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Study: ADHD Meds Given More Often to Youngest Kids in Class

“Youngest children in class more likely to get ADHD medication, study says,” The Guardian reports.

The results of an Australian study have caused concerns that, in some cases, immature behaviour may be misinterpreted as evidence of a behavioural disorder.

In a brief report, researchers found nearly 2% of 6-15-year-olds in Western Australia received a prescription for attention deficit hyperactivity disorder (ADHD) medication in 2013. Those born in the last months of the school year intake were more likely to have had a prescription than the oldest children in the year.

The gap between the oldest and youngest children in the class had a small, but significant, association with the increased use of ADHD medications. The researchers say their findings compare with those of other international studies.

It’s possible the youngest children in a school year may find it harder to keep up in lessons than children almost a year older than them, and may be more likely to have problems with concentration.

But it would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone.

The use of ADHD medication for under-16s in the UK is far lower than in many other developed nations – 0.4%, compared with Australia’s 1.9% or the US’ 4.4% – so the potential problem of inappropriate treatment may not be as much of an issue in this country.

Where did the story come from?

The report was authored by four researchers from Curtin University, Murdoch University and the University of Western Australia, all in Australia.

The study was published in the peer-reviewed Medical Journal of Australia, and the researchers declared no conflict of interest or study funding.

It’s available to read online on an open access basis, so you can download the study for free.

The UK media coverage was accurate, but does not point out the limitations of this brief report.

What kind of research was this?

In this brief one-page report, the researchers say four international studies found the youngest children in a school year are more likely to be receiving ADHD medication.

They aimed to see how Western Australia compares by analysing data from the Pharmaceutical Benefits Scheme – a scheme similar to the NHS, where the cost of medicine is subsidised by the Australian government – to see how many children were receiving ADHD medication.

This brief report provides very limited information about the authors’ methods, making it difficult to critique.

And we don’t know how the authors identified the four international studies they reported, so we don’t know whether this is a fully comprehensive look at the subject.

This means the report must largely be considered to be the opinion of its authors.

What did the researchers do?

The researchers compared the proportion of children born in the first and last months of a “recommended school year intake” who were recorded in the Pharmaceutical Benefits Scheme as receiving at least one prescription for ADHD medication in 2013.

The study included a total of 311,384 children, covering two age bands: those aged 6-10 (born July 2003 to June 2008) and those aged 11-15 (born July 1998 to June 2003).

The researchers looked at the number of children receiving medication and the patterns by time of birth.

What did they find?

The researchers found 1.9% of the full study sample (5,937 children) had received at least one prescription of ADHD medication, with more boys than girls being prescribed for (2.9% versus 0.8%).

In the 6-10-year-olds, they found those born in the last month of the school year intake (June) were nearly twice as likely to have been prescribed medication as those born in the first month (the previous July): relative risk (RR) 1.93 for boys (95% confidence interval [CI] 1.53 to 2.38) and RR 2.11 for girls (95% CI 1.57 to 2.53)

The same pattern was seen for 11-15-year-olds, but the risk increase was less, though still significant (RR 1.26, 95% CI 1.03 to 1.52 for boys; RR 1.43, 95% CI 1.15 to 1.76 for girls).

The authors say similar effects were also seen when comparing those in the first three to six months of intake with the last three to six months.

What did the researchers conclude?

The researchers say at 1.9%, their observed prescription rate is comparable to a recent Taiwanese study, and both this study and three North American studies observed the effects of birth month on prescription rates.

They describe a professional from the American Psychiatric Association who feels ADHD is overdiagnosed and overmedicated, saying that, “Developmental immaturity is mislabelled as a mental disorder and unnecessarily treated with stimulant medication.”

The authors say the findings indicate that, “Even at relatively low rates of prescribing, there are significant concerns about the validity of ADHD as a diagnosis.”

Conclusion

Overall, this study suggests that in Western Australia – and reportedly in other countries, too – the youngest children in a given school year are more likely to be diagnosed with and treated for ADHD than the eldest in the year.

However, it’s important not to draw too many conclusions from this brief report. The authors provide very limited information about their methods, so it’s not possible to critique how they conducted their study.

