Breaking the stigma: ADHD can make rejection feel even worse

Joshua Claytor lives with ADHD. (Photo via Kentucky Lantern)

By Sarah Ladd
Kentucky Lantern

Sitting in high school classes was “always a struggle” for a young Joshua Claytor. He filled his papers with “doodles.” Certain math concepts eluded his understanding.

Despite these early signs, it took the Vine Grove man decades to learn he had attention deficit hyperactivity disorder, or ADHD.

When he was diagnosed last year at the age of 42, some things about his life started to make sense.

He realized that “quirky” things about his character were actually part of his ADHD: Fixating on a hobby for a few months, then never touching it again. Taking rejections hyper-personally. Getting ready for work one moment, and realizing the next that too much time had passed and he was already late.

All these symptoms, from time blindness to rejection sensitive dysphoria (RSD) are common but often-ignored parts of ADHD, therapists who treat it said.

 
What is ADHD? Where does it come from?

The Centers for Disease Control and Prevention says ADHD is among the most common neurodevelopmental disorders, and almost always appears by the age of 7, with elementary school helping to reveal inattentiveness, according to Johns Hopkins University.

Often characterized by forgetfulness, daydreaming and carelessness, among other symptoms, the disorder affects millions around the country. Time blindness, too, is common in the ADHD brain, experts said, often making people who have it late to events.

“It’s really hard to manage time, to have an accurate sense of time, to have a good kind of internal guess of how long something is going to take or how long it’s been that you’ve been working at something,” Brenda Arellano, who specializes in treating ADHD, said. “That’s a really difficult thing for a person with ADHD to keep track of.”

Therapy can help people with ADHD become more aware of time and resolve other symptoms of the disorder. But ADHD’s causes are unknown, and the CDC says scientists want to find out if things like brain injury, low birthweight and exposure to alcohol or tobacco in utero can lead to it.

Like many other mental health conditions, people often misunderstand and stigmatize ADHD. For example, there’s this idea that ADHD is “caused by bad parenting,” said Arellano, who works at Well Kentucky.

But it’s just not that simple.

“Certainly, environment plays a factor,” Arellano said. “But it’s not something that’s going to be caused by bad parenting or eating too much sugar or watching too much TV or anything like that. Certainly those things might not help with your ADHD, but it’s not like that’s the reason why you have it.”

 
Different types of ADHD

A person with ADHD may be predominantly inattentive, predominantly hyperactive/impulsive – or have both presentations, Arellano said.

ADHD on television usually looks hyperactive or impulsive, Arellano said. “We often see it as … a little boy that’s just bouncing off the walls. Super, super energetic. Can’t sit still for a second. … And it certainly can be that way, but it also can be much more than that.”

People with hyperactive ADHD can struggle with impulse control, regulating frustration and balancing long and short-term goals, Arellano said. They may end up with more broken bones and traffic tickets than other people, or appear to talk more than average.

Inattentive folks may get distracted easily and struggle with time management. These challenges have “big impacts” on school and meeting deadlines at work.

Males are more likely to be hyperactive/impulsive or both, while females are more likely to be inattentive, Arellano said, though anyone can have any sort of presentation.

Males also are more likely to get diagnosed, she said. That may be because it’s easier for teachers and parents to spot disruption than daydreaming as an issue.

But there is a misconception that people with ADHD lack the ability to pay attention. That’s just not true, according to licensed clinical social worker Sarita E. Trawick.

“The people that have ADHD often can actually hyper-focus on something that they’re interested in,” said Trawick, who sees clients in Kentucky and Oregon.

Pairing an activity or area of interest with the boring or difficult task can help, she said.

Calling ADHD “dopamine deficit” may be more accurate, she said. That’s because “Boredom is like death to someone who has ADHD.”

Dopamine serves as a “reward center,” according to the Cleveland Clinic, and is also called the “feel-good hormone.” People with ADHD may not have enough dopamine — or too much.

 
Is ADHD ‘curable’?

Talk therapy and medications like Adderall can help manage ADHD symptoms.

And while it’s not clear if it’s curable, people can learn to manage symptoms with these treatments.

Some people do appear to “grow out” of ADHD as they get older, according to Arellano, who primarily works with youth.

