Quality of life for children with ADHD and their families worsens with greater disease severity

ScienceDaily (July 26, 2011) — The greater the severity of a child's Attention Deficit Hyperactivity Disorder (ADHD) symptoms, the more negative impacts on the child's health-related quality of life from the perspective of the child and the parent, a new study by a Baylor University psychologist has found.

Researchers compared children with ADHD in different types of treatment settings and found that children with ADHD being treated by a general pediatrician have better overall health-related quality of life and family functioning than children with ADHD being treated in a psychiatric clinic.

The study appears online in the Journal of Attention Disorders and is the first study to demonstrate greater negative impact on quality of life and family function in children with ADHD treated at a psychiatric clinic compared to those treated at a general pediatric clinic.

"These findings have potential implications for the health care needs of children with ADHD," said study author Dr. Christine Limbers, assistant professor of psychology and neuroscience at Baylor. ""The finding that overall agreement between children and parent ratings of the child's quality of life was low underscores the importance of evaluating both children's and parents' perspectives regarding quality of life in routine assessment in clinical practice and clinical trials for children with ADHD since their different perspectives potentially provide unique information."

The researchers surveyed nearly 200 families and evaluated health-related quality of life and family functioning, such as physical, emotional, social and family relationships, from both the perspective of children with physician-diagnosed ADHD and their parents. Researchers then compared those results to a sample of healthy children and to children with ADHD being seen in a psychiatric clinic.

The study found children with ADHD being treated at a general pediatric clinic reported fewer problems with quality of life compared to a sample of children with ADHD being treated in a psychiatric clinic. The study also showed that while children with ADHD treated by a general pediatrician have better overall health-related quality of life than children being seen in a psychiatric clinic, they still experience significant impairments in health-related quality of life compared to healthy children, particularly in psychosocial functioning, which encompasses a wide range of behaviors related to social and emotional well being.

The researchers said that parental worry and family relationships, such as lack of communication between family members and conflicts between family members, and daily family activities, such as family activities taking more time and effort and difficulty finding time to finish household tasks, are key areas to address in a family intervention.

"The data suggest that from the perspective of parents, child social functioning may have the strongest association with impaired family functioning. Consequently, it does not seem sufficient for interventions to only address social functioning with the child," Limbers said. "Teaching parents strategies for coping with their child's social impairments is also critical"

ADHD is one of the most prevalent chronic disorders in childhood and is characterized by impulsivity, a developmentally inappropriate activity level, low frustration tolerance, poor organization of behavior, distractibility, and an inability to sustain attention and concentration.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Baylor University.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Inpatient hospitalization rates appear to have increased among children and adolescents with psychiatric disorders, but decreased among elderly

ScienceDaily (Aug. 1, 2011) — Over a 10-year period, rates of short-stay inpatient hospitalizations increased for children and adolescents but decreased for elderly who had a primary psychiatric diagnosis, according to a report published Online First today by Archives of General Psychiatry, one of the JAMA/Archives journals. The article also finds the proportion of inpatient days paid for by private health insurance appeared to decline among children, adolescents and adults.

According to background information in the article, inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, payers have reduced expenditures in these acute care settings and mental health policy makers and advocates have emphasized treatment alternatives with less restrictiveness and less negative stigma. Between 1990 and 2000, admissions to U.S. inpatient psychiatric services declined, but various data have suggested an increase in more recent years.

Joseph C. Blader, Ph.D., from the Stony Brook University School of Medicine, State University of New York, Stony Brook, evaluated trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007, segmented by patient-level variables. He used demographic, clinical and payment data from the National Hospital Discharge Survey on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were classified as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment).

The study found increases in discharges for children and adolescents, as well as more moderate increases for adults, while discharge rates for elderly patients declined. However, the total inpatient days increased from 1,845 days per 100,000 in 1996 to 4,370 days in 2007 for children and from 5,882 days per 100,000 in 1996 to 8,247 days in 2007 for adolescents; again, a decrease was seen among elderly individuals, from 10,348 days per 100,000 in 1996 to 6,517 in 2007. Also, during the years studied, the proportion of inpatient days covered by private payers decreased among children, adolescents, and adults. Through the period surveyed, primary diagnoses of bipolar disorder increased and primary diagnoses of anxiety decreased.

