to adult care for late adolescents with ADHD include heavily leveraging the doctor–patient relationship, and capturing the young adult’s attention through technologies that already absorb them.

Full reference: Fogler, J.M. et al. (2017) Topical Review: Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder: A Process Map and Proposed Model to Overcoming Barriers to Care. Journal of Pediatric Psychology. Published online: 01 August 2017

Digital technology and adolescent conduct problems

Adolescents spend an unprecedented amount of time using digital technology to access the Internet and engage with social media. There is concern that this continuous connectivity could increase their mental health symptoms, especially for at-risk adolescents. | Journal of Pediatric Nursing

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A new US study has reported that on days that at-risk adolescents used technology more, they experienced more conduct problems and higher attention-deficit hyperactivity disorder (ADHD) symptoms compared to days when they used digital technologies less.

However, the study also found that on days when adolescents spent more time using digital technologies they were less likely to report symptoms of depression and anxiety.

Key findings:

•Daily digital technology use by at-risk adolescents is associated with worse mental health symptoms.
•Higher levels of digital technology use were associated with increases in next-day conduct problems.
•Attention-deficit hyperactivity disorder symptoms increased with increased digital technology use.
•When adolescents spent more time using digital technologies they reported fewer symptoms of depression and anxiety.

Full reference: McBride, Deborah L. Daily Digital Technology Use Linked to Mental Health Symptoms for High-risk Adolescents. Journal of Pediatric Nursing: Nursing Care of Children and Families. Published online 7th June 2017

Antidepressant use in early pregnancy does not increase autism & ADHD risk in kids

Large-scale analysis suggests fewer risks than previously thought from exposure to antidepressant medications in early pregnancy | ScienceDaily

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A study led by Indiana University suggests that mothers’ use of antidepressants during early pregnancy does not increase the risk of their children developing autism or attention deficit hyperactivity disorder, conditions previously associated with these medications.

The research, reported today in the Journal of the American Medical Association, found significant evidence for only a slight increase in risk for premature birth in the infants of mothers who used antidepressants during the first trimester of pregnancy.

After controlling for multiple other risk factors, the researchers did not find any increased risk of autism, ADHD or reduced fetal growth among exposed offspring. The risk for premature birth was about 1.3 times higher for exposed offspring compared to unexposed offspring.

Read the full commentary here

The original research abstract is available here

Practical guide to the management of ADHD

Fischer, B. & Herberholz, N. Paediatrics and Child Health. Published online: 5 August 2016

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Image source: Ian Barbour – Flickr // CC BY-SA 2.0

Attention Deficit Hyperactivity Disorder (ADHD) manifests in persistent and pervasive inattention, hyperactivity and impulsivity, which interferes with functioning. It usually presents in childhood and can persist into adulthood. Severity, psychiatric co-morbidity, and parental psychopathology predict persistence. UK prevalence (ages 5–15 years) is 3.62% (boys) and 0.85% (girls) and the reported prevalence of children and young people on medication has increased over time. However, pharmacological treatment is not a solution in itself.

Read the abstract here