An Out of Control Profession New Scientist

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Infant Mental Health Now Targeted

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FYI

 

A report in The New Scientist, " Prescribing of Hyperactivity Drugs is

Out of Control, " shows just how deviant U.S. prescribing of

psychostimulants for children is compared to the rest of the world. A

graph from the World Health Organization quantifies America's bizarre

prescribing pattern: " The figures are mind-boggling. Nearly 4

million Americans, most of them children and young adults, are being

prescribed amphetamine-like stimulants to treat attention deficit

hyperactivity disorder (ADHD). Up to a million more may be taking the

drugs illegally. " Specialists in addiction, including the head of

the National Institute of Drug Abuse (NIDA) worry about these drugs

leading to drug dependency: Dr. Nora Volkow argues " There has to be a

re-evaluation and reassessment of the extent to which there is proper

prescription. "

 

Scientists have known that as with chronic use of Cocaine, ADHD drugs

cause profound long-term changes in cognitive and other mental

functions. Indeed, in 1996, Dr. Steve Hyman, the former director of

the National Institute of Mental Health (now Harvard Provost) wrote:

These drugs cause " molecular and cellular changes in neural function

that are produced as adaptations to chronic administration of

addictive drugs such as psychostimulants. " Chronic exposure to

psychotropic drugs, he wrote, " creates perturbations in

neurotransmitter function that likely exceed the strength or time

course of almost any natural stimulus. "

 

In other words, the drugs induce a disease process by interfering with

normal brain function. They produce profound neural damage and drug

addiction--a disease. See: Hyman, SE. and Nestler, EJ. 1996.

Initiation and adaptation: a paradigm for understanding psychoactive

drug action. American Journal of Psychiatry, 153:151-162.

And in 2001, Dr. Nora Volkow and a team of researchers at Brookhaven

Laboratories, found evidence using photo imaging techniques that

contradicted the claims made by those who advocate the use of

psychostimulants: " A typical dose [of Ritalin] given to children, 0.5

mg/kg, blocked 70% of dopamine transporters " --more than

cocaine. " The data clearly show that the notion that Ritalin is a

weak stimulant is completely incorrect. " [see, JAMA

http://jama.ama-assn.org/issues/v286n8/ffull/jmn0822-1.html]

 

William Carlezon of Harvard Medical School, has studied the drugs'

effects in animals and believes that they do have some lasting effect

on the brain, even if its exact nature is not yet known. " Stimulant

drugs leave molecular signatures on the brain, and we have to be very

careful. "

 

The New Scientist reviews some of the documented drug hazards for

children reported at an FDA advisory committee (March 22): the

adverse psychiatric side effects include disturbing hallucinations

often involving worms, snakes or insects, experienced by up to 5 per

cent of children taking the drugs.

 

Stimulants are not the only drugs prescribed for children without

reliable or credible diagnostic criteria: antipsychotics, the most

toxic of all psychotropic drugs which are linked to life-threatening

hazards are prescribed for children with ADHD: A Vanderbilt report

last month revealed that in 2002 two and a half million children were

prescribed antipsychotic drugs. These toxic drugs have not been

approved for children; for adults they are approved for schizophrenia

and short-term treatment of bipolar disorder. The atypical

antipsychotics are linked to cardiac arrest, hyperthermia, acute

weight gain-over 100 lbs in children-dangerous levels of

cholesterol, and the most severe form of diabetes.

 

MSNBC reports what is surely reckless irresponsible professional

hucksterism: psychiatry's latest expansion is an intrusion into the

neurodevelopmental life of infants: " a hot topic at major

universities, and last year the American Academy of Pediatrics

launched a task force with at least part of its purpose to push more

infant/toddler mental health intervention. " Some are already calling

themselves expert " infant psychiatrists. "

 

We challenge these newly proclaimed " experts " to show empirical

evidence demonstrating that their intrusion into the life of an

infant will be beneficial to that infant. Given the uncertainty at

best-this constitutes an uncontrolled (hence scientifically useless)

human experiment. The record demonstrates that tinkering with

children's neurodevelopment is fraught with unintended harmful

consequences. It is, therefore, not acceptable for those who want

to intervene in infants and toddlers' lives, to be given license on

the basis of an unbinding statement: " With the right therapy and

care, many of these conditions can be helped significantly and often

swiftly. " Standards and rules of evidence must be established and

met before anyone should be given carte blanche to alter infants'

behavior patterns.

