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Friday, 5 February 2016

VICTORIA DERBYSHIRE SHOW - BBC-2 - 2-02-16 - Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism following NICE Guideline 2009


Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism –


Use slider bar to go 1hr 05 min into programme after 10 am sports news look for the pink shirt!


VICTORIA DERBYSHIRE SHOW  BBC 2 – 2-02-16 - Joanna Gosling presents the daily news and current affairs programme. Jean Mackenzie speaks to 10-year-old Becky, who had to wait six years for a diagnosis of autism

GUARDIAN NEWSPAPER - 22-12-14 - Survey by DECP(BPS) shows psycho-stimulants used more commonly to treat hyperactivity in preschoolers. By Sally Weale




FOR FULL ARTICLE USE HYPERLINK TO GUARDIAN ARTICLE - 22-12-14 

http://www.theguardian.com/society/2014/dec/21/adhd-medication-treat-hyperactivity-pre-school-children?fb_ref=Default&fb_source=message

An “alarming” number of pre-school children are being prescribed drugs to treat hyperactivity – contrary to medical guidelines that say they should not be used on children under six – because overstretched health workers go straight to medication rather than offering psychological interventions.
More than a fifth of educational psychologists say they know of preschool children who are being given medication such as Ritalin even though the National Institute for Health and Clinical Excellence (Nice) recommends psychological interventions should be tried first.
The survey, which aimed to investigate the medicalisation of childhood behaviour, also found there was an “intolerance of difference”, so children not conforming to the norm were increasingly being seen as having something wrong with them.
One educational psychologist who took part in the study, which was carried out by the University College London Institute of Education (IoE) and the British Psychological Society, wrote: “Our biggest difficulty is that children’s and adolescent mental health services and paediatric teams are so short-staffed they go straight to medication and completely ignore Nice guidance.”
Ritalin, which is the most commonly used trade name for methylphenidate, is a central nervous system stimulant used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD).
The Nice guidelines, which were amended in 2013, state: “Parent-training/ education programmes are the first-line treatment for parents or carers of pre-school children … Drug treatment is not recommended for pre-school children with ADHD.”
The findings are part of a survey of 136 educational psychologists from 70 local authorities across the UK, seeking their views on the assessment, diagnosis and treatment of ADHD.
The report found that medication was seen as the main solution in the treatment of ADHD. “Medication was felt to be the predominant form of treatment for ADHD despite Nice guidelines that psychological interventions should be implemented first,” the report said.
“Multiple systemic factors” were creating a “pressure for increasing rates of diagnosis and medication”.
The survey, which will be formally published next year, said there was an “urgent need to examine local policies regarding the effective prevention and intervention in cases of pre-school behavioural, emotional and social difficulties”.
Vivian Hill, director of professional educational psychology training at the IoE, who conducted the research with Horatio Turner of UCL, said: “It is very alarming to discover that terribly young children who often have not had access to alternative treatments are being put on medication.
“It is almost certainly to do with the fact that the whole of children’s mental health services is incredibly underfunded. It’s quick and easy – one off the waiting list, one intervention in place.
“To work with a child or a young person and their family over time is much more costly, but much safer and likely to have much better results. Medication has a short-term impact. It will not make the difference long-term.”
Educational psychologists who took part in the survey said “intolerance of difference” affected the way adults viewed children’s learning and behaviour. One wrote: “There is an increasingly prevalent view in society that people who do not fit a particular environment must have something wrong with them.”
The report said “within-child” factors were emphasised too often, rather than environmental factors, “due to families and schools wishing to abdicate responsibility for children’s behaviour and systemic failings in current diagnostic procedures”. One participant said: “It’s an easy explanation, which is convenient and comforting and absolves everyone of blame by locating the problem within the child.”
Educational psychologists said they were frustrated by factors that limited their ability to care effectively for children with ADHD. “Usually when [we] get involved the die is cast and is predominantly problem-focused, so much so that the only perceivable solution is medication,” one wrote.
The report concluded that educational psychologists should be involved in developing a broader understanding of contextual perspectives of ADHD among families and recommended establishing a multi-agency approach for its assessment and treatment.
One EP said: “My local authority has a behaviour pathway that includes ADHD.” Following its introduction one of the survey participants said that behavioural observation by an educational psychologist led to a significant fall in the diagnosis and medication of ADHD.
A Department of Health spokesman said: “Prescribing decisions are for doctors to make, but there are clear independent guidelines for the treatment of ADHD, which only recommend the use of drugs in severe cases and as part of a comprehensive treatment plan.
“Children’s mental health is a key priority, which is why we’ve formed a taskforce to look at how we can provide the best possible care and have invested £54m in improving access to psychological treatments.”

