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.

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association teamed up to develop a well needed book called ”ADHD Parents Medication Guide” to offer insights into medications and psychosocial treatments for ADHD. The guide contains an overview of ADHD followed by detailed information regarding medication options, effectiveness, and side effects. Non-medication treatment approaches such as behavioral therapies and school services are reviewed as well.

This is a great resource for families. The guide can empower patients to collaborate more effectively with their physicians around medication decisions.

You can download the ADHD Parents Medication Guide in both English and Spanish at http://www.parentsmedguide.org/pmg_adhd.html There is also a link available for the recently updated American Academy of Child and Adolescent Psychiatry Practice Parameters for the Assessment of Children and Adolescents with ADHD.

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

Teaching children from a young age to eat a low-fat diet can be effective — even as they reach their teens and begin eating more meals away from home, according to a new study. The study of children in Finland found that those who were taught to focus on healthy fats — those found in fish, nuts, seeds and oils from plants — had slightly lower cholesterol levels compared to those who ate an unrestricted diet. The researchers have been following the 1,062 children since the age of 7 months. About half of the children and their families were counseled to shift fat intake from animal-based saturated fats to healthier unsaturated fats. The rest did not get specific diet advice. The new study reported the results on the children at age 14. Dr. Harri Niinikoski, lead author of the study done at the University of Turku in Finland, said children begin forming their eating and lifestyle habits in childhood. “The earlier you intervene, the more likely you are going to be successful,” she said. 

A study published in the American Heart Association Journal recently compared 540 children assigned to a dietary counseling group to 522 who did not get special diet advice, starting from seven months of age and found that regular counseling of families and children about the benefits of avoiding saturated fats in their diet led to diets lower in fat and saturated fat, and reduced blood cholesterol levels in children up to the age of 14. There were no differences in stature between counseled children and those who were not, suggesting a low-fat diet can pay dividends from the start without affecting growth.  Among the findings, counseling seemed to have a bigger impact on the cholesterol level of boys than girls. The researchers were not sure why. The counseled children also ate more protein and carbohydrates than those who received no dietary advice. “At age 14, the dietary group had a small but statistically significant lower median cholesterol level,” the Heart Association said in a statement. Families in the counseling group received regular advice from a nutritionist and the children were counseled directly from the age of seven. 

Approximately 60% of children under the age of 11 experience some kind of sleep difficulty at least a few nights a week. A recent study conducted by published in the journal Sleep found that more than 80 percent of American children who visit a doctor because they have difficulty sleeping are given some form of prescription medication, even though no sleeping pills are currently approved for use in kids. The research was conducted at the Ohio State University College of Pharmacy in Columbus and complement a 2004 National Sleep Foundation poll that revealed that sleep difficulties are extremely widespread among the young. Specific medications included: about a third were prescribed antihistamines, a quarter alpha-2 agonists, 15% were offered benzodiazepines, and 6% antidepressants.
81% of these children and teens were prescribed medication for their sleep issues. Other recommendations included: 7% were recommended diet and nutritional counseling, 22 % were offered behavioral therapy, and 17% were offered mental health and stress management treatment. A combined regimen of medication plus behavioral therapy was prescribed in just under a fifth of cases. Patients who sought care from a psychiatrist were more than three times as likely to be prescribed a drug for their sleep trouble than those who visited a general practice physician.
Children having difficulty sleeping isn’t “normal”. Rather than simply treat the symptom it is important to figure out the cause – then we can more effectively correct the problem. Antidotally, my experiences as a psychologist have proven to me that therapy for sleep difficulties is very effective. It is critical to approach difficulties from a holistic perspective. In other words, assessing a child’s:
-          Diet: With particular focus on the level of caffeine intake as well as how close to bedtime he eating.
-          Exercise: How much physical exercise does the child engage in and when in the day is she most active.
-          Well-being: Areas to consider include what his school day like, anything new happening at home, is she being bullied or is he worried about upcoming tests, etc…? Often parents are surprised by the worries of a young person since to an adult they are not realistic. Without thoughtful discussion in a safe and relaxed environment, some kids never talk about their concerns and continue to have sleepless nights for long periods of time.
-          Home Life: How comfortable does the child feel in his room? Is the light and noise level appropriate for REM sleeping? Are parents fighting in the other room? How comfortable is the mattress?
-          Relaxation Techniques: Learning simple breathing techniques or body scanning strategies are a useful non-medication approach to falling asleep. 

Can you really train your brain? There are many companies now promoting “brain training” technologies, particularly for the treatment of attention deficit disorder or ADD. Not surprisingly, most of them have little or no research publications to support their spectacular claims. Is brain training technology really a legitimate alternative to medication? Buyer beware, these high tech tools for improving brain function are often just high tech marketing.

But Cogmed Working Memory Training caught my attention – no pun intended. The Cogmed program, originally developed in Sweden by a team of neuroscience researchers at the Karolinska Institute, is research-validated with more than 1,400 children and adults treated in Europe to date. Their program, showing 80% of patients have measurable improvements in brain function after treatment, is now coming to the U.S.

What is working memory training? (more…)