University of Florida study suggests our children are being over medicated for ADHD

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The University of Florida just published a news release about medication management for children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Particularly, the study focused on how early medication interventions impact chosen medications as the child ages. This has been a hot debate topic within the medical and mental health communities for several years, with a number of professionals concerned that children are being overly medicated for ADHD.

 

Basically, their findings show that children prescribed medication between the ages of 3-9 are at greater risk of being prescribed multiple psychotropic medications, antipsychotics or seizure medications (despite no scientific evidence that seizure or antipsychotic medications are effective strategies for ADHD) within the following 5-year timeframe. With a sample size of 16,500 children used for the study, these results appear pretty darn strong…and that’s alarming news.

 

What’s unclear from this research is the why behind these findings; what is causing these probabilities?

 

My interpretation of this would be that the diagnosis is wrong, the medication is wrong or research needs to be done to explore the efficacy of these intensive medication treatment strategies.

 

You can read the news release yourself here.

 

What alarms me most about this research is that 3 year old children are being treated with medication and diagnosed with ADHD. Considered a neurodevelopmental disorder, brain functioning plays an integral role in ADHD; particularly executive functioning or the decision-making ability of our brain. Kids this young are still developing executive functioning skills and are notorious for being highly energetic and disruptive by nature; particularly when tired. In fact, executive functioning isn’t entirely formed until around age 25!

 

I have seen quite a few children under the age of 6 already previously diagnosed with ADHD by a medical provider being treated with antipsychotic medications. It’s beyond my qualifications to determine whether these medications are needed, as I’m not a medical doctor, but a concern that I have had is that often there was never any therapy put into place prior to me; or that if therapy was recommended, it was not an evidence-based therapy for ADHD.

 

Behavior therapy and Applied Behavioral Analysis have been shown to be effective way of managing ADHD symptoms, particularly in younger children. There are also a number of factors that need to be taken into consideration before a diagnosis of ADHD is made. Some medical problems can mimic ADHD symptoms, as well as trauma symptoms, learning disorders and a number of environmental factors. Parent-training and school-based programs can not only provide supportive and behavioral interventions to manage symptoms but also rule out these other conditions prior to attempting medication. It’s my strong belief that medication should always be the treatment of last resort for children.

 

According to a 2011 American Academy of Pediatrics (AAP) subcommittee article, found here, behavior therapy should be prescribed for children 4-5 prior to any medication trials. Children under 3 years of age are not even recognized in this article. For older children, the recommendations are that behavior therapy be considered prior to medication use, at the family’s preference.

 

Well shoot, basically this is saying families have a choice of:

  1. A 30 second intervention in the morning of taking a pill      or
  2. Therapy – which requires a willingness to not only participate in weekly hour-long sessions but to follow through daily between sessions.

 

Hmmm.

 

The AAP is not anti-therapy, and they do advocate for its use; realistically, there are many reasons that family’s may not try therapy approaches first. The AAP article does discuss that behavioral therapy have been found to be effective, and that behavior therapy is effective when used in combination with medication. In my opinion, behavioral therapy and medication use should be treated as a magnetic relationship. However, not all physicians are knowledgeable about mental health treatment as it is not their area of expertise and I would be curious how they explain behavioral therapy and potential interventions in a way that would promote its use on the frontline of treatment.

 

I’m not against the prescribing of medication for ADHD, or any disorder, they are another tool to put into our toolboxes to assist us; many people benefit a tremendous deal from ADHD medications. But medication is a tool, not a cure. The use of medication without any additional therapy or alternative treatments does not help the child (or parent) gain new skills. Reliance is built on the medication and effective strategies are not learned for when medication may need to be stopped for funding issues, missed doctor appointments, medication changes; or even for in the afternoons when stimulant medications often wear off.

 

What are your thoughts on this research? Please share your viewpoint in the comments below!

Update: After reading through the comments, I decided to do a bit of research into vitamin deficiencies and ADHD symptoms. You can read about that here. My findings have sparked me into creating a posting series on vitamin deficiencies and mental health symptoms.

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via Daily Prompt: Magnetic

Those statistics the news shares with you… those are real people.

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According to a Los Angelas Times article from 2011, between the years of 1999-2011 there were 131,787 alcohol related firearm deaths in the United States; or 1/3 the entire number of firearm deaths for that time period. That number is 6x the population of my town.