 

Who has the authority to intervene with a child's birthright to be?

Or to be allowed to develop naturally and idiosyncratically at his/

her own individual pace? Who has the moral authority to say that some

children should be delivered for experimental human engineering?

 

" the signs and symptoms of mental disorders are often also the

characteristics of normal development. " [see:Surgeon General Report,

1999] As acknowledged by the chief NIMH child psychiatrist, Dr.

Benedetto Vitiello: " diagnostic uncertainty surround most

manifestations of psychopathology in early childhood " [see:

Psychopharmacology for Young Children, Pediatrics, 2001, 108:983-989]

What evidence do these self-anointed " experts " provide to

substantiate their claim of diagnosing infants? What evidence is

there to support the claim that a therapy is " right " for a

young child or infant? What empirical evidence do " infant

psychiatrists " provide for the claim " these conditions can be helped

significantly? "

At the very least, shouldn't we as a society require of every

professional seeking to render mental health services to children, to

show empirical evidence that all but guarantees that no harm will

result to the child who is exposed to the services being offered?

Dr. Joan Luby who is " diagnosing " toddlers with manic-depression

(bipolar)--one of the most severe mental disorders that hitherto has

never been unheard of in children-is quoted stating: " Treatment for

mood disorders really depends on the disorder but, in general,

behavioral and psychotherapeutic modalities are still the first

line. " But she is quick to add: " The more severe the impairment, the

more likely the child will eventually need psychotherapy and

medication. "

What evil Pied Piper has mesmerized American adults into suspending

their own judgment and common sense to the detriment of their

children? Why are intelligent parents blindly following medically

unsound directives whereas parents in other parts of the world do not

succumb to the lure of " quick fixes? " How can the " experts " who have

knowingly recommended harm-producing drugs for children be trusted?

