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Saturday, 12 May 2018

Too often, poverty is treated with pills - Children whose parents are eligible for Medicaid are much more likely to be prescribed psychotropic drugs - Courtesy of the Economist - May 10th 2018 |

Attention deficitToo often, poverty is treated with pills

Children whose parents are eligible for Medicaid are much more likely to be prescribed psychotropic drugs

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According to a study conducted by Milken Institute School of Public Health at George Washington University, in 2011 12% of American children and teenagers had a diagnosis of ADHD, an increase of 43% from 2003. IMS Health, a health-care information and services company, found that sales of prescription stimulants like those used to treat ADHD quintupled between 2002 and 2012 to nearly $9bn. People like Leigh and Nathanael, who sometimes turn to medication to cope with pressure, often spring to mind as typical consumers of such things. But they are not the only ones. A new study by researchers at the University of Maryland School of Pharmacy reveals high rates of psychiatric diagnosis and medication use among poor, very young Americans.
The study, which was published in JAMA Paediatrics, a medical journal,looked at 35,244 children born in an unidentified mid-Atlantic state in 2007 and followed them until the end of 2014, when they were seven years old. All the children were enrolled in Medicaid, which provides free or cheap health care to low-income Americans. By the age of eight, when children are typically learning about fractions and the solar system, nearly 20% of those studied had received a psychiatric diagnosis. The rate in the population at large is around 14%, according to the National Survey of Children’s Health. Just over 10% of children in the study group received medication to alter their mental state.
Dinci Pennap and Julie Zito, respectively a PhD candidate and professor at the University of Maryland School of Pharmacy, directed researchers to look at diagnoses including ADHD, learning disorders, anxiety disorders, depression and autism-spectrum disorders. ADHD was the most prevalent condition diagnosed, and stimulants were the most commonly prescribed drugs. The research also suggests startlingly high psychiatric diagnosis rates among young children receiving foster care. Nearly 60% of children in foster care had such a diagnosis, compared with 17% for “income-eligible” children whose families hover at or below the federal poverty level.
The finding that poor children are more likely to be medicated echoes previous research. A study conducted by researchers at Columbia and Rutgers Universities and published in 2009 found that children covered by Medicaid are provided with antipsychotic drugs, used to treat conditions such as bipolar disorder, at a rate four times higher than privately insured children, and often for less severe conditions.
“One problem is that we’re medicating behaviour,” says Ms Pennap, the Maryland study’s lead author. “If a child doesn’t do well in school, they’re medicated because they might be in homes where their parents work three jobs and don’t have the bandwidth to explore the underlying problems or nonmedical options.” Dr Zito partly blames direct-to-consumer drug advertising and the urge to reach for quick fixes. Her most pressing worry is that there has been little scrutiny of the long-term effects of exposing young children to such medication. “They have little hearts, little brains, and little livers. We really don’t know how the physiology of young kids will be impacted by these potent drugs,” Dr Zito muses. In most scenarios, poor children are likely to have less than wealthier children: less educational opportunity, less healthy food, less-safe neighbourhoods. When it comes to psychotropic drugs, the opposite is true.

This article appeared in the United States section of the print edition under the headline "Attention deficit"

Wednesday, 18 April 2018


More than medication' needed to treat ADHD

Image copyrightGETTY IMAGES
Image captionThe Scottish ADHD Coalition's report raises concerns that medication is overly relied on

Families of children with ADHD are warning that too often medication is the only option they are offered to manage the condition.
A survey of parents across Scotland found evidence of delays in diagnosing ADHD and inadequate support afterwards.
The Scottish ADHD Coalition also uncovered concerns about inadequate training of school staff.
The Scottish government said medication was offered in accordance with good clinical practice.
It was often accompanied by non-drug treatments such as counselling, it added.
About 5% of schoolchildren have ADHD, a neuro-developmental condition which causes hyperactivity, impulsiveness and inattention.
However, only 1% (9,000) children are known to have the condition north of the border. The Scottish ADHD Coalition believes it is under-diagnosed in many areas.