 

Again, that number is 6x the population of my entire town.

 

When we look at statistics, it’s easy for some to shrug it off; we know certain risk factors are involved in being gunned down, certain areas of high crime we should stay away from, yadda yadda yadda. We do our utmost to protect ourselves and our families, but reality is these statistics are not just numbers. We are talking about 131,787 people who lost their lives due to a combination of alcohol and a firearm (and possibly some conflict mixed in). We place blame on victims in order to make ourselves feel safe.

 

Working in human services, I’ve seen and heard a lot of sadness and injustices in the world. It’s challenged me to look beyond statistics and risk factors because life doesn’t fit neatly into little categories we can consistently define and manipulate to create numbers. But never was I more aware of how easy it is for us to victim blame than this past week.

 

Someone I knew was gunned down in a bar parking lot. My first thought was that he mouthed off at the wrong person – this is victim blaming at its finest.

 

I hadn’t spoken to him in a very long time besides the quick catch up conversations throughout the past 10 years when we would run into each other around our very small town. It honestly doesn’t feel right to say that I’m grieving, I feel that takes away from the people who are deeply affected by his murder and my heart goes out to them; but I am filled with a visceral rage that this happened.

 

He was an eternally optimistic and positive person; using humor to diffuse tense situations and I’ve never heard a negative thing spoken of him. I knew him and his older brother throughout high school; he was full of jokes and always willing to offer support. I cannot imagine anyone foreseeing him being murdered. From the times I’ve ran into him throughout the past few years, he remained full of positivity and optimism; he was always smiling.

 

And now, he is one of those statistics you’ll hear about on the news.

 

I’ve lost friends and family before: DUIs, illnesses, suicides, and drug overdoses. While I grieved deeply for those loved ones, I was able to come to terms with the cause of death. There were reasons it happened; and most of them weren’t unexpected, sudden events. My anger right now stems from this event being so ridiculously preventable. Sudden death is tragic; please, don’t misunderstand me, but

 

You see, he was shot down for leaning on a guy’s car hood. Of course, alcohol was involved and no one makes the most rational decisions while intoxicated. But surely, we can agree that no one deserves to die over leaning on our car. Knowing him, the scenario makes sense; he was a bundle of optimism and positivity and had never seemed to realize that other people don’t always function like that. Some people see sitting on the hood of their car as justifiable murder.

 

I hear parents tell their kids that one day they are going to joke with the wrong person. I usually imagine it turning into a physical altercation, maybe a punch is thrown, but we live in a day and age where people are carrying around loaded guns and we don’t know who. That is terrifying to me. This is a tragedy that I cannot make sense of and I’m actually grateful that I can’t make sense of it…that I’m not de-sensitized or jaded to violence. Because sometimes I do worry about about how violence is becoming a part of our daily lives and we are growing numb and forgetting the fact that statistics are actual people…

 

I’m not anti-gun; I’m anti-tragedy. As a society, I don’t know what the solution is. All I know in this moment is that a man filled with unwavering optimism was shot down in a parking lot and alcohol was involved; and it’s hard for me to believe that this would have happened if alcohol hadn’t been a factor or if the shooter had chosen to leave his gun at home. His death was the definition of tragedy.

 

From an individual standpoint, we are capable of preventing these types of occurrences. We are capable of preventing ourselves from shooting someone under the influence.

 

Even the NRA (National Rifle Association) advises not to have a gun loaded until ready for use. By the way, they also advise not to consume alcohol. These are their gun safety tips (amongst others)

 

Please, if you do insist on carrying a concealed weapon; consider how many regrettable things you have done while intoxicated before grabbing your gun and heading out. Please, don’t keep it loaded because these tragedies are happening every day.

Oh, and his name was Travis; not 131,788.

 

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via Daily Prompt: Visceral

Please, BE A ROLE MODEL – No need to stare into the sun

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“Setting an example is not the main means of influencing others; it is the only means.”
— Albert Einstein

Yesterday evening, I saw pictures of President Trump staring into the sun during the solar eclipse.

First, I laughed. I laughed really hard. I laughed until tears were running down my face. For over a week, I’ve been fielding questions from children about what would happen if they stared into the sun during the eclipse; parents fearful that the schools would do nothing to prevent this, kept their children home…well aware of children’s natural curiosity when told not to do something. All of the warnings plastered across television, radio and the internet about the dangers of starting directly into the sun (who does that anyway?!), the concern for our next generation, but I guess someone forgot to keep the President inside. The man oozes distrust; they should have known he’d question the warnings.

