Smart Kids With LD

Environmental toxins have long been associated with learning disabilities, and now a new study adds fuel to the fire (pun intended). Researchers at the University of Cincinnati and Cincinnati Children’s Hospital Medical Center have linked early exposure to traffic-related air pollution with ADHD.

The study, purportedly the largest and longest of its kind, followed a cohort of 576 children from infancy through age 7. By age 7, researchers found that children who were exposed to high levels of traffic-related air pollution (TRAP) during the first year of life were significantly more likely to be “at risk” for ADHD. According to a report in Medical News Today, “The ‘at risk’ range for hyperactivity in children means that they need to be monitored carefully because they are at risk for developing clinically important symptoms.”

“The observed association between traffic-related air pollution and hyperactivity may have far-reaching implications for public health,” explained lead author Nicholas Newman, DO, director of the Pediatric Environmental Health and Lead Clinic at Cincinnati Children’s Hospital. Newman pointed out that an estimated 11 percent of the U.S. population lives within 100 meters of a four-lane highway and that 40 percent of children attend school within 400 meters of a major highway.

“Traffic-related air pollution is one of many factors associated with changes in neurodevelopment,” Newman added. “But it is one that is potentially preventable.”

The study was published in Environmental Health Perspectives, a peer-reviewed open access journal of the National Institute of Environmental Health Sciences.

In the immortal words of singer Bon Jovi, “The more things change, the more they stay the same.”

Despite the well-documented and alarming rise in teen use of stimulant medications, most parents continue to believe that their child is not among those using the so-called “study drugs” recreationally.

According to an article on the Web Site My Health News Daily, “just 1% of parents said their teenage children had taken drugs such as Adderall or Ritalin without a prescription.” In fact, recent research shows about 10% of sophomores and 12% of seniors in the U.S. have used ADHD medications without receiving a prescription for them. 

Not My Child

The findings are from a national poll by the C.S. Mott Children’s Hospital to gauge awareness of prescription drug abuse among parents of children ages 13 to 17. While parents claim to be concerned about drug abuse in their community, they remain oblivious to the realities of teen behavior, believing the statistics refer to children other than theirs—a disconnect reminiscent of previous generations. As noted in the article:

This disconnect between teen drug abuse and parents’ awareness of drug abuse may be in part due to the fact that study drugs have more subtle effects than drugs such as heroin and cocaine, allowing teens to more easily hide their drug use, the researchers said.

About half of parents polled said they were very concerned about teens in their communities abusing study drugs. And more than three-quarters supported school policies aimed at stopping this type of drug abuse, such as rules that would require children with prescription ADHD medications to keep the pills in a secure place like the school nurse’s office.

The findings “underscore the need for greater communication among public health officials, schools, parents, and teens regarding this issue,” the researchers said.

What would you do if you found out that your doctor was not following medically approved guidelines to treat your high blood pressure or your broken leg?

That’s the situation many parents of preschoolers with ADHD find themselves in. According to a new study, a staggering 90% of doctors surveyed did not adhere to the treatment guidelines put forth by the American Academy of Pediatrics (AAP) for treating young children with ADHD. All doctors in the study specialized in diagnosing and treating children, ages four to six, with ADHD.

Going Rogue

In what ways do doctors defy the AAP guidelines? The most common violations involved the use of medication:

• 20% said that they often prescribed medication as their initial treatment, despite AAP recommendations that behavior therapy be tried first.
• 40% said that when they do prescribe medication, they don’t begin with Ritalin, the drug recommended by the AAP because it has been more rigorously tested than other drugs in this young population.

Results of this study play into the concerns voiced by an increasing number of parents and professionals alarmed by overuse and abuse of ADHD medications. Dr. Jaeah Chung of Cohen Children’s Medical Center and one of the researchers said, “At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children.”

Bottom Line

If your preschooler’s ADHD is being managed with medications prior to first trying behavior therapy, ask your doctor why. There may be legitimate reasons for the treatment plan prescribed—or as this study suggests, there may not be.

Prescription drug abuse is rampant among U.S. teens—and among the drugs they’re abusing most are Ritalin and Adderall, normally used for treating ADHD.

According to a national survey conducted in 2012 by The Partnership at Drugfree.org and the MetLife Foundation, 24% of high-school students—approximately 5 million teens—have abused prescription medications. The figure represents a staggering 33% increase from the previous survey conducted in 2008. Of those who admitted using prescription medications without a prescription 20% claimed their first experience occurred before age 14.

