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Archive for the ‘Child/Adolescent Psychology’ Category

Phillip Seymour Hoffman did not have choice or free will and neither do you.

In ADHD, Anxiety, Brain imaging, Brain studies, Child/Adolescent Psychology, General Psychology, Medicine, Mood Disorders, Neuropsychology, Neuroscience, Psychiatry on Tuesday, 11 March 2014 at 12:37

one of the best things about this subject that i’ve read in a long time.  give it a read. it makes you think.

Phillip Seymour Hoffman did not have choice or free will and neither do you..

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Continued Increases in Adhd Diagnoses, Treatment With Meds Among US Children

In ADHD, ADHD child/adolescent, ADHD stimulant treatment, Child/Adolescent Psychology, Psychiatry, Psychopharmacology on Tuesday, 26 November 2013 at 07:09

Continued Increases in Adhd Diagnoses, Treatment With Meds Among US Children

Nov. 22, 2013 — A new study led by the CDC reports that half of U.S. children diagnosed with ADHD received that diagnosis by age 6.

The study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) found that an estimated two million more children in the United States (U.S.) have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) between 2003-04 and 2011-12. One million more U.S. children were taking medication for ADHD between 2003-04 and 2011-12. According to the study conducted by the Centers for Disease Control and Prevention (CDC):

* 6.4 million children in the U.S. (11 percent of 4-17 year olds) were reported by their parents to have received an ADHD diagnosis from a healthcare provider, a 42 percent increase from 2003-04 to 2011-12.

* Over 3.5 million children in the U.S. (6 percent of 4-17 year olds) were reported by their parents to be taking medication for ADHD, a 28 percent increase from 2007-08 to 2011-12.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood. It often persists into adulthood. Children with ADHD may have trouble paying attention and/or controlling impulsive behaviors. Effective treatments for ADHD include medication, mental health treatment, or a combination of the two. When children diagnosed with ADHD receive proper treatment, they have the best chance of thriving at home, doing well at school, and making and keeping friends.

According to CDC scientists, children are commonly being diagnosed at a young age. Parents report that half of children diagnosed with ADHD were diagnosed by 6 years of age, but children with more severe ADHD tended to be diagnosed earlier, about half of them by the age of 4.

“This finding suggests that there are a large number of young children who could benefit from the early initiation of behavioral therapy, which is recommended as the first-line treatment for preschool children with ADHD,” said Susanna Visser, of the Centers for Disease Control and Prevention, lead author of the study.

The study increases our knowledge of ADHD treatment. Nearly 1 in 5 or 18 percent of children with ADHD did not receive mental health counseling or medication in 2011-2012. Of these children, one-third were reported to have moderate or severe ADHD.

“This finding raises concerns about whether these children and their families are receiving needed services,” said Dr. Michael Lu, Senior Administrator, Health Resources and Service Administration (HRSA).

The study also found that:

* Seven in 10 children (69 percent) with a current diagnosis of ADHD were taking medication to treat the disorder.

* Medication treatment is most common among children with more severe ADHD, according to parent reports.

* States vary widely in terms of the percentage of their child population diagnosed and treated with medication for ADHD. The percentage of children with a history of an ADHD diagnosis ranges from 15 percent in Arkansas and Kentucky to 4 percent in Nevada.

Nearly one in five high school boys and one in 11 high school girls in the U.S. were reported by their parents as having been diagnosed with ADHD by a healthcare provider. For this study, data from the 2011-2012 National Survey of Children’s Health (NSCH) were used to calculate estimates of the number of children in the U.S. ages 4-17 that, according to a parent, had received a diagnosis of ADHD by a healthcare provider and were currently taking medication for ADHD. The NSCH is conducted in collaboration between HRSA and CDC.

Retrieved from:  http://www.sciencedaily.com/releases/2013/11/131122112708.htm?goback=%2Egde_2450083_member_5810692543100264452#%21

what they eyes say about adhd…

In ADHD, ADHD Adult, ADHD child/adolescent, Child/Adolescent Psychology, General Psychology, Neuropsychology, Psychiatry on Tuesday, 21 May 2013 at 06:51

Eye May Be Key to More Accurate ADHD Diagnosis

Megan Brooks

SAN FRANCISCO — Examining the retina may aid in the diagnosis of attention-deficit/hyperactivity disorder (ADHD), new research suggests.