Media captionReece's top tips for living with ADHD

And in its latest report on ADHD services in Scotland, it raises concerns of an over-reliance on medication in treating the condition.
In a survey of more than 200 parents, 93% said their child had been prescribed medication for their condition and it was helpful.
But in many cases it was the only treatment offered. The survey also found:
  • Almost two third (63%) of parents were offered no training to help them manage their child's condition.
  • Almost half (41%) were given no written information about ADHD.
  • Around 15% said they had received psychological input.
Geraldine Mynors, the coalition's chairwoman, said many children could benefit from more support to address a complex range of difficulties.
"The voices of parents coming through this survey are very clear: there is an over-reliance on medication as the only treatment available to manage ADHD," she said.
"Excellent parent training programmes such as Parents Inc, developed by NHS Fife, are all too rarely available to give parents the long term skills that they need".

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Avril Sinclair

'Life is very fast'

Avril Sinclair set up the Brighter Days support group for families living with ADHD in Livingston, after two of her four children were diagnosed with the condition.
"Life is very fast," she said. "We're always on the go. We try to keep to a routine but it's difficult, it's got a lot of challenges."
Her eldest son, Reece, was seven when he was diagnosed with ADHD after experiencing problems at school.
She said he benefited from medication as well as a range of specialist help, including play therapy.
When his younger brother Ryan was diagnosed with the same condition, Ms Sinclair said the family decided not to give the youngster medication.
She said her experience of dealing with Reece means she knows how to cope with Ryan's condition.
"Until we find that he's fallen behind at school or we are not able to cope will I look at medication," she said.
But that decision means she has not been offered any additional support to deal with Ryan's ADHD.
She said she believed parents whose children come off medication find it more difficult to access extra support.

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The report, Attending to Parents: Children's ADHD Services in Scotland 2018,outlined the positive work carried out by the Child and Adolescent Mental Health Services (CAMHS).
But it found that many families had long waits for both diagnoses and CAMHS appointments, where some felt staff were over-stretched.
And some parents told the coalition that, when they refused medication for their child, CAMHS quickly discharged them, making it harder for them to obtain further support.
Problems in school were also highlighted in the report, which revealed that only a quarter of parents (26%) believed their child's teachers had a good understanding of ADHD.
About 5% of respondents said their child had been permanently excluded from school, while a third (33%) said their child had been temporarily suspended at least once.
The report found a perception among parents that access to support for learning staff to help classroom teachers was jeopardised by staff and funding cuts.
Lorna Redford, a trustee of the coalition, said: "The survey findings reflect what we hear from parents all the time.
"It is imperative that school staff are recruited in sufficient numbers and trained about ADHD to ensure our children and young people receive the same educational opportunities as their non-ADHD peers.
"This modest and realistic target would reap huge rewards in the mental health, quality of life and societal outcomes for sufferers."
The Scottish government said it took the mental health of young people "very seriously".
Mental Health Minister Maureen Watt said: "That is why we have doubled the number of child and adolescent mental health service psychology posts in recent years, and we're investing an extra £150m in mental health over five years.
"Drugs for ADHD are routinely prescribed in line with good clinical practice, including on-going supervision by health professionals to ensure patients only remain on them as long as appropriate.
"They are often used alongside treatments such as counselling or psychological therapies provided locally.
"Early intervention and prevention are the cornerstone of our approach to mental health and wellbeing."

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Rhys Sinclair
Image captionRhys Sinclair take medication for his ADHD and he has received additional specialist support

What is ADHD?

  • It is a neuro-developmental condition, with symptoms including inattention, impulsivity and hyperactivity.
  • ADHD is caused by a mix of factors, including environment and early childhood experiences but it strongly hereditary.
  • Symptoms are apparent in early childhood and for most people continue into adulthood.
  • It rarely exists on its own and is associated with autism, dyslexia, dyspraxia, sensory processing disorders and tic disorder.
  • It can lead to problems including poor academic achievement, unemployment, criminality, and drug and alcohol dependency.
Source: Scottish ADHD Coalition