"In conclusion, a substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Joseph C. Blader. Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.84

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Children and adolescent cell phone users at no greater risk of brain cancer than non-users, study suggests

ScienceDaily (July 28, 2011) — Children and adolescents who use mobile phones are not at a statistically significant increased risk of brain cancer compared to their peers who do not use mobile phones, according to a study published July 27 in the Journal of The National Cancer Institute.

Mobile phone usage has increased among children and adolescents in recent years. The increased usage has raised a concern about the possibility of the development of brain tumors in this population since children have a developing nervous system; also, because their head circumference is smaller, the radio frequency electromagnetic fields may penetrate regions that are deeper in their brains. However, no previous study has examined whether mobile phone usage among children and adolescents is associated with a difference in brain tumor risk.

To determine the relationship between mobile phone usage and brain tumor risk among children and adolescents, Martin Röösli, Ph.D, of the Swiss Tropical and Public Health Institute in Basel, Switzerland, and colleagues looked at the medical records of children aged 7-19 with brain tumors, identified through population registries. Researchers did face-to-face interviews with them regarding their mobile phone usage. They also consulted data from phone network providers.

The study, conducted between 2004 and 2008, included participants from Norway, Denmark, Sweden and Switzerland. They looked at data for 352 brain cancer patients, and 646 control subjects.

The researchers found that patients with brain tumors were not statistically significantly more likely to have been regular mobile phone users than control subjects. They found that 265 (75.3%) of case patients and 466 control subjects (72.1%) reported having spoken on a mobile phone more than 20 times before the time when the case patient was diagnosed. Furthermore, 194 case patients (55%) and 329 control subjects (51%) reported regular mobile phone usage. However, in a subset of study participants for whom operator recorded data were available, brain tumor risk was related to the time elapsed since the mobile phone subscription was started (but not to amount of use). No increased risk of brain tumors was observed for brain areas receiving the highest amount of exposure.

The researchers write, "Because we did not find a clear exposure-response relationship in most of these analyses, the available evidence does not support a causal association between the use of mobile phones and brain tumors." Nevertheless, since mobile phone usage among children and adolescents has increased over the years, they encourage a careful watch on the trend.

In an accompanying editorial, John D Boice, Jr., ScD. and Robert E. Tarone, PhD., of the International Epidemiology Institute in Rockville, Maryland and Vanderbilt University in Nashville, Tennessee write that Röösli and his colleagues "have filled an important gap in knowledge by showing no increased risk of brain tumors among children and adolescents who are regular cell phone users"

Boice and Tarone conclude that it is reassuring that the incidence rates of brain cancer in the general population, including children and teenagers, have not changed over the past 20 years in the United States and many other countries despite the steady and marked rise in the use of cell phones throughout the world since the 1980s. They recommend that investigators continue to monitor population incidence rates and that in the meantime, individuals who are concerned might consider alternatives to holding a cell phone up to their ears, such as using an ear piece or using the phone's speaker. They also point out that individuals should heed what is known about real risks by avoiding the use of cell phones while driving a car, because such distractions have been clearly documented to increase the risk of accidents and injuries.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Journal of the National Cancer Institute, via EurekAlert!, a service of AAAS.

Journal References:

John D. Boice, Jr and Robert E. Tarone. Cell Phones, Cancer, and Children. J Natl Cancer Inst, July 27, 2011 DOI: 10.1093/jnci/djr285Denis Aydin, Maria Feychting, Joachim Schüz, Tore Tynes, Tina Veje Andersen, Lisbeth Samsø Schmidt, Aslak Harbo Poulsen, Christoffer Johansen, Michaela Prochazka, Birgitta Lannering, Lars Klæboe, Tone Eggen, Daniela Jenni, Michael Grotzer, Nicolas Von der Weid, Claudia E. Kuehni, and Martin Röösli. Mobile Phone Use and Brain Tumors in Children and Adolescents: A Multicenter Case–Control Study. J Natl Cancer Inst, July 27, 2011 DOI: 10.1093/jnci/djr244

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Children born after unplanned pregnancy are slower to develop, UK study finds

ScienceDaily (July 27, 2011) — Children born after unplanned pregnancies tend to have a more limited vocabulary and poorer non-verbal and spatial abilities; however this is almost entirely explained by their disadvantaged circumstances, according to a new study published online in the British Medical Journal. The same study reported no adverse effects of infertility treatment on the children.

In the UK, as many as 30-40% of pregnancies that end in childbirth are unplanned, while the number of children born after assisted reproductive technologies is growing every year.