A small study by investigators at Albert-Ludwigs University of Freiburg, Germany, showed that patients with ADHD displayed significantly elevated “background noise” on a pattern electroretinogram (PERG) compared with their healthy peers.

Altered visual signal processing may be a “neuronal correlate for ADHD,” study presenter Emanuel Bubl, MD, told Medscape Medical News. “If we can replicate this finding, it would be of great clinical importance because it would be an objective marker of ADHD.”

Dr. Bubl presented the study here at the American Psychiatric Association’s 2013 Annual Meeting.

PERG — which is a kin to an electrocardiogram of the retina — provides an electrophysiologic measurement of the activity of the retinal ganglion cells.

“This technique is an easy-to-apply and already well-established instrument in ophthalmology. With adaption, it could be widely used,” Dr. Bubl said.

Inattention and distractability are core symptoms of ADHD, but a “clearcut neuronal correlate is missing. Any attempt to find objective markers of ADHD would be very helpful in this context,” Dr. Bubl said.

Dr. Bubl and colleagues used PERG to measure the response of the retina to a checkerboard visual stimuli in 20 patients with ADHD and 20 healthy control participants.

“An elevated neuronal noise or background firing has been proposed as an underlining pathophysiological mechanism and treatment target. We found evidence for an early alteration in visual perception or signal transmission in patients with ADHD, with significantly elevated neuronal noise (P < .014),” said Dr. Bubl. In particular, neuronal noise significantly correlated with inattention, as measured with the Conners’ Adult ADHD Rating Scale.

“The results might explain why patients with ADHD are easily distracted,” Dr. Bubl added.

With more study, the results could have potentially important clinical implications. “With ADHD, there is a debate about the existence of the disease on the one hand and a growing concern about overdiagnosing ADHD and prescription of medication on the other,” he said.

With PERG, the diagnosis of ADHD could be “objectified by measurable signals, and this would be dramatically helpful in the controversial public discussion.” Use of PERG might also help in determining the effects of methylphenidate or psychotherapy on ADHD.

The authors report no relevant financial relationships.

The American Psychiatric Association’s 2013 Annual Meeting. Abstract SCR02-2. Presented May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804409?src=nl_topic&uac=184795PG

and more dsm-v controversy…

In Child/Adolescent Psychology, DSM-V, Neuropsychology, Psychiatry, School Psychology on Tuesday, 21 May 2013 at 06:48

DSM-V: Past Imperfect

By: Nassir Ghaemi, MD, MPH

 Thoughts on a New DSM

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is here. We might as well pretend that Ronald Reagan is still president. Radical changes were made, with limited scientific evidence, when DSM-III was published in 1980 (the year Reagan was elected); even the tiniest changes, with great scientific evidence, are now the subject of outrage.

For me, DSM-5 is a disappointment. I take no pleasure in making this judgment. I wish I could say that DSM revisions are increasingly scientific and getting us closer to truths. But this simply hasn’t happened.

DSM-5 is a disappointment for me not because it is much different from DSM-IV, but because it is so similar. Almost 2 decades after the fourth revision in 1994, despite thousands of research studies on psychiatric conditions, our profession hardly can bring itself to change anything of importance. The radical bipolar/major depressive disorder (MDD) dichotomy is unchanged and untouchable — the third rail of US psychiatry — despite numerous studies casting doubt on the validity of the MDD definition and providing support for broader definitions of bipolar disorder.

The personality disorder concept was nothing but the description of psychoanalytic speculations in 1980. It has remained basically unchanged, despite little research evidence of validity. Personality traits, one of the most well-proven facts in psychology, were recommended by the DSM-5 task force but vetoed by the American Psychiatric Association Board of Trustees. Science was rejected; psychoanalytic tradition was not.

Clinicians may have assumed that we have scientific validity for most of the approximately 400 diagnoses in DSM-5; we have hardly any validity data for the vast majority of those diagnoses, and we have notable validity evidence for numerous concepts that are excluded.