But the “jury’s out” still on why that happens — and it’s not true for everyone. ADHD may also appear to fade with age for those who look for careers that play to their strengths and not their weaknesses.

“If you’re somebody who has a really hard time staying in their seat, it doesn’t make sense that you’re going to grow up and get an office job where you have to sit in a chair still for eight hours,” Arellano said. “You might do something that has a little bit more interaction or where you can move.”

In that case, she explained, it’s not that ADHD went away. The person is simply playing to their strengths.

The condition “is manageable,” Arellano said. “We can learn to work with the way that a person’s brain is wired and we can seek out situations and environments and supports that … (don’t) hold the person back from showing their intelligence and their other talents.”

 
Stigma of seeing yourself as flawed

ADHD, to Claytor, often felt like a “punchline,” a “joke,” especially in high school.

“We didn’t really talk about ADHD being a real mental illness,” he said. That made it difficult to recognize and address symptoms.

Even now, he struggles when he reflects on past events and realizes how much his ADHD-related rejection sensitivity disorder (RSD) has affected his life. It even forced him to give up dating, he said.

For years he took rejection as a personal attack on his value, making him lash out at perceived attackers.

“To look and see that you didn’t have to defend yourself, that you overreacted, that you hurt people that you cared about. It’s hard to confront,” Claytor said. “It’s hard to face … because it’s embarrassing.”

You must “relive that hurt and having to learn to not only hope for forgiveness from the person that you’ve hurt, but also to forgive yourself,” he said.

RSD can happen to people with ADHD because, Arellano said, the brain may hyper-focus on one thing — something a person said or did — and may overanalyze it. The person with ADHD may even blame themselves for the real or perceived rejection.

“It can be really hard to move on from that,” she explained. “Folks with ADHD have a hard time with regulating emotions, so their feelings can be more intense and it can be hard to work through and cope with those feelings.”

Because ADHD can hinder a person’s ability to focus or cause them to hyper-focus, it can be difficult to separate symptoms from the individual who has them — both for that person and those around them, Arellano explained.

“You’re seeing yourself as, like, ‘I’m stupid’ or ‘I’m a bad student’ or ‘I don’t like school’ or ‘I’m a bad friend,’” she said. “All of those thoughts that really have more to do with your ADHD than with you are going to make it really difficult for you to show up as your full, true, authentic self.”

That negative messaging and feedback can start at a young age, Trawick said.

“Think about how, on a daily basis even, hour to hour, how much feedback you might get about yourself not being like everyone else,” she said. “If you carry that over time, you’re constantly waiting for you to get in trouble or waiting for you to do the wrong thing and then be rejected.”

Think of the child who’s kicked out of class, out of school. Who’s told they can’t come over to a friend’s house anymore because they’re too hyper.

That’s a “lot of rejection” for kids with ADHD to endure, Trawick said.

It impacts how they interact with the world.

“How do you … demonstrate that you’re a good friend if you forget appointments … you forget things, you forget to show up. You can’t pay attention. You forget what they told you because memory is an issue,” Trawick explained. But: “what, often, people forget is that: That’s the friend that if you call them, they’ll be right over. They’ll drop everything to do something for you.”

 
Changing the narrative

Arellano teaches her clients to change how they speak about their ADHD and separate it from their sense of self, which she said is a key part of therapy.

For example, her clients learn to say: “I’m a smart kid. I know what I’m doing. I’m very knowledgeable. I’m actually a pretty good student. And I have ADHD and I procrastinate sometimes and that really bites me in the butt.”

Or: “I’m a very considerate person, and my ADHD sometimes wants me to interrupt people, and that’s something I’m working on.”

The way movies and television sometime depict the disorder makes it easy to generalize and stigmatize the disorder too. There is this image, Arellano said, that people with ADHD are “dumb” or “airheaded.”

In fact, “The research that’s out there that looks at folks with ADHD and their intelligence shows that they’re either average or even above average intelligence,” she said. “So this potential idea that might be floating out there that folks with ADHD are dumb or lazy or unmotivated is just simply not true and not supported by the research.”

‘There’s definitely hope’

Claytor uses a technique called “body doubling” to help cope with his ADHD symptoms. He has an “ADHD buddy” who stays on the phone with him so they can complete things together like cleaning or dishes.

Sometimes just having someone around, even virtually, helps him focus. He knows he can’t go back in time to high school and get a do-over knowing that he has ADHD. He’s in therapy and strives to make his life better now and in the future.

He wishes he could tell his younger self: “Hey, it’s going to get better and there are tools that you can use” to make sure of it.

That, and: “There’s definitely hope.”

 
Could I have ADHD? Signs to look for:

Experts say people with ADHD may have trouble focusing on just one thing and may take rejection hyper personally, among other symptoms.

Other symptoms of ADHD include: 

• Distractedness
• Forgetfulness
• Excessive talking
• Deep connection with music
• Entrepreneurial leanings
• Storytelling skills

You can find Kentucky therapists who specialize in ADHD here.

Nurse practitioners want to change law that requires them to make deals with physicians to prescribe strong painkillers

Nurse practitioners Julie Gaskins, left, and Beth Partin own
Family First Health in Columbia. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

Since 2006 Kentucky's nurse practitioners have been able to prescribe Schedule 2 drugs, the highest level of legal painkillers, under the supervision of a physician. Now their lobbying group says it's time to let them work without that restriction because it creates a barrier to care that is badly needed.

Nurse practitioners are advanced practice registered nurses with up to seven years of education, including post-graduate training. They may prescribe medications, diagnose conditions, order and interpret tests, and deliver general care.

Once a Kentucky nurse practitioner works under the supervision of a physician of the same specialty for four years, he or she may prescribe drugs on their own for medical conditions such as high blood pressure or diabetes. But to prescribe Schedule 2 drugs such as opioids, they must have an ongoing “collaborative agreement” with a physician to do so, regardless of their experience.

“A collaborative agreement is for prescribing only; there is no oversight written into the contract,” said Jessica Estes, a psychiatric mental health nurse practitioner in Lewisport. “The physician doesn't have to review any of my charts. I don't have to call the physician every time I write one. I only have to have that collaborative in the event I needed to have a conversation with him,” adding that in her 14 years of practice she has only consulted with her collaborator two or three times.

Estes said nurse practitioners are trained to work independently without any supervision over their prescribing. "In fact, I do tele-psychiatry in Minnesota, where I'm completely independent" under that state's law, she said. "Our scope of practice is actually limited by having to have that collaborator in Kentucky to be able to write those prescriptions."

The American Association of Nurse Practitioners says 22 states and the District of Columbia allow nurse practitioners to practice with no restrictions on prescribing; 16, including Kentucky, have reduced prescriptive authority; and 12 are considered restrictive. Kentucky has more than 5,400 nurse practitioners.

Being able to prescribe Schedule 2 drugs is not just about being able to prescribe pain pills, said Elizabeth "Beth" Partin, a 25-year family nurse practitioner.

“It's not always about pain,” Partin said, adding that the lack of a collaborating doctor leaves a nurse practitioner unable to prescribe medications for anxiety, insomnia, shingles, nerve pain, certain cough medicines or attention-deficit hyperactivity disorder – conditions that are often seen in a primary-care office.

Nurse practitioners often struggle to find a physician willing to sign an agreement for non-scheduled drugs, but it's even harder to find one that will sign an agreement for controlled substances, especially since some insurance companies are refusing to pay for a nurse practitioner's services unless their collaborating physician is also a provider for them.

Jessica Estes, psychiatric nurse practitioner in Hancock County,
testified at a 2014 Senate Licensing & Occupations Committee
meeting about a law that allows prescriptive authority for non-
scheduled drugs after four years of supervision.  (photo provided)

Estes said the psychiatric nurse practitioners in her group experienced this with WellCare, a managed-care organization for Medicare and Medicaid plans. She said because her collaborating psychiatrist was a private physician who accepted no insurance, the group had to change collaborators and ended up signing with a family practice physician who sees enough psychiatric patients to meet the requirements -- and was willing to accept WellCare.

“Last year between the four nurse practitioners, we saw about 2,000 visits that were WellCare clients,” Estes said. “If I had not been able to secure that collaborator that also took WellCare, that's 2,000 patient visits that we would not be able to see in 2017. They would have had to find a new provider.”

She owns Estes Behavioral Health, LLC, which serves more than 6,000 patients, an equal mix of adults and children, from 11 counties. She said about 40 percent of their patients are on Medicaid.

In “most of the counties that we serve, there really aren’t any other providers,” Estes said. “We've not run a single ad in the five years we've been open; it's all word of mouth.”

Partin and her daughter, Julie Gaskins, also a nurse practitioner, are co-owners of Family First Healthcare, a rural health clinic in Columbia. Their practice has over 6,000 patient visits a year, with 72 percent of their patients on Medicare or Medicaid.

Traveling from Partin's clinic in Columbia to Estes' behavioral-
health clinic in Lewisport takes a while. (Google map adapted)

Partin said it takes about three to four months for new patients to get an appointment in Estes' practice, about 124 miles from her clinic. Adair and Hancock counties are in two of the 87 Health Provider Shortage Areas in the state.

Psychiatric collaborative agreements are also hard to secure because Kentucky has such a shortage of mental health providers. The Association of American Medical Colleges reports that Kentucky has 362 active psychiatrists, or 1 for every 12,192 Kentuckians, and almost 40 percent of them are 60 or older. Estes said the state has fewer than 150 psychiatric APRNs.

“I just had a conversation this week with one of my former nurse-practitioner students who would like to do some private practice on her own, and she's called seven psychiatrists and they've all turned her down, because they are either employees of large organizations or they want an amount of money that she couldn't afford to pay,” Estes said.

While some collaborating physicians don't charge anything, most charge between $500 and $5,000 a month, or take a percentage of the nurse practitioner's annual earnings, Estes and Partin said.

Estes said psychiatric nurse practitioners in Kentucky who can't find a collaborator either end up working for a large medical group or hospital, or work in tele-psychiatry in states that don't require such an agreement.

Lobbying and legislating

Legislation to remove the collaborator requirement for prescribing Schedule 2 drugs was introduced during the 2017 legislative session as Senate Bill 158, but did not make it out of committee. The Kentucky Coalition of Nurse Practitioners & Nurse Midwives is in the “early stages” of the legislative process for the 2018 session, said Partin, who has held a leadership role in all nurse-practitioner legislation in Kentucky since 1992.

Her adversaries are the Kentucky Academy of Family Physicians and the Kentucky Medical Association, which have said they do not support any change to the law, contending that it would add to the prescription-drug abuse that continues to plague the state.

KAFP President William C. Thornbury said in a statement,”Family physicians believe SB 158 conflicts with our governor's policy to combat opioid abuse.” The KMA said, “With the ongoing issue of prescription drug abuse and the discussions around the country about the issue, we would oppose any changes to the current law.”

Senate President Robert Stivers, R-Manchester, who voted against the 2006 bill that expanded nurse practitioner's Schedule 2 prescription authority, told members of the Senate Judiciary Committee in March that he would be looking into why “half” of the pain pills written in his hometown of 20,000 were written by nurse practitioners -- a town that has 12 pharmacies and around 150 opioids prescribed per person each year.

Nurse practitioners disputed the alleged connection between the prescribing authority of nurse practitioners and the over-prescribing of opioids, citing data from the Kentucky All Schedule Prescription Electronic Reporting system.

“The problem in Kentucky existed prior to our ability to write those controlled substances,” Estes said. “The KASPER data very clearly shows that we are not the providers that are writing the majority of those prescriptions.”

Heather Shlosser, director of the psychiatric-mental health nurse practitioner program at Frontier Nursing University in Hyden, said efforts to decrease the number of opioid prescriptions will depend on making sure providers are trained to prescribe them based on evidence-based guidelines -- and changing the culture of patients so that they understand that a pill is not always the answer, rather than simply limiting the disciplines that can prescribe them.

“Restricting practice is not helping to expand access and it's not helping to educate the NP any further than where you stop them with the restriction,” she said. “All the literature tells us that the outcomes are the same whether the care is provided by the physician or a nurse practitioner.”

Tammy Adamson, a patient of Partin's: "I've never had an experience here as to

where they didn't give me the time that I needed, and explained things to me."

(Photo by Melissa Patrick)

Gaskins said nurse practitioners are trained to take a holistic approach to care that focuses on education and prevention along with the use of appropriate medications.

Kentucky law only allows psychiatric nurse practitioners to write 30-day prescriptions for ADHD medications with no refills, and primary-care nurse practitioners are limited to a 72-hour prescription.

“That's a huge problem, especially in Kentucky,” said Shlosser, who is also a mental health nurse practitioner in New Hampshire. “Kentucky has the highest rate of children being diagnosed with ADHD, according to the Centers for Disease Control [and Prevention].”

The CDC reports that 19 percent of Kentucky children aged 4 to 17 have ever been diagnosed with ADHD, compared to 11 percent of children nationwide.

Shlosser added that likely means “a huge number of children” in Kentucky need care for ADHD, but don't have access to it or have to wait months or drive great distances to get care.

“That is not helping the 10-year-old kid that is struggling,” she said. “We are as providers constantly telling patients, 'Get treatment, get help, you need to get it together,' but where are they supposed to go if there are no providers?”

This article was produced as part of the Health Care Workforce Media Fellowship of the Center for Health, Media & Policy, New York, N.Y. The fellowship is supported by a grant from the Johnson & Johnson Foundation. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Ky. tops nation in share of kids ever diagnosed with Attention Deficit Hyperactivity Disorder; here are facts and fiction about it

While almost one in five of Kentucky's children have been diagnosed with attention deficit hyperactivity disorder, myths and misinformation about the condition are common.

Percent of Youth Aged 4-17 Ever Diagnosed with ADHD
National Survey of Children's Health

ADHD is a common condition. The latest data from the U.S. Centers for Disease Control and Prevention show that 19 percent of Kentucky's children have ever been diagnosed with it, the highest rate in the nation. The national average is 11 percent. The data also show that 14.8 percent of Kentucky's children are currently diagnosed with ADHD, compared to 8.8 percent nationally.

ADHD is a behavioral condition characterized by difficulty focusing, acting without thinking, and hyperactivity.

In a news release, Dr. Joshua Cabrera, clinical psychiatrist and assistant professor at Texas A&M College of Medicine, distinguishes between what is fact and what is fiction when it comes to ADHD.

Fiction: Just because a child is hyper they have ADHD: Cabrera points out that children are "inherently energetic" and if this is the only symptom, then it would be difficult for a professional to diagnose the child with ADHD. He adds that the main symptoms of ADHD are inattention, hyperactivity and impulsivity and says that "Diagnosis (would) require observations of numerous symptoms in multiple settings and evidence of significant impairment.”

Fact: ADHD diagnosis is on the rise: A recent study showed that ADHD diagnosis has gone up 43 percent from 2003 to 2011. Cabrera said that the study did not determine the reasons for this increase, but noted his concerns that it could be because of over-diagnosis, which he says could overlook possible stressors the child is dealing with like anxiety, home conflicts and learning disorders.

Fiction: People with ADHD are only affected in the classroom: Cabrera says that while children with this condition are at a higher risk for reduced school performance, their inattentiveness, hyperactivity and impulsivity also affect their social relationships, increase their chances for developing a conduct disorder and increase their chances for substance use and incarceration later on.

Fiction: ADHD is caused by bad parenting: The general consensus is that ADHD is likely the result of both genetic and environmental factors, says Cabrera.

Fiction: Children on ADHD can seem “drugged": “The common way that the term ‘drugged’ is used suggests lethargy and loss of capacity,” Cabrera says. “Stimulants, the most commonly prescribed medication, typically do not have this effect.” According to the CDC, between 70 to 80 percent of children with ADHD have fewer symptoms when they take prescribed stimulants.

Fact: ADHD can be treated: Cabrera says this depends on the individual. “Many people with easier to treat ADHD can successfully manage their symptoms,” he said. “Unfortunately, many others will struggle with ADHD in all aspects of their life despite the best possible treatment.”

Study finds ADHD meds may help decrease risky behavior, but says more research is needed; ADHD is most common in Ky.

Researchers have found that medications for attention-deficit/hyperactivity disorder, which is more common in Kentucky than any other state, may offer some additional long-term benefits by discouraging children from risky behaviors.

"Treatment with ADHD medication made children less likely to suffer consequences of risky behaviors such as sexually transmitted diseases, substance abuse during their teen years and injuries," says a Princeton University news release abotu a study in South Carolina.

"ADHD is such a major issue, but no one seemed to be able to give a very definite answer to the long-term effect of the medication," researcher Anna Chorniy said in the release. "For our sample population, we were able to see everyone who had an ADHD diagnosis and track their health over time to identify any potential benefits of the medication or the lack of thereof."

The study looked at Medicaid claims for nearly 150,000 children diagnosed with ADHD in South Carolina between 2003 and 2013.

Percent of Youth Aged 4-17 with ADHD by State:
National Survey of Children's Health

The latest data from the U.S. Centers for Disease Control and Prevention show Kentucky leads the nation in the percentage of children ages 4-17 with ADHD at 15 percent; the national percentage is 11 percent. Almost 70 percent of children who are diagnosed with ADHD are treated with medications.

ADHD is a behavioral condition characterized by difficulty focusing, acting without thinking, and hyperactivity. Children with ADHD are known to be at higher risk for risky behaviors such as dangerous driving, drug use and risky sexual behavior.

The study, published in the journal Labour Economics, compared ADHD-medicated children to those who were diagnosed with ADHD, but not on medication. Those who took medication were 3.6 percent less likely to contract a sexually transmitted disease, 7.3 percent less likely to have a substance-abuse disorder and 2.3 percent less likely to be injured.

"In absolute numbers, in a sample of about 14,000 teens diagnosed with ADHD, it translates into 512 fewer teens contracting an STD and 998 fewer having a substance abuse disorder," teh release says. "There also would be 6,122 fewer yearly injury cases for children and teens under 19 years old."

Although research supports the use of drugs for treating core symptoms of ADHD, the release points to the need for more research on the long-term effects of ADHD medications, which thus far has produced mixed findings. It notes that a 2014 study found "such treatment is associated with a decrease in academic performance, a deterioration in relationship with parents and an increased likelihood of depression" while another shows "some reduction in hospital visits and police interactions."

Study shows students, especially those with ADHD, have improved academic performance after they exercise

Children do better in school when they aren't forced to sit still all day, especially those with attention deficit hyperactivity disorder, Gretchen Reynolds reports in The New York Times.

Recent research, published last year in The Journal of Pediatrics, suggests that even small amounts of exercise enable children to improve their focus and academic performance.

The study looked at 40 boys and girls, age 8 to 10, half of whom had ADHD. Researchers gave the students a baseline academic test and also one that tested their attention. They then gave the same tests two more times, first after they had sat and read quietly for 20 minutes and the other after they had walked briskly or jogged 20 minutes on treadmills. Brain activity was recorded as they repeated the original tests.

Little difference was found in any of the students after quietly reading, but "they all showed marked improvements in their math and reading comprehension scores after the exercise," Reynolds writes. Students with ADHD showed significant increases on their scores and had brain-wave readings that showed them better able to regulate their behavior, which helped them pay attention.

"The results should make administrators question the wisdom of cutting P.E. classes," Reynolds writes.

This information is a valuable tool for educators, especially in Kentucky, which leads the nation with 19 percent of children ages 4 to 17, compared to 11 percent nationally, who have ever been diagnosed with ADHD, according to the federal Centers for Disease Control and Prevention. The level of exercise needed to show academic and attentional improvement involves activities that can be done in the classroom throughout the day, like marching or hopping in place.

Pediatric therapist says ADHD rising because kids don't move their bodies enough; says they need to play outside

The percentage of children diagnosed with attention-deficit and hyperactivity disorder, or ADHD, is on the rise. While many reasons are mentioned, one that is not heard often is the length of time children are forced to sit while they are in school, writes Angela Hanscom, a pediatric occupational therapist, in the TimberNook blog, which was picked up by Valerie Strauss of the Washington Post.