It is already known that children born after a prolonged time to conception or assisted reproduction are at greater risk of poor health outcomes, such as preterm birth, low birth weight, and congenital anomalies, and some researchers have reported lower cognitive (mental) scores in such children.

Unplanned pregnancies also have poorer outcomes, but there has been little research to assess whether child development is associated with pregnancy planning.

So a team of UK researchers set out to investigate how pregnancy planning, time to conception, and infertility treatment influence a child's cognitive development at three and five years old.

They analysed data from approximately 12,000 children from the Millennium Cohort Study, a large UK study of families and infants born in 2000-2. Parents who took part were interviewed when their child was nine months old and then revisited when the child was three and five years old.

Mothers reported whether the pregnancy was planned, their feelings when first pregnant, time to conception, and details of any infertility treatment.

Each child's verbal, non-verbal and spatial abilities were tested at age three and five using the British Ability Scales.

Initial analyses showed that children born after an unplanned pregnancy were four to five months behind planned children in verbal abilities, while children born after assisted reproduction were three to four months ahead.

However, these differences all but disappeared when the researchers took into account the socioeconomic circumstances of each child.

The authors conclude: "These differences are almost entirely explained by socioeconomic factors, providing further evidence of the influence of socioeconomic inequalities on the lives of children in the UK. To help children achieve their full potential, policy makers should continue to target social inequalities."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.

Journal Reference:

C. Carson, Y. Kelly, J. J. Kurinczuk, A. Sacker, M. Redshaw, M. A. Quigley. Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study. BMJ, 2011; 343 (jul26 1): d4473 DOI: 10.1136/bmj.d4473

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Fast ripples confirmed to be valuable biomarker of area responsible for seizure activity in children

ScienceDaily (July 30, 2011) — New research focusing on high-frequency oscillations, termed ripples and fast ripples, recorded by intracranial electroencephalography (EEG), may provide an important marker for the localization of the brain region responsible for seizure activity. According to the study now available in Epilepsia, a journal of the International League Against Epilepsy (ILAE), the resection of brain regions containing fast ripples, along with the visually-identified seizure-onset zone, may achieve a good seizure outcome in pediatric epilepsy.

High-frequency oscillations at 80-200 Hz are known as ripples and those above 200 Hz are considered fast ripples. Medical evidence suggests that fast ripples are a specific surrogate marker of the seizure generation zone. Studies in adults have suggested that resection of the brain region containing fast ripples was associated with good seizure outcome. However, these studies used a small number of electrode (EEG) contacts, with limited brain coverage, which may not be optimal for pediatric patients who often exhibit a more generalized epileptic network than adults.

Hiroshi Otsubo, MD, with The Hospital for Sick Children in Toronto, Canada and lead researcher of the current study explains, "In pediatric patients, extensive surgical resection are often used, but may overestimate the link between high-frequency oscillations and seizure outcome. Good surgical success may also be achieved by more limited surgeries that include both the brain region with high-frequency oscillations and the brain region that appears to initiate seizures, even when they are independent." To further explore this hypothesis, the research team evaluated the relationship of resection of brain regions containing high-frequency oscillations and the area of seizure onset in pediatric epilepsy patients.

Researchers retrospectively analyzed 28 pediatric patients with epilepsy who underwent intracranial EEG monitoring prior to focal resection surgery. Brain regions containing a high occurrence of high-frequency oscillations were determined, and spatial relationships between regions with fast ripples and seizure-onset zones were investigated. The team compared seizure outcome with the size of these regions, the surgical resection, and amount of the regions with fast ripples and areas of seizure onset within the resection area.

Results show that 2 years after surgery, 10 patients were completely seizure free and 18 continued to have some seizure activity. Complete resection of the brain regions exhibiting fast ripples was significantly associated with better seizure outcome. Improved seizure outcome was also observed with complete resection of brain regions with ripples; surprisingly, however, resection of the area of seizure onset did not correlate with seizure outcome. The size of surgical resection was not linked to seizure outcome.

Furthermore, the authors, Drs. Akiyama and Otsubo et al., noted that the visually- determined seizure onset zone partially overlapped with regions containing high-rate fast ripples. "The entire epileptic network, containing fast ripples, ripples and seizure onset zones, must be thoroughly analyzed to ensure complete resection of the area causing seizures with the smallest resection possible," advised Drs. Akiyama and Otsubo et al. "While our results are preliminary and further validation is necessary, the analysis of high frequency oscillations offers clinicians a new surgical approach that could potentially improve seizure outcome in children with epilepsy."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.

Journal Reference:

Tomoyuki Akiyama, Bláthnaid McCoy, Cristina Y. Go, Ayako Ochi, Irene M. Elliott, Mari Akiyama, Elizabeth J. Donner, Shelly K. Weiss, O. Carter Snead, James T. Rutka, James M. Drake, Hiroshi Otsubo. Focal resection of fast ripples on extraoperative intracranial EEG improves seizure outcome in pediatric epilepsy. Epilepsia, 2011; DOI: 10.1111/j.1528-1167.2011.03199.x

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Quality of life for children with ADHD and their families worsens with greater disease severity

ScienceDaily (July 26, 2011) — The greater the severity of a child's Attention Deficit Hyperactivity Disorder (ADHD) symptoms, the more negative impacts on the child's health-related quality of life from the perspective of the child and the parent, a new study by a Baylor University psychologist has found.

Researchers compared children with ADHD in different types of treatment settings and found that children with ADHD being treated by a general pediatrician have better overall health-related quality of life and family functioning than children with ADHD being treated in a psychiatric clinic.

The study appears online in the Journal of Attention Disorders and is the first study to demonstrate greater negative impact on quality of life and family function in children with ADHD treated at a psychiatric clinic compared to those treated at a general pediatric clinic.

"These findings have potential implications for the health care needs of children with ADHD," said study author Dr. Christine Limbers, assistant professor of psychology and neuroscience at Baylor. ""The finding that overall agreement between children and parent ratings of the child's quality of life was low underscores the importance of evaluating both children's and parents' perspectives regarding quality of life in routine assessment in clinical practice and clinical trials for children with ADHD since their different perspectives potentially provide unique information."

The researchers surveyed nearly 200 families and evaluated health-related quality of life and family functioning, such as physical, emotional, social and family relationships, from both the perspective of children with physician-diagnosed ADHD and their parents. Researchers then compared those results to a sample of healthy children and to children with ADHD being seen in a psychiatric clinic.

The study found children with ADHD being treated at a general pediatric clinic reported fewer problems with quality of life compared to a sample of children with ADHD being treated in a psychiatric clinic. The study also showed that while children with ADHD treated by a general pediatrician have better overall health-related quality of life than children being seen in a psychiatric clinic, they still experience significant impairments in health-related quality of life compared to healthy children, particularly in psychosocial functioning, which encompasses a wide range of behaviors related to social and emotional well being.

The researchers said that parental worry and family relationships, such as lack of communication between family members and conflicts between family members, and daily family activities, such as family activities taking more time and effort and difficulty finding time to finish household tasks, are key areas to address in a family intervention.

"The data suggest that from the perspective of parents, child social functioning may have the strongest association with impaired family functioning. Consequently, it does not seem sufficient for interventions to only address social functioning with the child," Limbers said. "Teaching parents strategies for coping with their child's social impairments is also critical"

ADHD is one of the most prevalent chronic disorders in childhood and is characterized by impulsivity, a developmentally inappropriate activity level, low frustration tolerance, poor organization of behavior, distractibility, and an inability to sustain attention and concentration.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Baylor University.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Quality of life for children with ADHD and their families worsens with greater disease severity

ScienceDaily (July 26, 2011) — The greater the severity of a child's Attention Deficit Hyperactivity Disorder (ADHD) symptoms, the more negative impacts on the child's health-related quality of life from the perspective of the child and the parent, a new study by a Baylor University psychologist has found.

Researchers compared children with ADHD in different types of treatment settings and found that children with ADHD being treated by a general pediatrician have better overall health-related quality of life and family functioning than children with ADHD being treated in a psychiatric clinic.

The study appears online in the Journal of Attention Disorders and is the first study to demonstrate greater negative impact on quality of life and family function in children with ADHD treated at a psychiatric clinic compared to those treated at a general pediatric clinic.

"These findings have potential implications for the health care needs of children with ADHD," said study author Dr. Christine Limbers, assistant professor of psychology and neuroscience at Baylor. ""The finding that overall agreement between children and parent ratings of the child's quality of life was low underscores the importance of evaluating both children's and parents' perspectives regarding quality of life in routine assessment in clinical practice and clinical trials for children with ADHD since their different perspectives potentially provide unique information."

The researchers surveyed nearly 200 families and evaluated health-related quality of life and family functioning, such as physical, emotional, social and family relationships, from both the perspective of children with physician-diagnosed ADHD and their parents. Researchers then compared those results to a sample of healthy children and to children with ADHD being seen in a psychiatric clinic.

The study found children with ADHD being treated at a general pediatric clinic reported fewer problems with quality of life compared to a sample of children with ADHD being treated in a psychiatric clinic. The study also showed that while children with ADHD treated by a general pediatrician have better overall health-related quality of life than children being seen in a psychiatric clinic, they still experience significant impairments in health-related quality of life compared to healthy children, particularly in psychosocial functioning, which encompasses a wide range of behaviors related to social and emotional well being.

The researchers said that parental worry and family relationships, such as lack of communication between family members and conflicts between family members, and daily family activities, such as family activities taking more time and effort and difficulty finding time to finish household tasks, are key areas to address in a family intervention.

"The data suggest that from the perspective of parents, child social functioning may have the strongest association with impaired family functioning. Consequently, it does not seem sufficient for interventions to only address social functioning with the child," Limbers said. "Teaching parents strategies for coping with their child's social impairments is also critical"

ADHD is one of the most prevalent chronic disorders in childhood and is characterized by impulsivity, a developmentally inappropriate activity level, low frustration tolerance, poor organization of behavior, distractibility, and an inability to sustain attention and concentration.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Baylor University.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

New way to examine major depressive disorder in children

ScienceDaily (May 10, 2011) — A landmark study by scientists at Wayne State University published in the May 6, 2011, issue of Archives of General Psychiatry, has revealed a new way to distinguish children with major depressive disorder (MDD) from not only normal children, but also from children with obsessive compulsive disorder (OCD).

MDD is a common, debilitating disease prevalent in childhood and adolescence. Examination of cortical thickness in patients with MDD has not been widely studied, and WSU's team of researchers set out to determine if differences in cortical thickness might not only distinguish children with depression from healthy children who are not depressed but also from those with other psychiatric disorders such as OCD.

Using a new technique to measure cortical thickness of 24 MDD patients, 24 OCD patients and 30 healthy control patients, the research team led by David Rosenberg, M.D., the Miriam L. Hamburger Endowed Chair of Child Psychiatry and professor of psychiatry and behavioral neurosciences in the School of Medicine at Wayne State University, and Erin Fallucca, M.D., a psychiatry resident at Wayne State University and the Detroit Medical Center, observed cortical thinning in five regions of the brain and greater thickness in the bilateral temporal pole in MDD patients. In OCD patients, the only significantly different region from healthy control patients was a thinner left supramarginal gyrus.

"The findings from our study are very exciting," said Rosenberg. "By measuring cortical thickness, we were able to distinguish depressed children not only from healthy children without depression, but also from those with another psychiatric disorder, obsessive compulsive disorder."

The study also revealed that familial depressed patients, or children with at least one first-degree relative with depression, had distinct cortical thickness compared to children with no obvious family history of mood disorder.

"Depressed children with and without a family history of depression who met the same clinical criteria of depression and who appeared the same clinically, had completely different cortical thickness based on their family history of depression," said Rosenberg.

This study offers an exciting new way to identify more objective markers of psychiatric illness in children. "It may have potential treatment significance for one-third of depressed children who do not respond to any treatment, and also for many who only partially respond with continued functional impairment," said Rosenberg. "We have found a clue to guide us to look at subtypes of depression just as we would in other chronic medical illnesses like diabetes, such as insulin dependent and non-insulin dependent diabetes."

This study was supported in part by the Paul Strauss Endowment for the Integration of Computer Science and Psychiatry, the National Institute of Mental Health of the National Institutes of Health, the State of Michigan Joe F. Young Sr. Psychiatric Research and Training Program, the World Heritage Foundation, the Schutt Foundation, the United Way, the National Alliance for Research on Schizophrenia and Depression and the Mental Illness Research Association.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wayne State University.

Journal Reference:

E. Fallucca, F. P. MacMaster, J. Haddad, P. Easter, R. Dick, G. May, J. A. Stanley, C. Rix, D. R. Rosenberg. Distinguishing Between Major Depressive Disorder and Obsessive-Compulsive Disorder in Children by Measuring Regional Cortical Thickness. Archives of General Psychiatry, 2011; 68 (5): 527 DOI: 10.1001/archgenpsychiatry.2011.36

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here