The claim in the Reagan presidency was that DSM would provide reliability; we could agree on definitions. Then, we would do more research so that definitions would evolve toward better validity. Reliability would lead to validity.

When Bill Clinton was president and DSM-IV was published in 1994, a change happened: DSM became an end in itself. The DSM-IV leadership explicitly stated that unless a very high bar of scientific evidence was reached, no changes were allowed. The bar kept being moved higher and higher for science, and lower and lower for politics. The DSM-IV leadership called it “pragmatism”: DSM changes were made on the basis of what that leadership thought was best for patients, they said, and for the profession.

Reliability had become an end in itself; validity no longer mattered because, in a species of extreme social constructionism, the DSM-IV leadership saw the nosology as a way to influence practice, not as a way to discover causes of and treatments for mental illnesses. (They didn’t bother with the question of how you could practice well if you didn’t find out the causes and treatments of illnesses.)

There were hopes that DSM-5 would be different, with scientifically based changes. But a major backlash came: The DSM-IV leadership opposed changes on “pragmatic” grounds, and many in the larger public criticized DSM on social constructionist grounds, as just a means for psychiatrists to make money and influence people. Major changes became minor, and even the minor ones were often dropped to an appendix for further research, which is likely to be ignored.

After 2 decades of being a loyal follower of DSM, the debates of recent years led me to make a sad but definite conclusion: DSM has caused stagnation in psychiatry. If DSM categories are devised primarily because professional leaders want to achieve some clinical or even economic goals, there is no reason why nature should play along. By being “pragmatic” and not scientific, DSM has doomed biological and pharmacologic research in psychiatry to failure for 2 generations.

Now I see a generational change. The leaders of the DSM-III, -IV, and -5 workgroups are often literally the same people, representatives of the 1970’s/1980’s generation in psychiatry. Some of us in later generations do not venerate DSM as the bible of psychiatry, as it’s often called; we instead question it as theology instead of science. Recently, the leadership of the National Institute of Mental Health (NIMH) reached the same conclusion and stated it forcefully: DSM criteria are not scientifically valid, and patients deserve better.

DSM-5 is out, and clinicians will use it, but unfortunately it represents a failed past. Those of us who grew up in that past, and have seen how it has led us to stand still, are inclined to agree with the NIMH that our future deserves to be different.

Retrieved from: http://www.medscape.com/viewarticle/804102?src=nl_topic&uac=184795PG

Use DSM-5 ‘Cautiously, If at All,’ DSM-IV Chair Advises

By: Pam Harrison

On the eve of the official launch of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Allen Frances, MD, chair of the DSM-IV Task Force and one of the new manual’s staunchest critics, is advising physicians to use the DSM-5 “cautiously, if at all.”

“Psychiatric diagnosis is facing a renewed crisis of confidence caused by diagnostic inflation,” Dr. Frances, Duke University, Durham, North Carolina, writes in a new commentary published online May 17 in the Annals of Internal Medicine.

Unlike the DSM-IV, which held the line against diagnostic inflation, he states, “The DSM-5, the recently published fifth edition of the diagnostic manual, ignored this risk and introduced several high-prevalence diagnoses at the fuzzy boundary with normality.”

For example, the DSM-5 opens the door for patients worried about having a medical illness to be diagnosed with somatic symptom disorder.

Normal grief may be misdiagnosed as major depressive disorder, and the forgetfulness of old age may now be interpreted as mild neurocognitive disorder.

“The already overused diagnosis of attention-deficit disorder will be even easier to apply to adults thanks to criteria that have been loosened further,” Dr. Frances adds.

Other changes in the DSM-5 will allow clinicians to label a child with temper tantrums as having disruptive mood dysregulation disorder, and overeating can now be called binge eating disorder.

Real Danger

The real danger in diagnostic inflation is overdiagnosis and overtreatment of patients who are essentially well, he says.

“Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form,” Dr. Frances writes.

“New psychiatric diagnoses are now potentially more dangerous than new psychiatric drugs.”

Quite apart from the risk for overtreatment, however, is the risk of neglecting patients with clear psychiatric illness whose access to care has been sharply reduced by slashed state mental health budgets.