We don’t know why they selected the 2013 school year, for example. It was said to be recommended, but we don’t know why. It could be it was known there were an unusually high number of prescriptions noted in the Pharmaceutical Benefits Scheme that year, which means it might not be representative.

Also, this database can only tell us the number of children that filled out at least one prescription for ADHD medication. We don’t know how the children were diagnosed, how long they had been diagnosed or treated for, or whether they actually took the medication.

The authors also point out the possible limitation that they didn’t know how many children may have entered school outside of their recommended starting year – although this was thought to be few.

We also don’t know how the researchers identified the international studies, and we don’t know that these reported findings give a comprehensive look at ADHD diagnosis and treatment worldwide.

It would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone. And, as no UK studies were reported, we don’t know what the true situation is like in this country.

It’s possible the youngest children in a school year may find it harder to keep up with lessons than children almost a year older than them, and so could be more likely to be distracted – though this is clearly a big generalisation and is not always going to be the case.

However, it does perhaps highlight there is a need for children who are struggling or finding it difficult to concentrate at school to be recognised, and get the additional attention and support they need – something both teachers and parents of the youngest children in a school year may need to be aware of.

Analysis by Bazian. Edited by NHS Choices

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Video: Is Your Child’s Rash Fifth Disease and Should You Worry?

In this video Dr. Rob Hicks, a general practitioner (GP) or family physician, briefly describes Fifth Disease or “Slapped Cheek Syndrome,” and how you can tell this rash apart from other more concerning illnesses.

Editor’s Note: Video Highlights

  • child-fifth diseaseFifth Disease – or “slapped cheek syndrome” is a viral infection, caused by the virus, parvovirus B19
  • It is spread in the air when we cough or laugh, when we sneeze, or in saliva and air droplets when we’re in close contact
  • It is most commonly children who get it – usually between the age of four and 12 – and can spread very rapidly throughout a classroom or school
  • The symptoms to look out for are generally those of a common cold,so sneezing, runny nose, sore throat, headache, fever.
  • But the characteristic of this infection is the rash – the blotchy red rash on one or both cheeks that gives the slapped cheek appearance
  • The rash can remain on the face, but could spread to the rest of the body,including the palms of the hands and the soles of the feet
  • Generally, it’s not painful but it might be irritating for some
  • Unlike the worrying rash of meningitis, if you press this rash it will fade
  • Symptoms are often mild and parents should follow the usual management of any viral infection,
    • Plenty of rest and plenty of fluids
    • For sore throats or a high temperature children’s paracetamol (acetaminophen) or ibuprofen is perfectly reasonable
  • If you’re not sure have a word with a pharmacist or with your doctor
  • The people who need to be concerned are pregnant women – if you get the infection in early pregnancy and you’ve not had it before it can increase the risk of miscarriage





Video: Kids and Cancer – What You Need to Know About ALL

Dr Victoria Grandage, Consultant Hematologist at the Children and Young People’s Cancer Service at University College London, describes the signs and symptoms of Acute Lymphoblastic Leukemia, also known as A.L.L. She and the mother of a young former patient, Josh, talk about the treatment and experience of ALL; a cancer that, thankfully, has a high cure rate in children. Click on the picture below to go to the NHS YouTube channel to watch the video.

Editor’s Note: Video Highlights

  • Acute lymphoblastic leukaemia or ALL is a form of cancer of the blood
  • For reasons we do not yet fully understand, immature cells in the bone marrow – lymphocytes or lymphoblasts – rapidly build up and crowd out the normal bone marrow cells
  • Some of the symptoms of ALL include:
    • Anemia: tiredness, shortness of breath, lethargy
    • Infections, high fevers, maybe mouth ulcers
    • Bleeding, bruising and rashes
    • Enlargement of some lymph nodes around the neck or in the groin
    • Enlargement of the liver and spleen
    • Bone pain (a prominent symptom)

“When Josh was about two and a half, he went back to crawling rather than walking. He’d say his legs were too sore to walk and he’d crawl around for the first half hour or so (after getting up) and then start walking after that.”                                    Josh’s Mom, Angela