 Misinformation & Misperceptions

Experts speculate that the problem stems largely from misconceptions about the dangers associated with prescription drug misuse. The survey showed that 20% of teens who abused medications believed that prescription drugs were safer than “street drugs.”

An alarming number of parents surveyed shared this misperception, while nearly one-third also bought into the notion that Ritalin and Adderall improve school performance even if the child does not have ADHD.

In a recent HealthDay article about the survey results, Partnership president and CEO Steve Pasierb noted:

The key here is that kids and often their parents are buying into the myth and misunderstanding that prescription drug abuse is a safer way to get high, a safer alternative to street drugs, and that they can control it. And it’s very important to note that, on this, kids and parents are in the same place. Kids say that they don’t think that their parents are going to be upset if they know about this, and parents are essentially saying the same thing. Now, if cocaine or heroin use was going up the way prescription drug use is parents would certainly be freaking out. And they should be now, because prescription drug abuse is no better.”

Addressing the Problem Begins At Home

Given that more than half the prescription medications that teens abuse come from their family’s medicine cabinet, the role of parents is clear: Says Pasierb, “Parents need to intervene. They need to control supply and demand by locking up their medicine cabinets and throwing out old expired drugs. And they need to constantly weight in, starting at a very young age…They need to tell their child about the risks, and make clear how upset they will be if their child abuses these drugs.”

Under President Obama’s proposed budget for 2014, Federal funding for Special Education is slated to remain at 2012 levels, with $11.6 billion allocated for the 6.5 million students with disabilities. This figure restores funding lost to mandatory sequestration cuts in 2013. The proposal maintains the 15% Federal contribution for the Grants to States program for special education.

Another $236 million is requested for Special Education technical assistance, training, dissemination and other activities to assist states, local districts, and parents to improve the results for children with disabilities.

Education Priorities

Under the 2014 proposal, the Department of Education has prioritized six areas on which to focus: Early childhood education for all; K-12 teacher and learning improvements; school safety; career-readiness; postsecondary education affordability and quality improvements; and Ladders of Opportunity, which is an initiative aimed at high-poverty communities.

To learn more about the President’s Education Budget proposal, see Fiscal Year 2014 Budget Summary and Background Information

Challenges with motor and social skills may conspire to keep some children with learning disabilities and ADHD on the sidelines, despite research that shows all youngsters should be engaging in more–not less–physical activity.

An alarmingly high proportion of teens are currently on a path that may lead to heart disease. This was a key finding from a comprehensive five-year national assessment of teen health. The National Health and Nutrition Examination Surveys (NHANES), found that a “disconcertingly high” rate of poor eating habits and inadequate physical activity “may contribute to unacceptably high rates of adult-onset cardiovascular disease.”

According to an article in the Los Angeles Times, the results of the NHANES Survey clearly show that poor eating and exercise habits established in childhood can “powerfully redirect” an individual’s health in adulthood: 

In children as young as 6 years old who died of causes not related to heart disease, pathologists have detected fatty streaks in the large arteries in autopsies. By early adulthood, atherosclerosis–a narrowing of the arteries with fatty build-up–begins to turn into calcified coronary plaque. And by middle age, heart disease can be at an advanced stage.

Move-More Strategies

For parents who struggle to find exercise options for their children with LD and ADHD, experts suggest the following strategies:

• Forgo team sports for individual sports (e.g. swimming, diving, martial arts, etc.)
• Select activities appropriate for your child’s emotional development
• Consider one-on-one coaching
• Find ways to modify training and activities to keep your child engaged

New statistics from the Centers for Disease Control and Prevention (CDC) show a significant increase in the number of children diagnosed with ADHD in the past decade. According to a report in The New York Times, “Nearly one in five high school-age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder.” Historically, ADHD estimates have ranged from 3 to 7 percent.

In numerical terms, the CDC’s new figures indicate that 6.4 million children, ages 4-17 have been diagnosed with ADHD, which is a 41% increase over the past 10 years.

These figures fuel increasing concerns among experts that ADHD is being overdiagnosed and children are being medicated for a condition they do not have. “Those are astronomical numbers. I’m floored,” Dr. William Graf told a New York Times reporter. Graf is a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The CDC’s ADHD findings are part of a large government study of children’s health, involving interviews with more than 76,000 parents nationwide.