As Dr. Frances points out, only one third of persons with severe depression receive mental health care, and a large percentage of the swollen prison population in the United States is made up of true psychiatric patients who have no other place to go.

More damning, however, is the flawed process by which committee members of the DSM-5 arrived at their expanded diagnoses, in Dr. Frances’ view.

As he states, the DSM-5 did not address professional, public, and press charges that its changes lacked sufficient scientific support and defied clinical common sense.

Field trials produced reliability results that did not meet historical standards, and deadlines were consistently missed, he adds.

The American Psychiatric Association also refused a petition from an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations.

Dr. Frances said he personally found the DSM-5 process “secretive, closed, and disorganized.”

“I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product,” Dr. Frances states.

“The problems associated with the DSM-5 prove that the APA should no longer hold a monopoly on psychiatric diagnosis…. The codes needed for reimbursement are available for free on the Internet.”

The APA declined to comment.

Ann Intern Med. Published online May 17, 2013. Full article

DSM-5: Past Imperfect. Medscape. May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804378DSM-5 Officially Launched, but Controversy Persists

By: Caroline Cassels

SAN FRANCISCO — After more than a decade of development and more than 2 years of frequently searing controversy, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has finally been released.

Here at the American Psychiatric Association’s (APA’s) 2013 Annual Meeting, the APA leadership officially launched the manual, which is widely known by clinicians and patients alike as the “Bible of Psychiatry.”

“This is really an important day. I have been involved with the DSM-5 almost from the beginning, and I have seen the work unfold over the past decade. There have been literally hundreds of people, experts from all over the world, from different disciplines, who have contributed [to the DSM-5],” outgoing APA president Dilip Jeste, MD, told reporters attending a press briefing here.

“What we are seeing is a clinical manual based on the best science available…for today’s patients, this is the best manual that we could develop,” Dr. Jeste added.

Key changes in the new edition include a new chapter organization that shows how mental disorders may relate to one another on the basis of underlying vulnerabilities or symptom characteristics.

In addition, in DSM-5, disorders are organized in the context of age — that is, along a developmental lifespan within each chapter — as well as sex and cultural expectations.

What’s New

According to DSM-5 Task Force chair David Kupfer, MD, although the number of disorders are “about the same” as in the last edition of DSM, several new disorders have been added, including binge eating disorder, disruptive mood dysregulation disorder, and hoarding disorder.

A new section for the manual, Section III, describes several conditions that warrant more research before they can be considered as formal disorders in the main part of the manual.

The changes to the manual are designed to help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care.

“We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research.”

However, not everyone is as enthusiastic about the manual’s release. Allen Frances, MD, who chaired the DSM-IV Task Force and is among the DSM-5’s staunchest critics, told Medscape Medical News that he is filled with “sadness and worry — and I am not a person usually given to either emotion.”

He added that he is very concerned that the “DSM 5 will result in the mislabeling of potentially millions of people who are basically normal. This would turn our current diagnostic inflation into hyperinflation and exacerbate the excessive use of medication in the ‘worried well.’ ”

“DSM-5 turns grief into Major Depressive Disorder; temper tantrums into Disruptive Mood Dysregulation; the expectable forgetting of old age into Mild Neurocognitive Disorder; worrying about illness into Somatic Symptom Disorder; gluttony into Binge Eating Disorder; and anyone who wants a stimulant for recreation or performance enhancement can claim Attention Deficit Disorder,” he said.

“Don’t Buy It, Don’t Use It”

However, incoming APA president Jeffrey Lieberman, MD, told reporters that the idea that the revisions to the manual will lead to overtreatment is “inaccurate and unwarranted.”

“The DSM is a diagnostic guide that reflects what we currently know about how best to define disorders. How it is applied is something that reflects clinical practice,” he said.

The manual’s diagnostic criteria, he added, are based on the current state of the scientific evidence to “verify the existence of a certain condition that we know to be impairing and distressing and enduring for people,” Dr. Lieberman added.

Dr. Frances also expressed concern that the new manual will divert scarce mental health care resources away from those who need it most.

“While we are overtreating people with everyday problems who don’t need it, we are shamefully neglecting the people with moderate to severe psychiatric problems who desperately do.”