  • child with cancerInitial treatment, before a diagnosis has been confirmed, is supportive to address the above symptoms and can include fluids for hydration, antibiotics, and possibly a blood transfusion
  • Treatment of the leukemia itself involves chemotherapy, a broad term for many different drugs that may be given in tablet form, as injections, or directly into the blood stream as IV infusions
    • Some ALL chemotherapy drugs are also given via a lumbar puncture
  • Side effects of the chemotherapy include nausea, tiredness, and hair loss
  • Treatment begins with acute therapy – for Josh this lasted 9 months – and is followed by maintenance treatment for a couple of years
    • Josh’s total treatment lasted three years
  • The majority of children with ALL go into remission – and 75%-80% of those are cured
  • Further intensified treatment, including a stem cell transplant, may be required for children who do not go into remission

 





Which Complementary Therapies are Proven Effective for Asthma?

Most complementary therapies for asthma haven’t been shown to work. The exception is some types of breathing exercises, which do seem to improve symptoms and quality of life.

complementary therapy for asthmaResearch by Asthma UK shows that almost 1 in 10 people living with asthma use complementary medicine, and many would consider using it in the future.

According to Dr Mike Thomas from Asthma UK, there’s little evidence that complementary therapies in general improve asthma symptoms.

Specific remedies that are sometimes tried include homeopathy, acupuncture, air ionisers, the Alexander technique and Chinese herbal medicine, but the results have been disappointing. Read more about asthma treatment.

Breathing Exercises for Asthma

The exception is certain types of breathing exercises, which can help some people with asthma. These include breathing exercises taught by a lung (respiratory) physiotherapist, some types of yoga breathing exercises, and the Buteyko method of breathing.

People with asthma are taught slow, steady “diaphragmatic” breathing through the nose. This type of breathing is done by contracting the diaphragm, which is located between the chest and the stomach. This can result in fewer asthma symptoms and better quality of life. However, these exercises are not a cure, and people with asthma still need to use their regular inhalers.

The Buteyko Method

The Buteyko method, a system developed in Russia, teaches similar exercises and may improve asthma symptoms for some people. However, some find that the breathing exercises used during yoga also help their symptoms.

According to Leanne Male, Asthma UK’s assistant director of research, people with asthma who gain some relief from Buteyko and other types of breathing exercise should not rely on it so much that they stop their conventional medication.

“We know that some people with asthma use breathing techniques such as Buteyko but, while they may reduce symptoms, they will not reduce the sensitivity of the airway, and should not replace regular asthma medicine. Also, we don’t know what the long-term benefits are.”

Chinese and Other Herbal Medicines for Asthma

There isn’t enough clinical evidence to recommend the use of Chinese medicine, other herbal medicines, acupuncture, hypnosis and other complementary therapies.





Understanding Asthma and How to Overcome Its Challenges

According to the charity Asthma UK, one in five households has someone living with asthma.

understanding asthmaNobody knows for sure what causes asthma, but we do know you’re more likely to develop it if you have a family history of asthma, eczema or other allergies. You’re twice as likely to develop asthma if your parents have it.

Modern lifestyles, such as housing and diet, also may have contributed to the rise in asthma over the last 30 years.

Every 10 seconds someone has a potentially life-threatening asthma attack, and the latest data shows that deaths from asthma are on the rise again.

What Causes Asthma?

There are many theories about what’s caused the increase in the number of people with asthma.

One of the most popular is the “hygiene hypothesis”. According to this theory, asthma is more common in western societies. Because western society is becoming cleaner, we have less exposure to allergens and pathogens.

When a person with asthma comes into contact with a “trigger”, their airways become irritated. The muscles tighten, the airways narrow, and the lining of the airways gets inflamed and swollen.

The main symptoms are chest “wheeze” or noisy breathing, chest tightness and breathlessness. You may also develop a cough, particularly at night, but this is more common in children.

Boys under the age of two are more susceptible to asthma because their airways are narrower when they’re younger. But they usually grow out of it, whereas girls are more likely to have asthma beyond puberty.

