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Pediatric Group Issues Updated ADHD Guidelines

By Serena Gordon
HealthDay Reporter

MONDAY, Sept. 30, 2019 (HealthDay News) — Attention-deficit/hyperactivity disorder (ADHD) is in the news a lot, and now newer research has prompted a leading pediatricians’ group to update its guidelines for diagnosing and treating the disorder for the first time since 2011.

Dr. Mark Wolraich, lead author of the guidelines, noted that there weren’t any dramatic differences between these and previous guidelines. But, he said, these latest updates keep the American Academy of Pediatrics guidelines in sync with the same diagnostic and treatment criteria used by child and adolescent psychiatrists.

ADHD “is not a ‘new’ diagnosis. It’s a real diagnosis that needs treatment,” said Wolraich.

“There are two forms of treatment effective for ADHD: medications, especially stimulant medications; and behavioral treatments. Neither treatment is curative,” he said, but they can help manage the symptoms. Wolraich is an emeritus professor at the University of Oklahoma, in Oklahoma City.

More than 9% of U.S. children between the ages of 2 and 17 have been diagnosed with ADHD, according to the guideline authors. Boys are more than twice as likely as girls to be diagnosed with the disorder. Kids with ADHD often have symptoms of another mental disorder, such as depression or anxiety, and they may also have learning and language problems.

Updates to the guidelines include:

  • Changing the age at which symptoms need to have first started. Previously, symptoms needed to begin before age 7. That’s now been raised to age 12.
  • In patients older than 17, fewer problem behaviors are needed to make an ADHD diagnosis. Wolraich said as children get older, symptoms can change and behaviors such as hyperactivity usually diminish.
  • Emphasizing the need to rule out other causes of ADHD-like symptoms and to identify other conditions that may occur with ADHD, such as depression, anxiety, substance use, autism or trauma.
  • Highlighting the need for ongoing medical care and coordination within the school and community.
  • Recommending parent training in behavior management as a first-line treatment for preschoolers. Wolraich said behavior modification is an effective treatment that generally has two phases of treatment. The positive phase rewards a child for appropriate behavior, and the reward may just be praising, such as, “Johnny, I like the way you’re sitting in your chair.” The second phase includes consequences, such as “time-out.” But, he said, if you don’t have the positive side of treatment, time-out isn’t as helpful.

Continued

While the guidelines didn’t specifically recommend behavior management training for teachers and parents in high school students with ADHD, they noted that studies have found some value in this treatment for older kids.

Dr. Victor Fornari, vice chair of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., said it’s important for pediatricians to be familiar with the up-to-date guidelines, because “as many as 10% of all kids meet the criteria for ADHD, and many children with mild to moderate symptoms can be evaluated and treated by their pediatrician.”

Fornari said if treatment doesn’t go smoothly, or there are ongoing behavior problems or other mental health concerns, pediatricians can often collaborate with a child and adolescent psychiatrist to get additional guidance.

Both Wolraich and Fornari said pediatricians play a vital role in ADHD diagnosis and treatment because they already have an established relationship with the child and family.

“People may not fully appreciate that ADHD that’s untreated can lead to adverse outcomes. Failing to treat can lead to academic and conduct disturbances, and earlier substance use disorders. Children who are identified earlier and treated are more successful,” Fornari said.

The new guidelines were published online Sept. 30 in the journal Pediatrics.

WebMD News from HealthDay

Sources

SOURCES: Mark Wolraich, M.D., Shaun Walters emeritus professor, section of developmental and behavioral pediatrics, University of Oklahoma, Oklahoma City; Victor Fornari, M.D., vice chair, child and adolescent psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y., and investigator, Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, N.Y.; Sept. 30, 2019,Pediatrics, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Pediatric Group Issues Updated ADHD Guidelines

MONDAY, Sept. 30, 2019 — Attention-deficit/hyperactivity disorder (ADHD) is in the news a lot, and now newer research has prompted a leading pediatricians’ group to update its guidelines for diagnosing and treating the disorder for the first time since 2011.

Dr. Mark Wolraich, lead author of the guidelines, noted that there weren’t any dramatic differences between these and previous guidelines. But, he said, these latest updates keep the American Academy of Pediatrics guidelines in sync with the same diagnostic and treatment criteria used by child and adolescent psychiatrists.