His advice to frontline clinicians regarding the DSM-5? “Don’t buy it, don’t use it, don’t teach it. There is nothing at all official about DSM-5, and the codes for reimbursement are available for free on the Internet or in DSM-IV. APA is price-gouging a badly flawed document, no one need feel captive to it.”

NIMH Blog Not an Indictment of DSM-5?

Dr. Frances is not alone in his criticism of the manual. An April 29 blog post by Thomas Insel, MD, director of the National Institute of Mental Health (NIMH), and published on the NIMH Web site stated that although the upcoming manual is reliable, it lacks validity.

As reported by Medscape Medical News at that time, Dr. Insel pointed out that unlike diagnostic criteria for other diseases, the DSM-5 criteria are based on consensus rather than objective laboratory measures, and he noted that the NIMH will be “re-orienting its research away from DSM-5 categories.”

Toward that end, Dr. Insel went on to announce the launch of the NIMH Research Domain Criteria (RDoC) in a first step toward “precision medicine.”

Following Dr. Insel’s blog post, on May 14, the APA and the NIMH issued a joint statement in which the organizations emphasized the need to work together for the good of patients.

Nevertheless, the statement underscored the fact that the NIMH’s position on the DSM-5 had not changed and that “the diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

However, Dr. Lieberman, who has since collaborated with Dr. Insel, said that the blog post should not be viewed as an indictment of the DSM-5 but rather as an expression of frustration that psychiatry does not yet have the biologically based diagnostic tools as other areas of medicine.

“Even though his blog was interpreted this way, we don’t think Tom intended to impugn the DSM so much as to say that he wanted to exhort the biomedical research community to try and break new ground that will lead to more dynamic and fundamental changes in psychiatric diagnosis,” said Dr. Lieberman.

The DSM-5 is available immediately in print, and an electronic version will be available later this year.

The American Psychiatric Association’s 2013 Annual Meeting. Opening press conference. May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804410

flapping hands and wagging tails…

In Autism Spectrum Disorders, Child/Adolescent Psychology, Humane Education, Life with dogs, Pets, School Psychology on Tuesday, 26 February 2013 at 06:02

Your Hands Tell Me When You’re Happy

By: Stewart Duncan

Christmas was one week away, the excitement building as we prepared presents for friends and family. We laughed as we changed the words to our favorite Christmas songs, drank Egg Nog and opened the next door to find out what shape the next chocolate was in our advent calendars.

 

As we talk about Santa and what each of us is hoping for, I lean over to my son Cameron and say “Do you know how I always know when you’re happy?”

 

He said “No, how?”

I replied “Your hands tell me.”

He smiled and said “because I flap my hands!”

At that point, he began bouncing on his toes and flapping his hands so hard that I thought he might fly.

Beside us, sitting up against my hip, was my dog Spirit. She is Cameron’s best friend and, I think, Cameron is her best friend too.

I said to Cameron “Cameron, do you know how I always know when Spirit is happy?”

He said “No.”

I told him “Because her tail tells me.”

Again, the excitement building as he flapped his hands really hard, “She wags her tail!!”

I explained to him that Spirit doesn’t have hands so she wags her tail but I imagine that it’s very much the same feeling. There’s just so much happiness inside that it has to come out.

I told him that I know some people might bug him about it, some people might say silly things or tell him that he shouldn’t… but I’ll never stop him from showing me how happy he is.

He got up and gave me a big hug.

*******

About Stuart Duncan

My name is Stuart Duncan, creator of http://www.stuartduncan.name. My oldest son (Cameron) has Autism while my younger son (Tyler) does not. I am a work from home web developer with a background in radio. I do my very best to stay educated and do what ever is necessary to ensure my children have the tools they need to thrive. I share my stories and experiences in an effort to further grow and strengthen the online Autism community and to promote Autism Understanding and Acceptance.

Retrieved from:  http://www.stuartduncan.name/autism/your-hands-tell-me-when-youre-happy/

wired for anxiety?

In Anxiety, Child/Adolescent Psychology, General Psychology, Psychiatry, School Psychology on Sunday, 10 February 2013 at 08:31

Are We All Just Wired for Anxiety?

