ADHD More Common Than Depression in Child Suicide

Young children who die by suicide are less likely to have depression and more likely than their adolescent counterparts to have attention-deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD), new research shows.

An analysis of a national database that tracks violent deaths showed that among suicide decedents with known mental health problems, young children aged 5 to 11 years were more likely to experience ADD, with or without hyperactivity, and less likely to experience depression/dysthymia compared with children and adolescents aged 12 to 14 years.

"The major message of the study is that the circumstances preceding suicide in children are, to a large extent, similar to those for suicide in early adolescents, with a few key exceptions that tend to fall along developmental lines," lead author Arielle H. Sheftall, PhD, from Nationwide Children's Hospital, Columbus, Ohio, told Medscape Medical News.

"For example, elementary school-aged children who died by suicide were more likely to experience problems with family or friends, and among those with a current mental health problem, were more likely to be diagnosed with ADD/ADHD, whereas early adolescents who died by suicide were more likely to experience boyfriend or girlfriend problems and be diagnosed with depression or dysthymia," she added.

The study was published online September 19 in Pediatrics.

Impulsive Response to Stress

"Despite a recent increase in the suicide rate among young black children, suicide in elementary school-aged children is not well studied," senior author Jeffrey A. Bridge, PhD, also from Nationwide Children's Hospital, told Medscape Medical News.

The researchers used the National Violent Death Reporting System to examine characteristics and precipitating circumstances of suicide from 2003 to 2012 in 17 different states in two groups of children ― elementary school-aged children (5- to 11-year-olds) who died by suicide, and early adolescents (12- to 14-year-olds) who died by suicide.

They also examined potential racial differences in precipitating circumstances within each age group.

The investigators found similarities and differences between the two age groups that tended to track along developmental lines.

During the study period, there were a total of 693 suicides.

The investigators found that among approximately one third (n = 210) of the cohort with a current mental health problem, ADD/ADHD was more common in elementary school-aged children who died by suicide (59.3% vs 29.0%; P = .002) and that they were less likely to have depression/dysthymia (33.3% vs 65.6%; P = .001) compared with early adolescent decedents.

"The findings suggest that the children ages 5 to 11 who died by suicide may have been more vulnerable as a group and respond impulsively to interpersonal challenges," Dr Sheftall said.

In addition, the researchers found that 29% of all youth disclosed their intention for suicide to someone prior to their death. 

Although there were no racial differences in terms of precipitating circumstances, compared with early adolescents who died by suicide, children who died by suicide were more likely to be male, black, to die by hanging, strangulation or suffocation, and to die at home.

"Unfortunately, our study was not designed to address questions about potential factors that may have contributed to the increase in suicide rates among black children," Dr Bridge said.

More research is needed to establish whether unique patterns of suicide risk exist in order that prevention efforts might incorporate diverse strategies according to the children's developmental level, race, or ethnicity, the researchers note.

The analysis also showed that although rates of alcohol use and illicit drug use were low and did not differ significantly between the two age groups, 3.9% of children and 7.5% of early adolescents who died by suicide tested positive for opiates. "These rates are higher than alcohol and other substances," said Dr Bridge.

"Parents, teachers, and healthcare providers need to be aware that although suicide is extremely rare in elementary school–aged children, a child can and sometimes will think about and even attempt suicide," Dr Bridge said.

"It's important to ask children directly about suicide if there is a safety concern about a child. Parents also need to know the warning signs of suicide. These warning signs include a child making suicidal statements, being unhappy for an extended period, suddenly withdrawing from friends or school activities, or being increasingly aggressive or irritable. If these warning signs are present, then parents should be concerned about those behaviors and consider taking the child to see a mental health professional," he said.

Child Psychiatrist Shortage

Unfortunately, getting to see a qualified mental health professional may not be easy, Dr Bridge noted.

"In fact, there is a national shortage of child psychiatrists, with the greatest disparities seen in rural areas and areas with a high percentage of children living in poverty. This shortage means that pediatricians and other non–mental health professionals often are on the front lines of diagnosing and treating mental health problems in children," he said.

"The problem is compounded in that most pediatricians do not treat mood and anxiety problems in children but instead refer these patients to child psychiatrists, where families face long wait lists. It's a vicious cycle."

"One of the key and practical findings of this study has to do with existing psychiatric disorders," David C. Rettew, MD, from the University of Vermont College of Medicine, Burlington, told Medscape Medical News.

"We have spent a great deal of energy trying to make people aware of the link between suicide and depression, but in this group of younger children who died by suicide, it was ADHD that showed the strongest link.

"This doesn't mean, however, that all suicides in younger children were impulsive spur-of-the-moment acts, especially given the fact that hanging and suffocation, which require some amount of time, were the most likely means of suicide in this youngest group," Dr Rettew said.

"Lately there has been a lot of attention devoted to antidepressants possibly causing increased suicidal thinking and behavior. While the authors surprisingly did not address the issue at all in their text, their data show that antidepressants were being taken in only a small percentage of the cases," he added.

"Unfortunately, this study does not give us a good lead as to why young African American children are disproportionately more likely to die by suicide, while older African Americans show comparatively lower rates," Dr Rettew added.

