Historically there has been little to no research in the mental health field on very young children. Parents and professionals alike find themselves wondering what is the best path to take in safely healing our littlest population?

Fortunately long awaited evidence-based treatment guidelines are now available for your pre-schooler. A group of experts in early childhood psychiatry, psychology, and neurology have joined forces to publish clinical guidelines to treat psychological and behavioral problems in very young children. The guidelines include algorithms for managing conditions such as ADHD, depression, anxiety, bipolar disorder, and sleep disorders.

The experts highlighted the need to perform a thorough assessment of very young patients - and their home environment - before making diagnostic and treatment recommendations. First line treatment in very young children should be “evidence-supported psychosocial treatments” advised the group, even when medication is prescribed. For ADHD, family caregivers should be involved in every aspect of the therapy process including behavioral techniques and parent training. The guidelines strongly encourage physicians to try discontinuing medications over time and focus on family interventions.

You can review a copy of the published guidelines in the Journal of the American Academy of Child and Adolescent Psychiatry, Dec 2007 issue. Go to www.jaacap.com/pt/re/jaacap/home, click on “Archive”, Dec 2007.

Consider bringing this information to your provider to encourage an integrated, best-practices approach in treatment. The collaboration of care will be helpful to everyone, most importantly to your child.

A recent study at Harvard Medical School in Boston showed - surprisingly - that the use of stimulant medication in the past year was not associated with sleep problems in children and adolescents with ADHD. There were 225 children with and without ADHD in the study followed for one year. The children with ADHD (ages 6 to 17) were indeed much more likely to have insomnia than other children their age, but the sleep problems were occuring equally in those ADHD kids who took medication and those that did not.

Investigators did find a significant increase in behavioral problems among children who have ADHD and insomnia. Intuitively parents know that lack of sleep worsens behavioral problems for their children and this study strongly supports that not sleeping is truly a major risk factor for bad behavior. In fact this Harvard study reports that kids with ADHD who have sleep problems have significantly higher levels of behavioral difficulties than those non-ADHD kids with insomnia.

The message to all parents is that sleep is a major factor in reducing behavioral problems, but especially for those children with ADHD!

Try melatonin as a natural supplement known to improve sleep quality for children with ADHD. Prior research shows a 45 min earlier onset of sleep in ADHD kids who also took melatonin.

Tips from the American Diabetes Association

Knowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn’t good for you. Some basic principles have weathered the fad diets, and have stood the test of time. Here are a few tips on making healthful food choices for you and your entire family.
 
 
 Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
 
 Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti               with your favorite pasta sauce.
 
 Include dried beans (like kidney or pinto beans) and lentils into your meals.
 
 Include fish in your meals 2-3 times a week.
 
 Choose lean meats like cuts of beef and pork that end in “loin” such as pork loin and sirloin. Remove the skin from  chicken and turkey.
 
 Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
 
 Choose water and calorie-free “diet” drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened  drinks.
 
 Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats  are high in calories. If you’re trying to lose weight, watch your portion sizes of added fats.
 
 Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
 
 Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

If you want more information on foods that are healthier, or how to establish a plan for eating healthy foods, go to the American Diabetes Association www.diabetes.org.

Many children with ADHD have difficulty with transitions, especially very young children. A five year long study out of Lehigh University reviews the benefits of counting down the time before switching activities and found that at least in children, youngsters are better able to control outbursts spurred by ADHD. The five-year study, paid for by the National Institutes of Health, provided a range of behavioral-only therapies to 135 preschoolers with severe ADHD. Families were given either parent-education classes only, or parenting classes plus home and preschool visits by researchers who customized techniques for each child. After a year, aggression and other problem behaviors had dropped, and learning improved, by about 30 percent, the researchers report this month in a journal of the National Association of School Psychologists.

What helped? Stressing consistent rules and routines, and more praise for good behavior than punishment for bad. Surprisingly, both groups fared equally well, raising questions about how to tell which children need more intense aid. Preschoolers with ADHD learn best through repeated practice so the study stressed role-playing things like how to ask to share a toy. Parents were taught to reserve stronger punishments for worst cases, and to try reward systems where children gain or lose “points” for behavior instead. Even the time-out standby was to be used sparingly.