Contact: Vera Hassner Sharav

212-595-8974

veracare

~~~~~~~~~~~~~~~~~~~~~~

http://www.newscientist.com/article.ns?id=mg19025452.700 & print=true

Prescribing of hyperactivity drugs is out of control

.. 31 March 2006

.. NewScientist.com news service

.. Peter Aldhous

Rise in ADHD?

THE figures are mind-boggling. Nearly 4 million Americans, most of

them children and young adults, are being prescribed amphetamine-like

stimulants to treat attention deficit hyperactivity disorder (ADHD).

Up to a million more may be taking the drugs illegally. Now, amid

reports of rare but serious side effects, leading researchers and

doctors are calling for a review of the way ADHD is dealt with. Many

prescriptions are being written by family doctors with little

expertise in diagnosing ADHD, raising doubts about how many people on

these stimulants really need them. Just as worrying, large numbers of

children who do have ADHD are going undiagnosed.

Both trends could lead to problems with drug dependency, argue

specialists in addiction. " There has to be a re-evaluation and

reassessment of the extent to which there is proper prescription, "

says Nora Volkow, director of the National Institute on Drug Abuse in

Bethesda, Maryland.

Last week, the debate intensified, following two meetings of advisers

to the US Food and Drug Administration (FDA). First, the agency's

Pediatric Advisory Committee suggested that parents and doctors

should be warned about the risk of ADHD drugs triggering

hallucinations. This followed a review of evidence of the drugs'

psychiatric side effects, including disturbing hallucinations often

involving worms, snakes or insects, experienced by up to 5 per cent

of children taking the drugs. In February, a separate FDA panel

recommended that they should carry the most prominent type of safety

warning, following 25 reports of sudden deaths from heart problems

(New

Scientist, 18 February, p 7).

Another FDA committee last week voted to delay an application for a

drug

previously used to treat sleep disorders to be marketed for ADHD. The

drug,

modafinil, has less potential for abuse and addiction, but the FDA's

Psychopharmacologic Drugs Advisory Committee wants to see more

evidence

proving its safety before backing the application (see " Alternative

treatments for ADHD " ).

Stimulants such as methylphenidate, marketed by Novartis as Ritalin,

have

been used to treat ADHD for decades. As well as increasing arousal

and heart

rate, the drugs allow people who have difficulty concentrating to

focus on

tasks more effectively. Their use has exploded in recent years,

especially

in the US, where prescription rates are several times higher than

across

most of the developed world - in part because US doctors tend to use a

broader definition of the condition.

Psychiatrists stress that side effects are rare, and say that the

drugs have

helped millions of people who would otherwise have had huge problems

focusing at school and work. " These are some of the most effective

treatments that we have in psychiatry, " says Chris Kratochvil of the

University of Nebraska Medical Center in Omaha.

To diagnose ADHD reliably, a psychiatrist would ideally observe a

child for

several hours, checking their behaviour against a list of symptoms

relating

to activity and ability to concentrate. But in many cases, family

doctors

are prescribing the drugs after just a few minutes of consultation,

based

largely on evidence of boisterousness.

Doctors are under growing pressure from children and their parents to

prescribe the drugs, as many believe that stimulants will help them

get

better school grades. " I have a colleague whose son was mobbed by

friends

wanting prescriptions, " says Scott Kollins, a child psychologist at

Duke

University in Durham, North Carolina.

This demand is also fuelling an illegal trade. Findings published

last month

indicate that in 2002 more than 750,000 Americans aged 12 and over

were

taking the stimulants without medical supervision (Drug and Alcohol

Dependence, DOI: 10.1016/j.drugalcdep.2005.12.011). Some may have

been using

the drugs for a traditional " high " , or to keep going during all-night

parties. But Larry Kroutil of RTI International in Research Triangle

Park,

North Carolina, who led the study, suspects that much of the illegal

use is

by children and young adults taking the drugs as study aids. In some

cases,

they are being bought by parents from illicit websites that do not

ask for

evidence of a prescription. " We need to look more at how people are

getting

these drugs, and why, " Kroutil says.

Members of the FDA's Drug Safety and Risk Management Advisory

Committee,

which recommended the prominent safety warning on heart risks, say

that they

were motivated in part by concerns that many people who do not have

ADHD are

taking the stimulants. " It has been clear that the drugs are

overused, " says

Peter Gross of Hackensack University Medical Center in New Jersey, who

chairs the committee.

The American Psychiatric Association argues that the picture is more

complex. " Yes, there is overprescribing, " says Jason Young, the

association's communications manager. " But there is also

underprescribing. "

Among poorer sections of the US population, and particularly in

minority

groups such as African Americans and Hispanics, ADHD is believed to be

widely underdiagnosed.

Volkow is worried that underprescription of stimulants could lead to

problems with drug abuse. Children with ADHD who are not given

stimulant

drugs are more likely to develop problems with drug abuse and

dependency

than those who are, perhaps because they have to turn to illegal

stimulants

on which they can become hooked to get relief from their symptoms. So