By: Ben Michaels, Ph.D.

 Michael Shermer’s TEDTalk, “The Pattern Behind Self-deception” is both groundbreaking and earth-shattering. The neuroscience Shermer cites in his talk is tight, his examples are strong and his conclusions far-reaching. The implications that many have drawn from his talk regarding larger belief systems are beyond my expertise as a clinical psychologist and so I will (wisely or cowardly — you choose) sidestep these arguments.

I do however, think that one of the factors that Dr. Shermer stumbles upon in his talk has a wide applications for the field of clinical psychology, which is this:

If Shermer is right (and he is), and that our default setting is to see patterns where they don’t exist because the cost of being wrong (that there is no pattern) is usually much higher than the cost of being right (that there is a pattern) then I have some bad news for you:

We are all just wired for anxiety.

Let me break it down:

Let’s say something bad happens to us: We have a breakup, a breakdown, a trauma, an insult or injury of any kind. This leads us to seek out patterns in our environments that could signify the possibility of future pain. In fact, Shermer says that when we feel uncertain (like after a trauma) we will be even more prone to seeking out patterns, possibly seeing them where they don’t exist.

This desperate pattern seeking is, in essence, the pernicious spiral of anxiety: We are afraid of what’s next so our minds exit the present to try to solve an unsolveable math problem about our futures. The reason the problem is unsolveable is that all of the variables don’t yet exist. The key variable being the actual event.

If this tendency is our natural weakness, we must overcome it by using our natural strength: Thinking and testing our beliefs.

For example, I once worked with a handsome young man, who we will call, Nate, who was constantly told that he was “ugly” and “stupid” by his abusive father. When he first came to me, Nate was convinced that no woman would ever want to date him, let alone, marry him.

I responded to him by saying, maybe he’s right maybe no woman would have him, but there is only one way to find out: test his beliefs in the real world. I told him that if he asked out all the women in the world and none of them want to date him, than his anxiety would be justified If at least one woman wanted to then it would not be.

He realized that this was absurd, but after a great deal of relentless pushing, Nate agreed to try to approach a few women over time.

Fourteen months later he was engaged. He is now happily married and currently expecting his third child.

Science/Empiricism = 1; Anxiety/Fear = 0

The takeaway is this: We may indeed be wired for anxiety, but that does not mean that anxiety is our fate. If we use the gift of our minds well, we can overcome our wiring.

If you read this and are feeling anxious or are buried under the weight of any false belief because of your wiring, do the hard thing: Test it out. The only thing you have to lose is your anxiety!

Ideas are not set in stone. When exposed to thoughtful people, they morph and adapt into their most potent form. TEDWeekends will highlight some of today’s most intriguing ideas and allow them to develop in real time through your voice! Tweet #TEDWeekends to share your perspective or emailtedweekends@huffingtonpost.com to learn about future weekend’s ideas to contribute as a writer.

Retrieved from: http://www.huffingtonpost.com/ben-michaelis-phd/wired-for-anxiety_b_2599944.html?utm_source=linkedin&utm_medium=social&utm_content=2c773f97-31e5-4b88-bbb2-fa255a762ed1

Click here to read the original op-ed from the TED speaker who inspired the post and watch the TEDtalk below:

http://www.huffingtonpost.com/michael-shermer/what-is-skepticism-anyway_b_2581917.html?ir=TED+Weekends&ref=topbar

 

Girls with ADHD often diagnosed later than boys

In ADHD, ADHD Adult, ADHD child/adolescent, ADHD stimulant treatment, Child/Adolescent Psychology, Psychiatry, School Psychology on Saturday, 10 November 2012 at 11:06

Girls with ADHD often diagnosed later than boys.

important information regarding child abuse

In Child/Adolescent Psychology, Psychiatry, School Psychology on Wednesday, 31 October 2012 at 08:12

please be proactive if you suspect child abuse.  you are not determining that there is definitive abuse if you report, that determination is made by the respective agencies responsible for child welfare.  ignoring it will not make the problem go away and can have deleterious effects for children.