The study was supported by the National Institute of Mental Health, the National Institutes of Health, and the Centers for Disease Control and Prevention. Dr Sheftall, Dr Bridge, and Dr Rettew report no relevant financial relationships.

Article Resources:http://www.medscape.com/

New Research Shows Physical Activity Is a 'Medicine' Against ADHD

Gym programs – and the underfunding of them – may be as important as math or reading to learning. A new study shows that addressing the ADHD epidemic may require a dose of physical activity, so kids can refocus and learn effectively in a classroom.

Study, after study have given enough reason to think there may be a causal effect in addressing ADHD symptoms with physical activity. Researchers from another study published in the medical journal Pediatrics said they were able to "demonstrate a causal effect of a physical program on executive control, and provide support for physical activity for improving childhood cognition and brain health."

The image below shows the results from a group of 221 kids between the ages of eight and nine who were randomly selected to participate in the two-hour FITKids after school PE program, and those who didn’t. The program lasted for nine months and the differences in cognitive health, focus, and physical well-being were noticeable.

These electrophysiological plots represent the brain’s processing capacity and mental workload (P3 amplitude) during cognitive tests, which requireed executive control. The red represents the greatest amount of executive control and bluerepresents the lowest.
(Hillman et al, Pediatrics/The Atlantic)

The researchers make a plea to policymakers and schools to consider their results, writing, “Given the rapid decline in [physical activity] opportunities for children at school, the dissemination of our findings is particularly important… Specifically, policies that reduce or replace [physical activity] opportunities during the school day (eg, recess), in an attempt to increase academic achievement, may have unintended effects.”

The measures put in place to prepare kids for tests in the future may actually be putting them at a severe disadvantage. It’s important to put this in perspective — our children are our future, after all. They will dictate the successes in this country and in their own lives.

Article Resources:http://bigthink.com/

Here’s Why ADHD May Have Been An Evolutionary Advantage

If you've ever learned something by playing a game, observing someone else, or watching a TED talk, you're doing it the way humans have for the majority of our history.

Rather than learning in a classroom, our hunting and gathering ancestors played, observed each other and, occasionally, got a lesson from family or friends. If you were lucky enough to have a personality that was well-suited to this style of learning, it not only meant you acquired new skills quicker — it probably also meant you lived longer.

As nomads, those of us who could learn the best way to get a meal or avoid getting eaten by a wild animal were the ones who survived, reproduced, and passed their traits on to their children.

It turns out that many of those traits are surprisingly similar to the ones we now associate with Attention Deficit Hyperactivity Disorder, better-known as ADHD. Being impulsive, impatient, or easily distracted might make learning in a formal classroom more difficult. But those traits may have helped all of us, as a species, get to where we are today.

Nomads With ADHD

"Having the profile of what we now call ADHD would have made you a Paleolithic success story,” Weill Cornell Medical College clinical psychiatry professor Richard A. Friedmansuggested in a recent op-ed for The New York Times. In fact, there's limited evidence, based on modern-day tribes, that supports the theory that some or all of these ADHD-like traits were beneficial for our ancestors.

Take the Ariaal, a group of people in Kenya who originally lived as nomadic animal herders: Some have a gene variant that's been linked to a portion of ADHD cases. The variant doesn't necessarily determine whether or not someone has ADHD — the genetic particulars of the disorder are still being investigated — but it's one of the strongest genetic links to ADHD that's been found to date. It's also much more common among nomadic populations.

In recent years, some of the Ariaal separated from the original group and adopted a settled lifestyle instead. In the people who still live nomadically, those who have the ADHD-associated gene variant tend to be better- nourished. But in those who have settled, people with that gene variant tend to be underweight.

That finding suggests one possible explanation of the variant's frequency in nomadic societies that resemble those of our ancestors: Certain characteristics that we now link with ADHD may have helped some people survive and thrive under conditions more akin to those of our earliest ancestors than to the offices and classrooms of today.

Business Insider / Matt Johnston

'Socially Valuable'

All of this suggests that the characteristics we now associate with ADHD are meaningful, and may even give those who have them an edge over others in certain situations.

"It is not hard at all to think of conditions in which ADHD-like characteristics are socially valuable,” Boston College professor of psychiatry Peter Gray wrote in his Psychology Today blog.

Think of your most impulsive friend. On the one hand, his or her inability to wait for a result or to stay focused on one thing could be slightly annoying. On the other hand, being impulsive could let him or her act quickly when something unexpected happens, some research suggests.

Or, take someone who can never seem to follow directions. While annoying to the teacher or parent whose job it is to make sure children do as they are told, this tendency could help that person come up with creative solutions to a problem that someone else might not see. Recent research backs up that idea; in two studies (one of children and one of adults), participants with ADHD came up with more novel ideas than those without the disorder.

All this also helps explain why more and more children are being diagnosed with ADHD each year: People might not be getting sicker so much as our values as a society are changing. Teachers, parents, coworkers, and bosses increasingly want people who sit still, follow instructions, and stay focused on one task at a time, Gray suggests.

In contrast, people with ADHD might be better suited for schools or jobs that take advantage of their flexibility and impatience and put these characteristics into use. "Let's not rush to medicalize...curiosity, energy and novelty-seeking," Friedman wrote. "In the right environment, these traits are not a disability, and can be a real asset."

Article Resources:http://www.businessinsider.com/