After I was done laughing, I felt a deep sadness.

Regardless of your views of the President, I hope that we can all agree that, by completely disregarding the many warnings of the dangers of looking directly into the sun, he set a horrendous example for our children yesterday (as well as his own son, standing beside him). I’m not going to get into all the other ways he has made me fearful for our next generation.

I’m not going to make this a political post; politics are way to complicated for me. But what I do know is that we desperately need stronger role models in today’s world.

We are all role models for someone, even if we are completely unaware. Someone is looking up to you right now, this very moment.

We all talk about wanting to be treated with respect from others; remember the Golden Rule we heard so much about as kids? Treat others the way you want to be treated. Let’s take that even further – always act in ways that you want others to act.

Respect is not gained by telling people how to act. It’s unrealistic of us to make demands of our children, or our employees, if we aren’t willing to display those same behaviors ourselves. We respect those that we see emulating the same characteristics, traits and behaviors that they are suggesting for us. Kids, in particular, will look for discrepancies in your words and actions.

We don’t learn from others’ experiences; they can share their stories with us and while we may be filled with compassion; we generally think to ourselves that won’t happen to me. I’m a strong believer in honesty about our mistakes in life; but I know that simply telling others about my struggles and how I overcame them would do nothing. I have to show them, through action, through living my life the best I know how, through purposefully making decisions based off of whether I would want someone else to make that very same choice, and by owning up to my mistakes is how I elicit respect and influence others. The moment you’re caught acting in ways against what you’ve implied you believe in is the moment you’ve lost influence.

Today, live your life the way you want others to live theirs. And please, don’t look at the sun! I surely won’t be.

via Daily Prompt: Ooze

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Impulsive decisions and Willy Nilly are not synonymous

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via Daily Prompt: Willy-nilly

As I watched him fall forward, books scattering across the classroom floor, I was filled with horror. While he screeched that I had tripped him, I glanced around the room and saw that no one seemed to believe him. After all, quiet shy kids don’t purposefully trip people willy nilly. But that was exactly what had happened; I had no idea why I stuck my foot out in front of him, but I had.

 

Impulsive behavior is one of the hallmarks of childhood. Because of this, it’s easy for us to understand that brain functioning plays a large role in how impulsive we are. Children are naturally more impulsive because their executive functioning is not up to par yet.

 

Side note:  In case you’re wondering, I’ve never (purposefully) tripped another person; I genuinely felt horrible about it (I was overly nice to that kid the rest of the year). I was in 1rst, maybe 2nd, grade when it happened and still remember it vividly so it must have also been mildly traumatizing for me. I often wonder if he remembers it happening.

 

We tend to focus on the negative connotation of impulsivity. It is an indicator of several psychiatric disorders: for example, bipolar, borderline personality disorder, and ADHD. Individuals with a propensity towards impulsivity may appear to make decisions or take action willy nilly, with no purpose behind their choice; but remember, all behavior has a purpose and a function. We are goal-oriented beings.

 

So what is the purpose of impulsive behavior?

 

In life or death situations, impulsive choices may save our lives (or kill us, depends on the decision I suppose). If a bear is coming up to your campsite, would you sit around weighing the pros and cons? By the time you consider that he may eat you…well, you get the picture. Impulsive decisions can keep life exciting; if someone described you as spontaneous would that offend you?

 

At the same time, if impulsive decision making becomes a pattern in our lives, it can have detrimental effects. Who would trust our capabilities if all of our decisions appear willy nilly?

 

In determining the function of impulsive behavior in your own life, it’s important to identify the patterns. Does it occur when faced with a daunting task (avoidance)? Is it when you are feeling bored (escape function)? Is it when faced with the option of having a cookie now or a cookie later (getting something)?

 

Impulsive behavior can function as an escape/avoidance behavior, a way of getting positive reinforcement frequently, self-stimulation, a way of gaining a sense of thrill, among others. Again, it’s not the behavior that is important but the what the behavior gives us.

 

There is a great article by George Tesar and Raul Seballos that you can find here that discusses dysfunctional patterns of behavior in adults with attention-deficit/hyperactivity disorder.

 

What are some ways that impulsive behaviors function in your own life?

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