Friday, 29 January 2016

BRITISH MEDICAL JOURNAL - Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed. - Courtesy of BMJ Website



Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed.
Researchers said that children and adolescents have a doubled risk of aggression and suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression.
The authors recommended “minimal use of antidepressants in children, adolescents, and young adults” after releasing their findings. The researchers stressed that there is not enough patient data available from clinical trials to assess the true risk of all associated serious harms.
The study, published in the BMJ, examined clinical study reports of 70 trials with 18,526 patients. The researchers, from Denmark, found no significant link between antidepressants and suicide and aggression among adults, but in children and adolescents the risk doubled.
“We suggest minimal use of antidepressants in children, adolescents, and young adults as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant,” the authors wrote.
“Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered.”
The research led one expert to call for stricter prescribing rules. Shirley Reynolds, professor of evidence-based psychological therapies at the University of Reading, said that only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.
“But do the results mean that children and young people should never be prescribed antidepressant medication? No. There are alternative treatments and all young people should be offered an evidence-based psychological treatment immediately.
“However, antidepressants should be available when a young person does not respond to psychological treatment or does not want psychological treatment.
“Combining antidepressant treatment and psychological treatment is associated with improved outcomes and can lead to more a rapid reduction in symptoms.
“But only a specialist child and adolescent psychiatrist should prescribe antidepressant medication to children and young people and all children and young people who are prescribed antidepressants must be carefully and regularly monitored.”
However, Dr Mara Parellada, specialist in child and adolescent psychiatry at Complutense University of Madrid, said of the research: “The results from this study do not allow us to state that ‘antidepressants double the risk of aggression and suicide in children’.
“There was no single death by suicide in children and adolescents in the 70 trials reviewed for the article.”
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14

Monday, 11 January 2016

Psychiatric Medications Kill More Americans than Heroin Posted January 5, 2016 in Behavioral Health, Roundtable Discussion by Kenneth Anderson




Psychiatric Medications Kill More Americans than Heroin
Posted January 5, 2016 in Behavioral HealthRoundtable Discussion by Kenneth Anderson
In 2014, 10,574 people died of heroin overdose while 15,778 died from an overdose of psychiatric medications, nearly 50% more.
We often hear the shocking fact that deaths from heroin increased nearly 5 fold (374%) between 1999 and 2014, but rarely – if ever – do we hear that deaths from psychiatric drug overdoses have increased nearly 4 fold (278%) over the same time period. The data are summarized in Figure 1.
The biggest killers are sedatives (benzodiazepines such as Xanax and Z-drugs such as Ambien), antidepressants, psychostimulants (Ritalin, amphetamine, and methamphetamine), and antipsychotics, in that order, as shown in Figure 2.
What accounts for this high overdose death rate for users of psychiatric medications and for the steep climb in death rates over the past 15 years? A number of factors appear to contribute to this, including increased prescribing, increased polypharmacy (prescribing multiple drugs to the same person at once), increased off-label prescribing, and increased prescribing of psychiatric drugs by non specialists, including general practitioners, nurse practitioners, and others untrained in the field of psychiatry. We will proceed to look at each of these factors below.



According to data from the MEPS (Medical Expenditure Panel Survey) database, the number of prescriptions for psychiatric medications (i. e. sedatives, antidepressants, psychostimulants, and antipsychotics) increased 117% between 1999 and 2013, from 197,247,557 prescriptions in 1999 to 427,837,506 prescriptions in 2013. Meanwhile, death rates from psychiatric medication overdose climbed a whopping 240% over the same time period, from 1.31 deaths per 100,000 in 1999 to 4.46 deaths per 100,000 in 2013 (we are excluding the CDC death rate data from 2014 since the MEPS 2014 data has not yet been published).
Details of prescribing by drug class are given in Figure 3 and percentage of increase in prescribing is in Figure 4. Although the increase in number of prescriptions partially accounts for the increase in death rates, it is clear that it does not account for all of them, and that there must be other factors involved. Those primary factors are most likely polypharmacy, off-label prescribing, and non-specialist prescribing.

