Child Development
Should Children Take Antipsychotic Drugs?
07/15/15 22:55
A current article in Scientific American addresses a serious problem in psychiatry: the overmedication of children, not only by psychiatrists but also by pediatricians and family physicians. Some years ago I reviewed the case of a child who was admitted to a psychiatric hospital, and at the time of the admission this five-year-old was on three psychiatric medications. Five days later the child was discharged on five medications, four of which the child was not taking on Day One of the hospitalization. I was astonished. In the 1980's, when I was a medical director in a specialty hospital treating young children, these kids would stay with us for months, not days. The entire first month was devoted to getting the diagnosis right and developing a coherent treatment plan. Our assumption, which is still true today, is that the doctor and the team must get to know the patient.
According to Scientific American: "Modern antipsychotic drugs are increasingly prescribed to children and adolescents diagnosed with a broad variety of ailments. The drugs help to alleviate symptoms in some disorders, such as schizophrenia and bipolar disorder, but in others their effectiveness is questionable. Yet off-label prescribing is on the rise, especially in children receiving public assistance and Medicaid. Psychotic disorders typically arise in adulthood and affect only a small proportion of children and adolescents. Off-label prescriptions, however, most often target aggressive and disruptive behaviors associated with attention-deficit hyperactivity disorder (ADHD). “What's really concerning now is that a lot of this prescription is occurring in the face of emerging evidence that there are significant adverse effects that may be worse in youth than in adults,” says David Rubin, a general pediatrician and co-director of PolicyLab at Children's Hospital of Philadelphia. Here we review the evidence for the effectiveness of antipsychotic medications commonly prescribed for five childhood conditions. But do the benefits outweigh the risks?" To read the entire article, click here.
The mental health system can sometimes be complicated and difficult for parents to understand. A child's emotional distress often causes disruption to both the parent's and the child's world. Parents may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them.
If you are worried about your child's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your child needs help, you should get as much information as possible about where to find help for your child. Parents should be cautious about using the internet as their only source of information and referral.
According to Scientific American: "Modern antipsychotic drugs are increasingly prescribed to children and adolescents diagnosed with a broad variety of ailments. The drugs help to alleviate symptoms in some disorders, such as schizophrenia and bipolar disorder, but in others their effectiveness is questionable. Yet off-label prescribing is on the rise, especially in children receiving public assistance and Medicaid. Psychotic disorders typically arise in adulthood and affect only a small proportion of children and adolescents. Off-label prescriptions, however, most often target aggressive and disruptive behaviors associated with attention-deficit hyperactivity disorder (ADHD). “What's really concerning now is that a lot of this prescription is occurring in the face of emerging evidence that there are significant adverse effects that may be worse in youth than in adults,” says David Rubin, a general pediatrician and co-director of PolicyLab at Children's Hospital of Philadelphia. Here we review the evidence for the effectiveness of antipsychotic medications commonly prescribed for five childhood conditions. But do the benefits outweigh the risks?" To read the entire article, click here.
The mental health system can sometimes be complicated and difficult for parents to understand. A child's emotional distress often causes disruption to both the parent's and the child's world. Parents may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them.
If you are worried about your child's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your child needs help, you should get as much information as possible about where to find help for your child. Parents should be cautious about using the internet as their only source of information and referral.
Child Development and Brain Health
06/04/15 19:32
In teaching medical students about psychiatry, I say that there are two key factors that influence how an individual fares in life. One factor is biological vulnerability, and the other factor is developmental opportunity. A person may be born with a genetically influenced condition like dyslexia, or a genetic vulnerability to addiction (alcoholism, for example, tends to run in families). Someone with biological vulnerability may, however, do quite well if life is filled with developmental opportunity. A person who grows up in a stable family, who attends good schools, and who gets a good job has a life rich in developmental opportunities that may ultimately enable them to overcome the biological vulnerability.
Someone with dyslexia may attend schools that recognize the deficit and help the child learn to read well; or they may have the help of a skilled educational psychologist who can work the magic and overcome the learning differences. On the other hand, someone who grows up in less fortunate circumstances, like living in poverty or suffering a broken home, may do very well if they are biologically resilient and strong. Problems arise, however, when some suffers biological vulnerability as well as a life short on developmental opportunity. When we see the chronically mentally ill, we often see the overlap of these two conditions.
New research suggests that family income, and to a lesser degree parental education, are associated with brain structure differences in children and young adults. Focusing on brain regions critical for language, memory, and executive function in participants aged three to 20 years, scientists found that small differences in income were associated with relatively large differences in brain surface area in young people from the lowest-income families. This effect was smaller in higher-income families. Higher income was also associated with better performance in tests of cognitive ability. Increased levels of parental education were also related to increased brain surface area, although this effect was smaller when compared to the influence of income.
Although these study results do not suggest that low-income children have poor cognitive function, they indicate that interventions to reduce family poverty may help reduce socioeconomic disparities in child development and achievement. The full text of the findings can be found here.
Someone with dyslexia may attend schools that recognize the deficit and help the child learn to read well; or they may have the help of a skilled educational psychologist who can work the magic and overcome the learning differences. On the other hand, someone who grows up in less fortunate circumstances, like living in poverty or suffering a broken home, may do very well if they are biologically resilient and strong. Problems arise, however, when some suffers biological vulnerability as well as a life short on developmental opportunity. When we see the chronically mentally ill, we often see the overlap of these two conditions.
New research suggests that family income, and to a lesser degree parental education, are associated with brain structure differences in children and young adults. Focusing on brain regions critical for language, memory, and executive function in participants aged three to 20 years, scientists found that small differences in income were associated with relatively large differences in brain surface area in young people from the lowest-income families. This effect was smaller in higher-income families. Higher income was also associated with better performance in tests of cognitive ability. Increased levels of parental education were also related to increased brain surface area, although this effect was smaller when compared to the influence of income.
Although these study results do not suggest that low-income children have poor cognitive function, they indicate that interventions to reduce family poverty may help reduce socioeconomic disparities in child development and achievement. The full text of the findings can be found here.