ADHD “is not a ‘new’ diagnosis. It’s a real diagnosis that needs treatment,” said Wolraich.

“There are two forms of treatment effective for ADHD: medications, especially stimulant medications; and behavioral treatments. Neither treatment is curative,” he said, but they can help manage the symptoms. Wolraich is an emeritus professor at the University of Oklahoma, in Oklahoma City.

More than 9% of U.S. children between the ages of 2 and 17 have been diagnosed with ADHD, according to the guideline authors. Boys are more than twice as likely as girls to be diagnosed with the disorder. Kids with ADHD often have symptoms of another mental disorder, such as depression or anxiety, and they may also have learning and language problems.

Updates to the guidelines include:

  • Changing the age at which symptoms need to have first started. Previously, symptoms needed to begin before age 7. That’s now been raised to age 12.
  • In patients older than 17, fewer problem behaviors are needed to make an ADHD diagnosis. Wolraich said as children get older, symptoms can change and behaviors such as hyperactivity usually diminish.
  • Emphasizing the need to rule out other causes of ADHD-like symptoms and to identify other conditions that may occur with ADHD, such as depression, anxiety, substance use, autism or trauma.
  • Highlighting the need for ongoing medical care and coordination within the school and community.
  • Recommending parent training in behavior management as a first-line treatment for preschoolers. Wolraich said behavior modification is an effective treatment that generally has two phases of treatment. The positive phase rewards a child for appropriate behavior, and the reward may just be praising, such as, “Johnny, I like the way you’re sitting in your chair.” The second phase includes consequences, such as “time-out.” But, he said, if you don’t have the positive side of treatment, time-out isn’t as helpful.

While the guidelines didn’t specifically recommend behavior management training for teachers and parents in high school students with ADHD, they noted that studies have found some value in this treatment for older kids.

Dr. Victor Fornari, vice chair of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., said it’s important for pediatricians to be familiar with the up-to-date guidelines, because “as many as 10% of all kids meet the criteria for ADHD, and many children with mild to moderate symptoms can be evaluated and treated by their pediatrician.”

Fornari said if treatment doesn’t go smoothly, or there are ongoing behavior problems or other mental health concerns, pediatricians can often collaborate with a child and adolescent psychiatrist to get additional guidance.

Both Wolraich and Fornari said pediatricians play a vital role in ADHD diagnosis and treatment because they already have an established relationship with the child and family.

“People may not fully appreciate that ADHD that’s untreated can lead to adverse outcomes. Failing to treat can lead to academic and conduct disturbances, and earlier substance use disorders. Children who are identified earlier and treated are more successful,” Fornari said.

The new guidelines were published online Sept. 30 in the journal Pediatrics.

More information

Learn more about ADHD from the U.S. National Institute of Mental Health.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Many Smokers Switch to Vaping While Pregnant, But Safety Issues Remain

MONDAY, April 29, 2019 — Are many women who smoke switching to e-cigarettes during pregnancy?

That’s the suggestion from a new study that finds close to 4% of pregnant American women are vaping, and the rate of e-cigarette use is actually higher among pregnant women than women who aren’t pregnant.

The researchers also found that e-cigarette use in pregnancy was highest for women who also used conventional cigarettes.

“Pregnant women may erroneously think that e-cigarette vaping is safer” than traditional smoking, said obstetrician/gynecologist Dr. Jennifer Wu, of Lenox Hill Hospital in New York City. She wasn’t involved in the new research.

However, Wu stressed that “babies face the same risks from nicotine exposure [with vaping], which include brain and lung damage and increasing risks of sudden infant death syndrome.”

The new study was led by Wei Bao, assistant professor of epidemiology at the University of Iowa. His team analyzed data from more than 27,000 women, aged 18 to 44, who took part in a U.S. health survey between 2014 and 2017. Nearly 1,200 of the women were pregnant when they took part in the survey.

There was good news: The survey showed that conventional cigarette use was much lower among pregnant women (8%) than among those who weren’t pregnant (14%).

However, the research also showed that the rate of e-cigarette use was higher for pregnant women (3.6%) than those who weren’t pregnant (3.3%).

The researchers also found that 39% of pregnant women who were current conventional cigarette smokers were also current e-cigarettes users, according to the study published April 29 in the journal JAMA Pediatrics.