Obesity is also thought to make asthma more likely. Symptoms often get better when the person loses weight.

Find out more in Are we too clean for our own good?

Smoking and Asthma

Smoking also has a definite impact. Parents’ cigarette smoke will affect their child’s lung function development, and it irritates the airways. People with asthma are advised not to smoke.

Research shows that smoking during pregnancy increases the risk of your child developing asthma. Children whose parents smoke are also more likely to develop the condition.

Once you have asthma, high levels of pollution and smoking may make it worse. But there’s no proof that these triggers actually cause it.

Asthma Treatment

How to Help Yourself/Your Child

If certain things trigger your asthma, such as dust mites, minimise your exposure to them. Put mattress covers on your bed, use a damp cloth when you dust, don’t have too many soft furnishings in your house, and put down laminate or wooden flooring instead of carpets.

Asthma Triggers

Asthma triggers include pets, but studies show that getting rid of animals doesn’t improve asthma. In fact, the emotional upset of getting rid of your pet may make your asthma worse. Keep your exposure to pets to a minimum in areas such as the bedroom, and consider not getting any new pets.

Asthma Medicines

If you have symptoms more than three times a week and you need to use a reliever inhaler (usually blue), you should also use a preventer inhaler (usually brown).

But if you only have symptoms a few times a week when exercising, you can manage your symptoms safely with a reliever inhaler before you exercise.

Asthma is an inflammatory disease. This means preventative treatment is vital, and you must take it even when your asthma symptoms aren’t present. This will ensure your asthma is well controlled.

Review your treatment with your asthma nurse or GP (*family doctor) at least once a year as you might be able to reduce your dosage of medicine.

Find out more information about asthma treatments.

Taking Steroids When You Have Asthma

Because asthma is caused by an inflammation of the airways, anti-inflammatory drugs such as steroids are sometimes used to treat it.

You may be concerned about the potential side effects of steroids, such as weight gain, stunted growth (in children) and weakened bones.

The risk of side effects if you or your child are using a steroid inhaler is lower than with steroid tablets because less of the medicine gets into your system. With both steroid inhalers and tablets, the risk of side effects increases if the dose is high and if you use them for long periods.

Generally, if inhaled steroids are prescribed carefully and at the lowest dose needed, the risk of side effects is outweighed by the ability to reduce your or your child’s need for steroid tablets. Discuss the risks of steroid treatment with your doctor if you’re concerned.

If you have queries about any aspect of asthma, you can call the Asthma UK helpline, which is a free telephone helpline staffed by asthma nurse specialists on 0800 121 62 44, Monday to Friday, 9am to 5pm.

Find asthma services in your area. (*UK)

Asthma Resources in the US:

Editor’s Note: *clarification provided for our US readers.





Video: Parents Talk about Their Children with Diabetes

Parents describe how they deal with having a diabetic child, including daily routines such as insulin injections, and how children can live life to the fullest.



 

Editor’s Note: Video Highlights

  • measuring glucose level blood test from diabetes child babyParents talk about the challenges of their child’s diabetes diagnosis
  • Others describe how they must learn to care for their children like medical professionals
  • A particular concern is when the children go off to school – it can be hard to accept someone else taking control over their diabetes
    • This requires a close, integrated approach between the family and school
  • Some of the children also talk about managing their diabetes while at school
  • Parents also describe the disruption that diabetes management represents for their kids’ lives
    • But these steps are absolutely required to keep them alive
  • Another worry covered is when children grow into teenagers – and that new habits and concerns could get in the way of good diabetes control
  • A diabetes physician talks about how the real challenge of diabetes for both parents and the child is maintaining motivation to manage this chronic condition well over decades
  • Parents also emphasize that you will make mistakes and shouldn’t beat yourself up about it – you’re only human and you will get the hang of it all
  • Managing your child’s diabetes can be challenging and stressful, but it does become more normal over time – and your family will be able to focus on other things in life
  • Finally, parents emphasize that a child with diabetes can live a normal life to a full extent

For more information on babies and rashes, click on this link from NHS Choices.






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