While some doctors and advocates applaud the findings as evidence that ADHD is finally being recognized and addressed by parents, medical professionals, and schools, many others are concerned by the increase as noted in The NYT article:

Experts cited several factors in the rising rates. Some doctors are hastily viewing any complaints of inattention as full-blown A.D.H.D., they said, while pharmaceutical advertising emphasizes how medication can substantially improve a child’s life. Moreover, they said, some parents are pressuring doctors to help with their children’s troublesome behavior and slipping grades.

“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of How Doctors Think.

To learn more about the CDC study results see ADHD Seen in 11% of U.S. Children as Diagnoses Rise.

In a provocative new study, researchers have found a “statistically significant” correlation between sunshine and the prevalence of ADHD. According to an article in the Columbus Dispatch, in states and countries where sunshine is plentiful, fewer children are diagnosed with ADHD.

Before you pack your bags for sunnier climes, researchers acknowledge that, while the study published in the journal Biological Psychiatry raises interesting questions, the results do not confirm a cause-effect relationship between sunshine-exposure and ADHD.

Nonetheless, experts are intrigued. “Nobody has thought to look at this before,” Russell Barkley, an ADHD expert and clinical professor of psychiatry and pediatrics at the Medical University of South Carolina told the Columbus Dispatch. “I think it’s a very important paper.”

Lead researcher, Martijn Arns of Utrect University in the Netherlands, speculates the correlation may have something to do with light exposure enhancing sleep patterns: Sleeping difficulties interfere with attentiveness; sleeping difficulties may be caused by behaviors that interfere with melatonin production (e.g., sitting in front of the computer or using hand-held devices prior to bedtime); exposure to light (in this case, sunshine) may offset the decrease in melatonin, restoring levels to what’s necessary for a good night’s sleep.

According to the article, Barkley, who was not involved with the study, believes these findings “could prove important for children and clinicians if more research in a controlled setting confirms a connection between light exposure and ADHD symptoms.”

In the past two decades, there has been a seismic shift in the number of elementary school classrooms that use ability grouping when teaching reading and math. According to research from the Brookings Institution’s Brown Center on American Education, the percentage of fourth grade teachers who placed students in reading groups based on the student’s ability jumped from 28% in 1998 to 71% in 2009. In math, the practice increased from 40% in 1996 to 61% in 2011.

Ability grouping has been controversial for years; in the 1990s it was considered a civil-rights issue, akin to separating students based on their race or class. Why then is the practice commonplace today?

Unintended Consequence of NCLB

In an article in USA Today, Brookings researcher Tom Loveless suggests that No Child Left Behind (NCLB) spurred the change. He contends that the anti-grouping sentiments so popular in the 1990s “gave way in the last decade to new demands from the federal 2002 NCLB law, which required schools to focus on struggling students in reading and math.”

Despite the shift in the classroom, ability grouping remains controversial. Greg Toppo of USA Today cites the official position of the National Education Association, the union that represents 3 million teachers:

In a statement on its website, the union says that for struggling students, “a steady diet of lower expectations leads to a low level of motivation toward school.” While acknowledging that proponents see grouping as a way to tailor instruction to students’ needs, NEA notes critics’ claims that it “channels poor and minority students to low tracks where they receive a lower quality of instruction.”

But as New Hampshire principal, Patrick Boodey said, “ability grouping has been going on since the one-room schoolhouse — what we call it has changed over time. As a teacher you know in your heart you need to meet the needs of each child.”

In recent weeks there have been several high-profile news stories about ADHD medication abuse among teens looking for an academic edge. This week the American Academy of Neurology (AAN) made news of the their own when they came out strongly against the practice of prescribing ADHD drugs to young people simply seeking to improve test performance or their GPA.

In a position paper published in the journal Neurology, the AAN was highly critical of the practice referred to as “brain doping,” “meducation,” or “neuroenhancement,” citing both ethical and medical concerns.

According to an article on the HealthDay Web Site, Dr. William Graf, lead author of the paper and professor of pediatrics and neurology at Yale School of Medicine clarified that the AAN’s position “doesn’t apply to the appropriate diagnosis and treatment of ADHD.” Rather, he is concerned about what he calls “neuroenhancement in the classroom.”  As the article explains:

In children and teens, the use of drugs to improve academic performance raises issues including the potential long-term effect of medications on the developing brain, the distinction between normal and abnormal intellectual development, the question of whether it is ethical for parents to force their children to take drugs just to improve their academic performance, and the risks of overmedication and chemical dependency, Graf noted.

The position paper received the approval of the Child Neurology Society and the American Neurological Association.