I am excited to share with you news that the adult version of the Cogmed working memory training program will soon be available in the U.S! Jonas Jendi, CEO of Cogmed, announced that this adult tool for improving focus and concentration should be arriving in the next 2-3 weeks. The Cogmed home-based software program originated in Sweden and is based on the neuroscience research work of Dr. Torkel Klingberg at the Karolinska Institute.  For those of you interested in the science behind working memory training, Dr. Torkel’s website, www.klingberglab.se, posts full journal articles on the benefits of training working memory in multiple conditions such as ADHD, stroke, and normal aging.

Over the past 6 months we at ADD Health and Wellness have had great success with the child version of the software and are pleased to now be able to extend this treatment option to our adult clients as well. Clients completing the program report signficant improvements in attention, learning, and academic skills with this brain training.

The working memory training program offers great flexibility. It can be done -

• in both children and adults
• in person or by phone.
• in individuals with other co-existing condtions or learning disabilities
• in conjunction with multiple other treatment modalities

For a free demo of the software, visit www.Cogmed.com 

Back to school is here again. For those with Attention Deficity Hyperactivity Disorder (ADHD) this can be a difficult time of year. Many schools do not have the resources to give students with learning differences what they need. With ADHD being one of the most common disorders in children and adolescents, affecting approximately 7% of school aged children, it is clear that additional supports are critical.

Good news for those looking for an alternative path. The newly established Hartford Accelerated Learning Center has been designed with the goal of teaching and accommodating children with ADHD and learning disabilities. Teachers incorporate physical activity and music instruction in the curriculum and allow students to build on their strengths and work at their own pace. I was particularly impressed with the school’s flex-time schedule which enables students to start and end their school day later if they are not early morning risers. It is very common for children, adolescents, and adults with ADHD to have a shifted sleep/wake cycle and struggle with their mornings, yet be on their game later in the day.

Most people with ADHD are generally above average intelligence, but may have difficulty in a standard classroom due to problems focusing, restlessness, and impulsive or disruptive behaviors. They need more stimulation and engaging activities to promote concentration and learning.

The to eligible for enrollment in the new school, the child must be in first through sixth grade and be diagnosed with ADHD and/or a learning disability. The tuition is $500 per month. For more information you can contact Dr. Anne Morris at 205-822-6363 or Flora Eaddy at 205-588-3952 http://www.dothaneagle.com/content/gulfcoasteast/dea/lifestyle.apx.-content-articles-DEA-2007-08-19-0008.html

Do you ever forget to take your medications? Most of us do, and if you have ADD this may be a regular event. Your pill cap may have the answers for you. We found a new pill cap on the market that glows to remind you when it’s time to take your meds. And when you are running low on medications, this smart pill cap sends a refill request to your pharmacy. Great way to manage those last minute monthly refill calls! At risk of sounding like an infomercial, but wait there’s more….this pill cap apparently emails you or a designated family member reminder messages about taking your medication. Check out http://rxvitality.com and give us your feedback. We are always on the lookout for tools to help you manage your day.

Is there really more to say about Omega 3 fatty acids? Yes! According to Dr. Alex Richardson, a research fellow at Oxford University’s Department of Physiology, Anatomy and Genetics. “Our brain is built, maintained, and repaired by what we eat” says Richardson. It is clear that nutrients do affect brain development, and in particular the omega-3 fatty acids DHA and EPA play an important role in brain cell health. Omega-3’s have shown benefits in improving symptoms of ADHD, dyslexia, autism, and developmental coordination disorder. Still not convinced you need these essential fats? A 2005 study of 117 children ages 5-12 showed signficiant improvements in reading, spelling and ADHD symptoms after only a few months of omega-3’s. Smart tip: add a tsp of liquid fish oil to your protein shake in the morning to improve mood, learning, and behavior!http://thestar.com.my/health/story.aspfile=/2007/5/10/health/17640080&sec=health