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

social-1206614_1920.png

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

pregnancy-466129_960_720.jpg

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

8574916468_1d715bff60_z

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

Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence

Beau-Lejdstrom, R. et al. BMJ Open. 2016. 6:e010508

https://www.flickr.com/photos/practicalcures/23280349432/in/photolist-BtcSP3-pve5sm-pRf9pH-65RDqb-6cyayd-5ZkLtC-5YzodT-5ZjDEQ-oYcoU3-qvA6Yg-5ZkPg3-p9Pmyf-oUn7hN-66JPd4-66P7wy-bk9tfm-pbzBMx-AFn9hr-7VutWw-pCyzMp-6c78vN-BvuiRT-AFfYn9-5YzsRV-qQ7AFn-BCMBZz-ofshvp-qeNNkZ-kvUQ5w-pbzE8p-633oRB-5YTXTf-5rQPsZ-6aui83-5s6YvA-5Zmxja-5vaZuR-gG7crv-5ZkyTN-6GCtJL-5Z8cUW-826K5h-bjnjKX-5Z7Rdi-6c78vy-MUA3A-Dq4qGj-CT9Fku-ppNDJ2-bFJJ5c

Image source: Practical Cures // CC BY 2.0

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.

Read the full article here

Diagnosis and treatment of ADHD in Primary Care

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review

Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school-age children. This review is intended to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents.

PubMed, PsychInfo, and Science Citation Index databases were searched from March 1990 to 2015 with the keywords: ADHD, primary care/pediatrics and children/adolescents, abstracts addressing diagnosis and/or treatment with 105 citations identified including supplementary treatment guidelines/books.

Adolescent ADHD presents with significant disturbances in attention, academic performance, and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis, and limited training and time for PCPs to conduct thorough evaluations.

The evidence base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification, and treatment of conditions associated with ADHD that emerge during adolescence as substance use disorders.

Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care psychiatric models, to assist in determining the optimal care for patients at this critical period.

Full reference: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder During Adolescence in the Primary Care Setting: A Concise Review. Journal of Adolescent Health. Published Online:May 18, 2016

Teen suicide: ADHD medication as prevention

Black-box warnings about the dangers of attention-deficit hyperactivity disorder (ADHD) medications are confusing and could have serious consequences for the risk of youth suicide, according to researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and the University of Montreal, whose correspondence has just been published in the most recent issue of the journal The Lancet Psychiatry.

5960653408_5690881fc1_z

Image source: Anders Sandberg

“Health Canada has issued a series of black-box warnings about the suicidal potential of ADHD medications. However, these warnings have failed to take into account epidemiological studies showing the opposite, that increased use of this medication has been associated with reduced suicide risk in adolescents,” says Dr. Alain Lesage, psychiatrist and researcher at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and one of study’s authors.

In the past decade, the medical treatment of ADHD increased three-fold in Quebec, reaching 9% of boys aged 10 years and 4% of boys aged 15 years. However, suicide rates in Quebec’s adolescents decreased by nearly 50% during that period among 15-19 year olds, which contradicts the warnings issued by Health Canada.

“Clearly, the increased use of ADHD drugs indicates that they might actually reduce rather than augment the risk of suicide,” says Edouard Kouassi, pharmacist and researcher at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and co-author of the study.

View the full commentary article here

View the original research abstract: Lesage, A. et al. Canadian ADHD black-box warnings. The Lancet Psychiatry, 2015; 2 (12): 1057

Emerging Substance Use of Teenagers With ADHD

Belanger, R. et al. Journal of Adolescent Health. February 2016 Volume 58, Issue 2, Supplement, Page S113

237055775_baa84ef9a8_m

Image source: Raul Lieberwirth

Abstract: ADHD is a risk factor for adolescent and young adult substance use. However, emerging substance use of teenagers with ADHD is still poorly understood. The purpose of this research was to (1) assess if ADHD is linked to both initiation and current use of tobacco, alcohol and other substances in the transition from childhood to adolescence; (2) examine how important covariates may moderate the expected associations.

Read the abstract here