How Child Abuse Primes the Brain for Future Mental Illness

By: Maia Szalvitz

Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse may contribute to virtually all types of mental illness.

Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of young adults who were maltreated or neglected in childhood. These changes may leave victims more vulnerable to depression, addiction and post-traumatic stress disorder (PTSD), the study suggests.

Harvard researchers led by Dr. Martin Teicher studied nearly 200 people aged 18 to 25, who were mainly middle class and well-educated. They were recruited through newspaper and transit ads for a study on “memories of childhood.” Because the authors wanted to look specifically at the results of abuse and neglect, people who had suffered other types of trauma like car accidents or gang violence were excluded.

MORE: Study: How Chronic Stress Can Lead to Depression

Child maltreatment often leads to conditions like depression and PTSD, so the researchers specifically included people with those diagnoses. However, the study excluded severely addicted people and people on psychiatric medications, because brain changes related to the drugs could obscure the findings.

Overall, about 25% of participants had suffered major depression at some point in their lives and 7% had been diagnosed with PTSD. But among the 16% of participants who had suffered three or more types of child maltreatment  — for example, physical abuse, neglect and verbal abuse — the situation was much worse. Most of them — 53% — had suffered depression and 40% had had full or partial PTSD.

The aftermath of that trauma could be seen in their brain scans, whether or not the young adults had developed diagnosable disorders. Regardless of their mental health status, formerly maltreated youth showed reductions in volume of about 6% on average in two parts of the hippocampus, and 4% reductions in regions called the subiculum and presubiculum, compared with people who had not been abused.

That’s where this study begins to tie together loose ends seen in prior research. Previous data have suggested that the high levels of stress hormones associated with child maltreatment can damage the hippocampus, which may in turn affect people’s ability to cope with stress later in life. In other words, early stress makes the brain less resilient to the effects of later stress. “We suspect that [the reductions we saw are] a consequence of maltreatment and a risk factor for developing PTSD following exposure to further traumas,” the authors write.

Indeed, brain scans of adults with depression and PTSD often show reductions in size in the hippocampus. Although earlier research on abused children did not find the same changes, animal studies on early life stress have suggested that measurable differences in the hippocampus may not arise until after puberty. The new study suggests that the same is true for humans.

MORE: Nurturing Moms May Boost Children’s Brain Growth

The findings also help elucidate a possible pathway from maltreatment to PTSD, depression and addiction. The subiculum is uniquely positioned to affect all of these conditions. Receiving output from the hippocampus, it helps determine both behavioral and biochemical responses to stress.

If, for example, the best thing to do in a stressful situation is flee, the subiculum sends a signal shouting “run” to the appropriate brain regions. But the subiculum is also involved in regulating another brain system that, when overactive during chronic high stress such as abuse, produces toxic levels of neurotransmitters that kill brain cells — particularly in the hippocampus.

It can be a counterproductive feedback loop: high levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production.

What this means is that chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases — for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers — but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD.

MORE: Boxer Quanitta Underwood’s Inspiring Fight Against Sexual Abuse — and for Olympic Gold

The subiculum also regulates the stress response of a key dopamine network, which may have implications for addiction risk. “It is presumably through this pathway that stress exposure interacts with the dopaminergic reward system to produce stress-induced craving and stress-induced relapse,” the authors write.

In other words, dysregulation of the stress system might lead to intensified feelings of anxiety, fear or lack of pleasure, which may in turn prompt people to escape into alcohol or other drugs.

With nearly 4 million children evaluated for child abuse or neglect in the U.S. every year — a problem that costs the U.S. $124 billion in lost productivity and health, child welfare and criminal justice costs — child maltreatment isn’t something we can afford to ignore.

Even among the most resilient survivors, the aftereffects of abuse may linger. Not only are such children at later risk for mental illness, but because of the way trauma affects the stress system, they are also more vulnerable to developing chronic diseases like diabetes, high blood pressure, heart attack and stroke.

We can do better for our kids.

The study was published in the Proceedings of the National Academy of Sciences.

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.
Retrieved from: http://healthland.time.com/2012/02/15/how-child-abuse-primes-the-brain-for-future-mental-illness/#ixzz2AsTNhYSB

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