Polypharmacy
Although medical scholars use the word polypharmacy in several different ways, the simplest definition is “the prescription of two or more drugs at the same time.” In other words, drug mixing. In some cases, such as HIV treatment, polypharmacy is an evidence-based best practice. In other cases, such as psychiatric treatment, there is little research to back up most instances of polypharmacy; moreover, inappropriate polypharmacy can be harmful or even deadly.

Off-label and general practitioner prescribing of psychiatric medications: Off-label prescribing refers to prescribing a drug for a reason other than one which has been approved by the FDA. Although there are instances where off-label prescribing is based on sound published scientific evidence, this is not so in the vast majority of cases. Radley et al. (2006) found that only 4% of off-label psychiatric prescriptions had strong scientific support. Ali and Ajmal (2012)report that off-label prescribing carries clinical risks, such as adverse effects and unproven efficacy. Additionally, Mojtabai and Olfson (2011) report that 72.7% of antidepressant prescriptions in 2007 were written in the absence of any psychiatric diagnosis. Moreover, according to Mark et al. (2009) less than one fourth of prescriptions for psychiatric medications are written by psychiatrist, over three fourths are written by general practitioners, nurse practitioners, and others untrained in the field of psychiatry.
In my personal experience running an alcohol support group, I have had countless women tell me that, despite admitting they were drinking too much, their GPs still prescribed an SSRI antidepressant and, shortly after starting the antidepressant, their alcohol consumption went through the roof. This is not surprising, in light of the fact that research by Naranjo et al. (1995) showed that women treated with SSRIs drank significantly more than women given a placebo; a survey by Graham and Massak (2007) also found antidepressants were useless for reducing drinking in women. Unfortunately, doctors who have been encouraged to write off-label prescriptions frequently jump to the conclusion that women who drink too much must be depressed, so they wind up prescribing an antidepressant that actually makes them drink more. There is a great deal of potential harm which can result from off-label prescribing.




Alternatives to Drug Therapy
Wouldn’t it be great if there were some way we could permanently change the wiring of the brain to ameliorate or eliminate things like depression, anxiety, and schizophrenia without a lifetime reliance on potentially deadly drugs? Actually there is: it is called psychotherapy.
Everything you do which changes the way you think also changes your brain. Recent neuroimaging studies of people who have undergone Cognitive Behavioral Therapy (CBT) by Porto et al. and by Quide et al. show different patterns of brain function than those who have not had such therapy. There is another type of psychotherapy known as Dialectical Behavioral Therapy (DBT) which incorporates mindfulness and meditation practices into CBT. A large body of neuroimaging studies by Newberg demonstrate that mindfulness and meditation practices also permanently change the functioning of the brain.
But what about schizophrenia? Isn’t the only hope for schizophrenics to keep them doped up in a zombified stupor until the day they day? A recent New York Times article titled “New Approach Advised to Treat Schizophrenia” says no; the best treatment for schizophrenics is minimal use of antipsychotic drugs and lots of psychosocial therapy. The article then goes on to tell us that there is actually nothing “new” in this treatment approach, as it has been used in Scandinavia and Australia with great success for decades. It is only new to American psychiatrists who are too ignorant and arrogant to learn anything from the rest of the world and will only accept a study that has been carried out in America. But the reality is that it is not new – even in America. It is the model pioneered byLoren Mosher back in the 1970’s before Big Pharma got him fired from his post as chief of NIMH’s Center for the Study of Schizophrenia…because he was interfering with the profits from their latest huge money maker: antipsychotic drugs.
The reality is that drugging patients into a stupor with huge doses of antipsychotics prevents recovery from schizophrenia. This is why third world countries like India and Nigeria have much higher recovery rates for schizophrenia than the US; they cannot afford antipsychotic drugs which have good short term effects and very bad long term effects. Harding’s Vermont studyfound that half to two thirds of unmedicated schizophrenics recovered andHarrow found similar results. This is in stark contrast to medicated schizophrenics whose recovery rate is around 10 to 20%.


