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).
The full text article is available here from The Journal of Child and Adolescent Psychopharmacology
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
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
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.
A Process Map and Proposed Model to Overcoming Barriers to Care | Journal of Pediatric Psychology
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.
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
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.
•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.
Large-scale analysis suggests fewer risks than previously thought from exposure to antidepressant medications in early pregnancy | ScienceDaily
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.
Fischer, B. & Herberholz, N. Paediatrics and Child Health. Published online: 5 August 2016
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.
Beau-Lejdstrom, R. et al. BMJ Open. 2016. 6:e010508
Objectives To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013.
Methods All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated.
Results The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years.
Conclusions There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries.