Young Families INSIGHTS
October 1999
Linda Swann, Young Families Program Coordinator, Editor
Linda Buzard, Layout Manager

 
Young Family Highlights from NAMI Convention July 1999

Reported by Diane Weaver, NAMI NC Family Advocate, Western North Carolina

Peter Jensen, MD, Chief, Child and Adolescent Disorders Research Branch, National Institute of Mental Health (NIMH), made the following points on treatment strategies for ADHD in children as a result of research conducted over the last five years:

• Behavioral therapies are very effective while being administered, but once the child leaves the setting, "nothing seems to stick."

• Success of treatment varies with each child.

• Combined therapy - medications and behavioral therapy - is the most effective at improving academic performance.

• Teachers are more effective than parents at identifying hyperactive behavior while parents are more effective at recognizing symptoms of depression and anxiety.

• Family therapy is not what is needed.

• Children and adolescents in the typical community setting receive suboptimal treatment for ADHD.

• The best replicated genetic studies in all of mental health research are in ADHD!! Some specific genes are being studied, for example, a dopamine transporter gene that when knocked out leads to hyperactivity.

• A pediatric brain atlas is in beginning stages of development. It should be available in 5-10 years to all researchers.

• Early identification of mental disorders in children is key! Scientists know the human brain has the ability to "recruit" additional neural tissue (referred to as neural plasticity). In other words, the brain has the ability to work around brain disorders. The sooner treatment begins, the better the outcome

Benjamin Lahey, PhD, professor of Psychiatry, University of Chicago made the following points on ADHD.

• ADHD causes problems in daily living, including friendship problems, not reaching intellectual capacity in mathematics, and disliking peers. All of these problems correlate with inattention. Accidental injuries are also a problem and correlate with hyperactivity and impulsivity.

• The risks of medication are smaller than the risks of accidental injuries.

• Controlling for comorbidities, intelligence, age, gender, socioeconomic status, and ethnicity, ADHD alone results in reduced academic achievement, reduced occupational attainment, and increased motor vehicle accidents.

• In summary, the risk of not treating ADHD in children is "very serious!"

Demitri Papolos, associate clinical professor, Dept. of Psychiatry, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY is a behavioral geneticist studying bipolar disorder. He recently authored a book on Childhood Onset Bipolar Disorder (COBPD). He spoke on the differential diagnosis of ADHD and bipolar disorder based on a retrospective study of 140 children ages 2-20. He reported:

• 57-96% if children with COBPD also meet ADHD criteria.

• COBPD must be ruled out before prescribing stimulant medication for ADHD. In 67% of children with COBPD, stimulant medication will trigger mania, rapid cycling, mixed mania, violence, hospitalization, and/or psychosis.

• Destructiveness is present in both diagnoses, but in ADHD it results from carelessness; in COBPD it results from anger.

• Tantrums in ADHD are triggered by overstimulation and tend to be shorter and milder than tantrums in bipolar disorder. COBPD tantrums are triggered by limit setting and are severe, often involving destruction of property.

• Children with ADHD tend to arouse quickly in the morning and children with COBPD tend to be irritable in the morning, have somatic complaints, and take several hours to reach full arousal. At night they tend to be hyperactive, with racing thoughts, and cannot get to sleep.

Timothy Wilens, MD, Harvard Medical School presented findings on the overlap between ADHD and substance use disorders (SUDS).

• ADHD puts young people at risk for substance abuse.

• 20% of addicts/alcoholics have ADHD.

• Impulsivity causes lots of problems with recovery from addiction. Untreated ADHD probably leads to higher relapse rates.

• 40 to 60% of adolescents with SUDS have ADHD.

• Childhood-onset bipolar disorder and conduct disorders carry extreme risk of substance abuse.

• Kids with ADHD abuse whatever substance is available. That is, availability drives which substance is used.

• "Altering mood" is the strongest self-reported reason for substance use.

• Marijuana relaxes internal restlessness.