Conclusion
When prescribed appropriately, psychiatric medications are lifesaving, life changing wonder drugs. However, when over-prescribed or inappropriately prescribed they can lead to great harm and even death. What is needed is a major curtailment of polypharmacy, off-label prescribing, and non-specialist prescribing. The use of psychiatric drugs needs to be reduced to a mere fraction of current use rates and needs to be replaced or supplemented with appropriate psychosocial interventions which include not only therapy but such basics as housing, food security, and education. Money needs to be invested in social change rather than pill popping if we wish to create a healthy nation.
Would we say that just because insulin is good for diabetics that everyone should take it? No, that is nonsense because it would totally destroy a normal metabolism. Yet this is exactly the approach we are taking with psychiatric medications thanks to the misinformation that Big Pharma feeds to doctors and the general public in order to increase their sales and line their pockets. 
Definitions Used in this Article
Sedatives: MCD codes T42.3 Barbiturates, T42.4 Benzodiazepines, and T42.6 Other antiepileptic and sedative-hypnotic drugs (Z-drugs such as Ambien and Lunesta)
Antidepressants: MCD codes T43.0 Tricyclic and tetracyclic antidepressants, T43.1 Monoamine-oxidase-inhibitor antidepressants, and T43.2 Other and unspecified antidepressants (SSRIs/SNRIs)
Antipsychotics: MCD codes T43.3 Phenothiazine antipsychotics and neuroleptics, T43.4 Butyrophenone and thioxanthene neuroleptics, and T43.5 Other and unspecified antipsychotics and neuroleptics
Psychostimulants: MCD codes T43.6 Psychostimulants with abuse potential

These MCD codes were used with UCD codes X40-X44, X60-X64, X85, Y10-Y14 to extract data from 
CDC WONDER.


Being Bullied by Age Eight Linked to Depression in Adulthood In The News - MadinAmerica January 8, 2016


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Being Bullied by Age Eight Linked to Depression in Adulthood


There is a growing body of evidence suggesting that being exposed to bullying in childhood can contribute to mental health problems later in life. In a new study, published in JAMA Psychiatry, the researchers found that children who reported being bullied at age eight were significantly more likely to seek treatment for mental health problems by age twenty-nine.
“The findings of the study are important for mental health research, prevention, assessment, and intervention,” the researchers write. “Frequent exposure to bullying at 8 years of age was associated with later adult psychiatric disorders, even in the absence of childhood psychiatric symptoms.”
The study is the largest to date to look at childhood bullying in both boys and girls and includes the longest follow-up period for tracking the participants mental health. It is part of the multicenter Finnish Nationwide Birth Cohort Study which began with a nationwide sample of eight-year-old children in 1981. The connection between bullying and adult mental health problems, while previously examined, is strengthened considerably by this study's size, design, and ability to control for health and demographic factors.
“To our knowledge, the present study provides the strongest evidence todate that frequent exposure to bullying in early childhood increases the risk fordepressive disorder later in life,” they write.
The researchers point out that these findings strengthen psychological explanations of depression. Specifically, the interpersonal theory of depression suggests that our close relationships act as a buffer against depression and that negative relationships in early childhood, through bullying or other types of trauma and humiliation, can disrupt the ability to build and maintain quality relationships.
In their conclusion, the study authors urge parents, teachers, and doctors to take preventative measures to prevent bullying.

*
Sourander, A., Gyllenberg, D., Klomek, A. B., Sillanmäki, L., Ilola, A. M., & Kumpulainen, K. (2015). Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age.JAMA psychiatry, 1-7. (Abstract)

Sunday, 3 January 2016

Children Still in a Crib, Yet Being Given Antipsychotics by the Thousand - Coutesy of The New York Times - Dec 15th 2015









Andrew Rios’s seizures began when he was 5 months old and only got worse. At 18 months, when an epilepsy medication resulted in violent behavior, he was prescribed the antipsychotic Risperdal, a drug typically used to treat schizophrenia and bipolar disorder in adults, and rarely used for children as young as 5 years.

When Andrew screamed in his sleep and seemed to
interact with people and objects that were not there, his frightened mother researched Risperdal and discovered that the drug was not approved, and had never even been studied, in children anywhere near as young as Andrew.
“It was just ‘Take this, no big deal,’ like they were Tic Tacs,” said Genesis Rios, a mother of five in Rancho Dominguez, Calif. “He was just a baby.”
Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.