improving diagnosis and treatment among people with poor access to

mental

health services is important, Volkow argues.

Meanwhile, the long-term effects of giving prescription stimulants to

healthy people remain largely unknown. Kroutil's team asked illicit

users

whether the drugs were interfering with various aspects of their

lives. On

this basis, the researchers estimated that about 10 per cent were

having

problems with dependency.

Volkow fears that problems with dependency may be more widespread.

There are

also hints that taking stimulants may lead to abuse of other drugs.

Some

studies suggest that exposing juvenile animals to stimulants makes

them less

likely to self-administer drugs such as cocaine when they are offered

the

drugs as adults, but other studies indicate the opposite. What is

needed,

says Volkow, are long-term follow-up studies on people who do not

have ADHD

and who have taken stimulants such as methylphenidate. In the

meantime, she

wants medical associations to take a stronger lead in educating

doctors

about the proper diagnosis and treatment of ADHD.

William Carlezon of Harvard Medical School agrees. He has studied the

drugs'

effects in animals and believes that they do have some lasting effect

on the

brain, even if its exact nature is not yet known. " Stimulant drugs

leave

molecular signatures on the brain, and we have to be very careful, "

he says.

" Diagnosis needs to be taken less lightly. "

Alternative treatments for ADHD

Despite concerns about the possible side effects of stimulant drugs

such as

methylphenidate, the alternative treatment options are limited. A

non-stimulant called atomoxetine was approved in the US for ADHD in

November

2002. Although it belongs to a different class of drugs from the more

widely

used stimulants, atomoxetine was implicated in some of the cases of

hallucinations considered by the FDA's Pediatric Advisory Committee

last

week.

ADHD specialists had hoped that atomoxetine would be joined by

modafinil

later this year. This drug is currently used to treat excessive

sleepiness,

and seems to improve focus and alertness (New Scientist, 18 February,

p 34).

But an application to approve modafinil for treating ADHD suffered a

setback

on 23 March when the FDA's Psychopharmacologic Drugs Advisory

Committee

recommended that the drug's manufacturer, Cephalon, conduct a further

study

in 3000 children. Committee members were worried about a single case

of a

potentially fatal skin condition among the 933 patients in Cephalon's

trials

so far.

Though slightly less effective than methylphenidate in treating ADHD,

both

modafinil and atomoxetine are less likely to lead to addiction

problems.

That may make them particularly useful in treating patients whose

social

environment makes them vulnerable to drug abuse.

Apr 03 13:30:42 BST 2006

http://www.msnbc.msn.com/id/12037118/from/ET/

When babies see shrinks

Sometimes very young minds need special care, experts say

By Victoria Clayton

MSNBC contributor

Updated: 10:38 a.m. ET April 3, 2006

Traditionally, young children have rarely crossed paths with

psychiatrists

or psychologists. Not anymore. With a growing amount of research

focusing on

early brain development, more youngsters - even infants - are being

targeted

to receive the services of mental-health professionals.

There are no hard numbers available for just how many pre-kindergarten

children are being seen, but experts say infant/toddler mental health

is

moving into the mainstream. Psychological research on this age group

is a

hot topic at major universities, and last year the American Academy of

Pediatrics launched a task force with at least part of its purpose to

push

more infant/toddler mental health intervention.

This may cause some readers to roll their eyes - especially those who

believe Americans have a tendency to pathologize and treat the

slightest

blip of a bad mood.

Before you pass judgment, however, it's important to understand what

infant/toddler mental health is all about, says Ngozi Onunaku, a

policy

analyst with Zero to Three, a Washington, D.C.-based nonprofit

organization

dedicated to furthering mental wellness for preschool-age children.

" When you put the words 'infant' and 'mental-health treatment' next

to each

other, that's really scary to some people, " says Onunaku. " People

think of

medication and, from a more comical standpoint, they think of a baby

on the

couch. "

Onunaku says that, in fact, a more accurate way to talk about this

issue is

to call it infant/toddler mental wellness. " It's more helpful to see

mental

health as a continuum. There are kids who need intense interventions,

there

are kids in the middle who are at risk for a problem and then at the

other

end you have your everyday, typical children who also need their

caregivers

to promote mental health and wellness. "

While all humans can benefit from what researchers and doctors are

learning

about infant mental development - namely, that infants are sentient,

perceptive beings whose brain development can be strongly influenced

in the

first weeks, months and years of life - there are certain issues that

drive

most parents to get help for their children.

Eating and sleep issues are primarily why mental-health professionals

see

infants, says Dr. Thomas Anders, an infant psychiatrist at the

University of

California, Davis M.I.N.D. Institute and president of the American

Academy

of Child and Adolescent Psychiatry. Toddlers are more often seen

because of

developmental delays or behavioral problems such as temper tantrums.

Other

reasons infants and toddlers are evaluated include abuse, adoption or

other

separation from a birth parent, maternal depression, premature birth

and

trauma such as a natural disaster or illness.