Patricia Folan directs the Center for Tobacco Control at Northwell Health in Great Neck, N.Y. Reading over the findings, she stressed that vaping is in no way harmless to the fetus.

“The substances in e-cigarettes can have a damaging effect on the brain and lungs of the unborn baby,” she explained. “Some studies have shown that the flavorings in e-cigarettes also can harm the developing child.”

But young women may not be aware of that.

“The pervasive advertising of these vape products has caused many to perceive these devices as a ‘safe and effective'” means of quitting smoking, she said. But neither the safety nor the effectiveness of e-cigarettes — especially when consumed while pregnant — has yet been shown, Folan added.

All of this supports the need for “more studies related to e-cigarettes and pregnancy, and more widespread education about the potential harm related to their use,” she said.

More information

The U.S. Centers for Disease Control and Prevention has more on e-cigarettes and pregnancy.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

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More TV, Tablets, More Attention Issues at Age 5

WEDNESDAY, April 17, 2019 — Five-year-olds who spend more than two hours a day in front of a smartphone or tablet may be at risk of attention problems, a new study suggests.

Excessive “screen time” among children has been the subject of much research — particularly now that even the youngest kids are staring at phones and iPads every day.

The American Academy of Pediatrics advises parents to set limits on screen time for preschoolers: no more than one hour a day for 2- to 5-year-olds. That’s, in part, to make sure they have plenty of “unplugged” playtime.

In the new study, researchers found that when young children went well above those limits, they were at much higher risk of attention issues.

Compared with their peers who spent no more than a half-hour in front of a screen each day, 5-year-olds who logged over two hours were six times more likely to have “clinically significant” attention issues.

And they were nearly eight times as likely to have signs and symptoms of attention deficit hyperactivity disorder (ADHD).

The findings do not prove that screen-gazing is to blame, acknowledged senior researcher Dr. Piush Mandhane, an associate professor at the University of Alberta in Canada.

But two-plus hours of screen time a day is clearly excessive, Mandhane said. “And it’s something that parents can act on,” he noted.

Preschoolers should be up and moving instead, said Mandhane. His team found that youngsters who regularly had “organized” physical activity were at lower risk of attention problems.

Given the ubiquity of mobile devices — and young children’s interest in them — “it’s never too early to make a screen-time plan for your kids,” Mandhane said.

“And less is better,” he added.

It’s true that screen limits make sense, and that young kids should be physically active, said Yamalis Diaz, a clinical assistant professor of child psychiatry at NYU Langone Health in New York City.

“No one disputes the need for children to be active,” said Diaz, who was not involved in the study. “I tell parents, ‘screen time steals real time.'”

However, she cautioned, this study cannot pinpoint screens as the culprit behind kids’ attention issues. It’s possible those children “battle” their parents on a lot of things — and parents either give in, or hand over a phone as a way to avert a meltdown.

“These may be the children who have difficulty accepting limits in general,” Diaz said.

There’s also the question of how much time their parents were spending on devices. Some kids, Diaz noted, learn that the best way to get mom and dad to look up from their phones is by misbehaving.

As it stands, she added, “we’re still waiting on research to show whether [screen time] has any particular effects on children’s brain development.”

The findings were published online April 17 in the journal PLOS ONE. They’re based on more than 2,300 Canadian families taking part in a long-term health study.

Parents reported on their children’s typical screen use — including TV, computers, tablets, gaming devices and smartphones — at ages 3 and 5. When their kids were 5, parents completed a standard questionnaire on child behavior.

Overall, heavy screen use at age 5 was linked to higher risks of attention problems and behavior problems consistent with ADHD. That was true, Mandhane said, even when factors like family income and parents’ stress levels were taken into account.

Why would screen time affect kids’ ability to pay attention? One way, Mandhane said, could be by supplanting other activities, such as exercise and sleep.

Organized physical activity is important in building attention skills, Diaz agreed. “There’s real peer-to-peer interaction,” she said. “They’re having to listen to an adult. And they’re learning new things, like fine-motor skills.”

Adequate sleep is critical, too, Diaz said. “Even as adults, we see that,” she noted. “If we’re sleep-deprived, we’re grouchy and it’s hard to pay attention.”

More information

The American Academy of Pediatrics has advice on screen time.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

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