Photo

Angela Davis, a speech-language pathologist, working with Andrew at home in Rancho Dominguez, Calif. CreditJenna Schoenefeld for The New York Times

Almost 20,000 prescriptions for risperidone (commonly known as Risperdal), quetiapine (Seroquel) and other antipsychotic medications were written in 2014 for children 2 and younger, a 50 percent jump from 13,000 just one year before, according to the prescription data companyIMS Health. Prescriptions for the antidepressant fluoxetine (Prozac) rose 23 percent in one year for that age group, to about 83,000.
The company’s data does not indicate how many children received these prescriptions (many children receive several prescriptions a year), but previous studies suggest that the number is at least 10,000. IMS Health researched the data at the request of The New York Times.
The data did not indicate the condition for which these prescriptions were written. Doctors are generally free to prescribe any medication for any purpose they see fit, so some drugs can occasionally be used in unproven and debatable ways. But the volume and rapid rise in psychotropics such as antipsychotics and antidepressants in children 2 and younger suggest a trend.
In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it. They presumed that parents and doctors, probably desperate and well meaning, were trying to alleviate thrashingtemper tantrums — the kind that get children kicked out of day care — or an overly depressed disposition, like being strikingly inhibited, nonverbal or lethargic.
“People are doing their very best with the tools available to them,” said Dr. Mary Margaret Gleason, a pediatrician and child psychiatrist at Tulane University School of Medicine. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.”
But Dr. Gleason said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers.
“There are not studies,” Dr. Gleason said, “and I’m not pushing for them.”
Dr. Martin Drell, former president of the American Academy of Child and Adolescent Psychiatry, said he was “hard-pressed to figure out what the rationale would be” for the prescriptions. Similarly taken aback, some experts wondered if the medicine was never actually consumed by the child, or if it was issued in the name of a child covered by Medicaid but in fact taken by an ill parent who was uninsured.
“But where there’s smoke, there’s fire,” Dr. Drell said. “For the protection of kids, we should evaluate this. We should identify who these cases are. Maybe it’s not 10,000, but I’ll be unhappy if it’s even in the hundreds.”
Most experts suspected that the trend of medicating younger and younger children for suspected psychiatric disorders was trickling down to very young children. Last year, a report from the Centers for Disease Control and Prevention found that health care providers had given a diagnosis ofattention deficit hyperactivity disorder to at least 10,000 children age 2 or 3 and then prescribed medications such as Adderall outside American Academy of Pediatrics guidelines.
“I think you simply cannot make anything close to a diagnosis of these types of disorders in children of that age,” said Dr. Ed Tronick, a professor of developmental and brain sciences at the University of Massachusetts Boston. “There’s this very narrow range of what people think the prototype child should look like. Deviations from that lead them to seek out interventions like these. I think it’s just nuts.”
Prozac is approved by the Food and Drug Administration for depression in children 8 and older and for obsessive compulsive disorder in those age 7 and older. Most antipsychotics, which treat schizophrenia and bipolar disorder, are indicated only for children 10 and older. Risperdal is approved for children as young as 5, but only for irritability associated withautism.
Some other psychiatric medications, such as the antianxiety drugs Valium or Klonopin, are widely accepted to control intractable seizures in the very young. Although their effects on the young brain remain unknown, stopping a child’s seizure warrants their occasional one-time use, said Dr. Amy R. Brooks-Kayal, the head of pediatric neurology at Children’s Hospital Colorado and president of the American Epilepsy Society.




Antidepressants and antipsychotic medications, however, have no established use in young people beyond tempering chronically disruptive behavior, experts maintained, suggesting that the drugs were probably used for that purpose.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Neurology have no guidelines or position statements regarding use of antidepressants and antipsychotics in children younger than 3.
Finding specific examples of such children taking the drugs can be difficult, because of family privacy concerns or because the practice remains controversial. IMS Health records but does not release the names of prescribing physicians.
Mrs. Rios said that after Andrew began taking the epilepsy medication felbamate, he became strikingly erratic and aggressive: He pushed his siblings down and destroyed toys. She said that Andrew’s neurologist, at Children’s Hospital of Orange County, Dr. Lily Tran, then prescribed Risperdal, medication that can temper severe mood swings in older children.
Andrew took the medication for four months before his mother decided it was causing harmful side effects — behavior he had never shown before — and took him off it. “Everything became worse,” Mrs. Rios said.
Dr. Tran declined an interview request.
The use of Risperdal for children has been hotly debated among child psychiatrists, with some experts — many financially backed by the pharmaceutical industry — citing positive effects among suffering young people, and others criticizing their use as shortsighted responses to complex problems.
“There are behavioral ways of working with the problems rather than medication,” said Dr. Tronick, who runs a program that teaches health care providers to assist families with troubled children. “What is generating such fear and anger and withdrawal in the child? What is frustrating or causing stress in the parent? These are the things that have to be explored. But that takes time and money.”
Many experts say that the rise in the use of all psychotropics in children of all ages derives from the scarcity of child psychiatrists — only 8,350practice in the United States, many of them with long waiting lists and higher cost than a family’s established pediatrician. Those pediatricians receive little training in child psychiatry but are then asked to practice it.