With the right therapy and care, many of these conditions can be

helped

significantly and often swiftly. " Sometimes one session or two

sessions and

a couple of phone consultations are all you need to take care of a

problem, "

Anders says.

Parent-infant therapy

Oftentimes, it's just a matter of educating parents or teaching them

some

very specific parenting skills. For example, Anders, who studies

infant

sleep, says he may get a call because an infant appears to have a

sleep

disorder but sometimes it's a matter of working with parents to

establish a

more productive bedtime ritual.

" Most of the treatment for children under 3 or 4 is what we call

parent-infant therapy, " says Anders. " Medications are very rarely

used in

this age group. " In fact, when a young child is having any sort of

problem

it's always a matter of determining how the family can solve the

problem.

" What we're really doing primarily with infant and toddler mental

health is

saying, 'What guidance can we provide to help a parent cope better?' "

says

Penny Glass, a developmental psychologist with Children's National

Medical

Center in Washington, D.C. " Sometimes it's amazing when you just

counsel

parents on how to establish structure. "

Glass notes that having organized mealtimes and bedtimes often help

families

feel as if they have more control and helps eliminate toddler

behavioral

problems. " Even if you just help a child get a decent amount of sleep

many

of the problems don't seem so big, " says Glass.

In some cases, parents may mistake one issue for another. Glass

recently saw

a boy, age 3 and a half, who was referred to her for behavior

problems. But

when Glass did the full evaluation she found out that the child was

actually

developmentally delayed and operating more at a 2-year-old level. He

didn't

understand some of the words or thoughts and ideas that people were

trying

to convey to him because they were speaking to him at the level of a

3- or

4-year-old. Once this was understood Glass could recommend therapy to

help

get him up to speed but she could also counsel the parents, teachers

and

caregivers in how to speak and treat him appropriately.

Just knowing the problem and what they were dealing with, Glass says,

helped

the parents feel better, understand the child better and treat him in

a more

health-promoting way.

Some conditions are being detected at much earlier ages than ever.

Dr. Joan

Luby, a child psychiatrist at Washington University in St. Louis, says

thanks to the attention being focused on infant mental health,

professionals

are now more likely to diagnose certain problems such as autism

spectrum

disorders as early as 18 months.

Research in the past several years by Luby and colleagues, published

in the

Journal of the American Academy of Child and Adolescent Psychiatry and

elsewhere, has helped scientifically validate that children as young

as

preschool age can suffer from depression, anxiety and other mood

disorders.

Even with these disorders, though, doctors tend to be wary about

medicating

the pre-kindergarten set because most of the drugs used to treat the

disorders haven't been properly studied in children.

" Treatment for mood disorders really depends on the disorder but, in

general, behavioral and psychotherapeutic modalities are still the

first

line, " says Luby. The more severe the impairment, she adds, the more

likely

the child will eventually need psychotherapy and medication.

" It sometimes helps to think about [mental illness] in terms of

diabetes, "

says Anders. " If a child was diabetic you wouldn't like it but you'd

get

treatment. If it's true that your child has a problem, you need to

treat

it. "

Teen problems can have early roots

Experts say that while many of us haven't realized it, our children

have

often paid steep prices for not having their mental health taken into

consideration. Dropout rates, drug abuse, suicide and eating

disorders are

all adolescent problems that could have roots in treatable early

childhood

mental health issues.

Zero to Three's Onunaku points out that we don't even have to wait

until

adolescence to see the impact of ignoring early childhood mental

wellness.

A Yale study last year looked at the problem of pre-kindergarten

children

being expelled. Led by Yale Child Study Center researcher Walter S.

Gilliam,

the study found that in classrooms where the teacher had no access to

a

psychologist or psychiatrist, preschool students were expelled about

twice

as frequently.

" We know for certain that kids this young can have significant

problems. By

catching the problems early and working with them we have a chance to

positively influence how their lives progress, " says Onunaku.

Researchers point out that more than just influencing whether a child

gets

kicked out of a school or not, by identifying and treating certain

mental

and emotional problems extremely early there is a chance that the

brain

could even be altered positively.

" If we intervene early there is the issue of plasticity of the

brain, " says

Glass. The ability of the brain to change with learning is called

neuroplasticity, or plasticity. " There are no absolutes and we know

we can't

just fix everything that isn't right. "

But, she says, there is reason to believe that if we help early on we

may be

able to help more and perhaps in a more permanent way.

There's even hope, says Glass, that with early intervention we'll

have fewer

teens and adults " on the couch " in the future.

Victoria Clayton is a freelance writer based in California and co-

author of

" Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife

and a

Mom, " published by Fair Winds Press.

C 2006 MSNBC Interactive

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