• Nicotine enhances attention, stimulates neurotransmitter release.

• ADHD tends to lengthen the duration of substance use.

• Medication reduces mid-teen SUDS.

• Medication for ADHD cut the risk of mid-teen alcohol abuse from 30 to 10%; marijuana abuse from 30 to 10%, and cocaine use to normal risk (a dramatic finding).

• In summary, medications have a protective effect for later substance abuse by children and adolescents with ADHD. Overall, there is a 68% reduction in risk.

Clinical depression goes beyond sadness. It's more than having a bad day or coping with a major loss such as the death of a parent, grandparent, or even a favorite pet. It's also not a personal weakness or a character flaw. Youth suffering from clinical depression cannot simply "snap out of it."

Depression is a brain disorder (mental illness) that affects the whole person-it affects the way one feels, thinks, and acts. Early-onset depression can lead to school failure, alcohol or other drug use, and even suicide. However, it is highly treatable.

What are the signs of early-onset depression?

• Persistent sadness and hopelessness
• Withdrawal from friends and from activities once enjoyed
• Increased irritability or agitation
• Missed school or poor school performance
• Changes in eating and sleeping habits
• Indecision, lack of concentration, or forgetfulness
• Poor self-esteem or guilt
• Frequent physical complaints, such as headaches and stomachaches
• Lack of enthusiasm, low energy, or low motivation
• Drug and/or alcohol abuse
• Thoughts of death or suicide

Youth under stress who experience a loss or who have attention, learning, or conduct disorders are at a higher risk for depression. (American Academy of Child & Adolescent Psychiatry [AACAP], 1995)

Almost one-third of six to twelve-year-old children diagnosed with major depression will develop bipolar disorder within a few years. (AACAP, 1995)

Four out of every five runaway youths suffer from depression. (U.S. Select Committee on Children, Youth & Families)

Clinical depression can contribute to eating disorders. On the other hand, an eating disorder can lead to a state of clinical depression. (Stellefson, Medical University of South Carolina, 1998)

What can parents or caregivers do?

If parents or another adult in a young person's life suspect a problem with depression, they should:

• be aware of the behaviors that concern them and note how long the behaviors have been going on, how often they occur, and how severe they seem;

• see a mental health professional or the child's doctor for evaluation and diagnosis;

• get accurate information from libraries, helplines and other sources;

• ask questions about treatments and services;

• talk to other families with similar problems in the community; and

• find a family support group such as NAMI.

Know the facts:

As many as one in every 33 children and one in eight adolescents may have depression. (U.S. Center for Mental Health Services [CMHS], 1996)

Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next five years. (CMHS, 1996)

Two-thirds of children with mental health problems do not get the help they need. (CMHS, 1996)

A recent study led by Dr. Graham Emslie of the University of Texas, Southwestern Medical Center, concludes that treatment of major depression is as effective for children as it is for adults. (American Medical Association, Archives of General Psychiatry, November 15, 1997)

Suicide is the third leading cause of death for 15 to 24 year olds (approximately 5,000 young people) and the sixth leading cause of death for five to 15 year olds. The rate of suicide for five to 24 year olds has nearly tripled since 1960. (American Academy of Child & Adolescent Psychiatry [AACAP], 1995.)

A great response!!

Many thanks to the hundred plus educators who have attended our recent school presentations in Wake, Orange, and Mecklenburg counties! We appreciate your kind remarks and helpful feedback. NAMI North Carolina also wishes to acknowledge the volunteers across the state who have been trained and are ready to make presentations to schools in their areas. They include: Gail Johnson, Rosalie Hurst, Ralph Wingerter, Betty Lane, Hazel Dordoni, and Diane Weaver, all from Western North Carolina; Diane Kienzle, Diane Palmer, and Chary Sundstrom from the central part of the state. Let's keep these folks busy! Please call me at the office if you are interested in having me contact someone in your school district about our presentation. Thanks.