Saturday, 2 January 2016

Psycho- Stimulant Drugs Linked to a Doubling of Psychotic Symptoms in Children - Courtesy of the MadinAmerica website December 2015


ADHD Drugs Linked to Psychotic Symptoms in Children


Stimulant medications like Ritalin and Adderall, often prescribed to treat children diagnosed with ADHD, are known to cause hallucinations and psychotic symptoms. Until recently these adverse effects were considered to be rare. A new study to be published in the January issue of Pediatrics challenges this belief, however, and finds that many more children may be experiencing psychotic symptoms as a result of these drugs than previously acknowledged.
stimulantIn a study of 141 children of parents who had previously been diagnosed with a mental “disorder,” the researchers found that a shocking 62.5% of youth on stimulants had psychotic symptoms compared to only 27.4% of those who had never taken stimulants.
ADHD has become one of the most commonly diagnosed childhood psychiatric “disorders,” and the prescription of stimulant drugs, such as such as Ritalin (methylphenidate), Vyvanse (lisdexamfetamine), or Dexedrine (dextroamphetamine), among others, has become increasingly common. Earlier this month new reports made headlines citing a43% increase in school-aged children in the US diagnosed with ADHD. It is now estimated that 5.8 million youths in the US have such a diagnosis.
Several adverse effects are associated with the use of stimulants, including loss of appetite, sleep problems, growth suppression. A recent high quality systematic Cochrane review of the drug Ritalin found that the side-effects of the drug may outweigh the evidence of its effectiveness. Stimulants, which act on the dopamine systems in the brain, are also known to increase the risk for psychotic symptoms like hallucinations, delusions, and disorganized behavior.
The randomized control trials used to test the safety and efficacy of these drugs have estimated that only around 1-2% of children on stimulants have such a reaction. The researchers suggest that these are likely underestimates, however, as these trials tend to enroll participants that are healthier than the general patient population and psychotic symptoms are not usually assessed thoroughly. Researchers often rely on participants to spontaneously report these symptoms, leading to rampant underreporting.
To investigate the association between stimulant medication and psychotic symptoms in children and adolescents, the researchers, led by Dr. Rudolf Uher from Dalhousie University in Halifax, Nova Scotia, studied 141 children and adolescents enrolled in the Families Overcoming Risks and Building Opportunities for Wellbeing program. The program is designed to study the offspring of parents who have been diagnosed with severe mental “disorders.”
Of the 141 children enrolled, they found that 24 (17%) had taken stimulant medication and that 33 (23.4%) had been diagnosed with ADHD. Fifteen of the 24 participants who had taken stimulants related the experience of psychotic symptoms, while only 32 ( 27.4%) of the 117 participants who had not taken stimulants reported these experiences.
The presence of psychotic symptoms did not appear to be related to the diagnosis of the parent or the family history of psychotic symptoms, according to the researchers. Also, the association between stimulants and psychotic symptoms remained consistent after the researchers controlled for other risk factors, age, gender, and parent diagnosis.
Among the children who had been diagnosed with ADHD, they found that 11 (65%) of the 17 treated with stimulants had experienced psychotic symptoms while only 4 (25%) of the 16 who were not treated had such symptoms. This analysis served to expel the possibility that the symptoms were arising from ADHD rather than the prescription drugs.
The researchers were also able to verify that the time the symptoms arose commonly coincided with the periods when the children were actively taking stimulant medications.
They conclude:
“We report an association between the use of stimulant medication and psychotic symptoms in children and adolescents at familial risk of mental illness. The association of current use of stimulants with current psychotic symptoms and the close temporal relationship between stimulant use and psychotic symptoms in youth who started and stopped stimulants indicated a potential causal relationship. The findings suggest that psychotic symptoms may be relatively common adverse effects of stimulants in youths with a family history of major psychiatric disorders.”

*
MacKenzie, L., Abidi, S., Fisher, H., Propper, L., Bagnell, A., & Morash-Conway, J. et al. (2016). Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness. Pediatrics, peds.2015-2486. doi:10.1542/peds.2015-2486 (Abstract)