Kentucky leads the nation in the percentage of children with a current diagnosis of ADHD, at 14.8 percent, a jump from 10.2 percent diagnosed in 2007, according to the U.S. Centers for Disease Control and Prevention. An even higher 19 percent of Kentucky children ages 4-17, compared to 11 percent nationally, have ever been diagnosed with ADHD at some point. (CDC map)

Reasons given for this rise in diagnosis include changes in "diagnostic criteria, medication treatment and more awareness of the condition," Strauss writes. Over-diagnosis, genetic predisposition and "financial incentives" that can go along with an ADHD diagnosis are other possible reasons for this increase in diagnosis, reports Laura Ungar of The Courier-Journal.

Hanscom says the amount of time children are forced to sit while they are in school is also a contributing factor. She reflects in her article about a recent phone call from a parent of a 6-year-old whose self-esteem is being crushed because he is told every day at school that his behavior isn't good enough simply because he can's sit for long periods of time. She also writes about a local elementary teacher who told her that "at least eight of her 22 students have trouble paying attention on a good day."

The problem, Hanscom writes, is that "Children are constantly in an upright position these days" and are not moving their bodies enough.

Hanscom writes about her recent observations of a fifth-grade classroom where she found fidgeting, kids tilting chairs, kids rocking their bodies back and forth and one child hitting a water bottle against her head in a rhythmic pattern. She writes, "This was not a special-needs classroom, but a typical classroom at a popular, art-integrated charter school."

She noted that some of this behavior could have been because it was the end of the day, but she also did testing on the students' core strength and balance in several of the classrooms and found it to be poor, with "only one" out of 12 of the students having normal strength and balance when compared to children from the early 1980s.

Hanscom says children have underdeveloped balance systems today because of so much restricted movement. To develop a strong balance system, she says, children need to move their bodies in all directions for hours at a time daily.

Children often fidget in the classroom to get the movement their bodies need, which helps to "turn their brain on." But, subsequently the fidgeting gets them in trouble and so when they sit still as required, their brains "turn off," Hanscom writes. "Children are going to class with bodies that are less prepared to learn than ever before."

Hanscom suggests that the solution is to fix the underlying issues: put recess back into our schools and let kids play outside for hours when they get home from school, and "20 minutes of movement a day is not enough! In order for children to learn, they need to be able to pay attention. In order to pay attention, we need to let them move."

Study finds ADHD treatment might discourage smoking; Kentucky ranks high in both

Stimulant medications used to treat attention deficit hyperactivity disorder might also reduce smoking risk, particularly if the medication is taken regularly, according to an analysis performed by Duke University. The study, online in the journal Pediatrics, has special signifcance for Kentucky, which first among the states in smoking and percentage of young people diagnosed with ADHD.

"Given that individuals with ADHD are more likely to smoke, our study supports the use of stimulant treatment to reduce the likelihood of smoking in youth with ADHD," said senior author Scott Kollins, Ph.D., a professor of psychiatry and behavioral sciences at Duke.

ADHD, which causes hyperactivity, impulsivity and difficulty paying attention, is often treated with stimulant medication, behavior therapy or both. The smoking rates are much higher for people who have ADHD than for the rest of the population. "Studies have shown that youth with ADHD are two to three times mores likely to smoke cigarettes than their peers, and 40 percent of adults with ADHD smoke regularly, more than twice the rate" among adults without the disorder, a Duke release says.

Some studies regarding potential connections between the using stimulant medications and smoking showed that taking stimulant medications increases smoking, and others didn't reveal any effects. "It has been suggested that some people with ADHD 'self-medicate' their attention deficits using nicotine," said lead author Erin Schoenfelder, a Duke psychologist. "Our findings show that treating ADHD effectively with medication may prevent young people from picking up the habit."

So far, the Duke study is the largest meta-analysis about the effects of stimulant medications on smoking habits. It looked at 14 longitudinal studies about smoking and ADHD treatment. The study found a "significant association between stimulant treatment and lower smoking rates. The effect was larger in those with more severe ADHD and when participants took stimulant medications continuously," the release says. The researchers said more studies are required to figure out the nature of the stimulant treatment needed to assist in reducing smoking risk.

"This study may debunk the perception that stimulants will increase one's risk for smoking," Kollins said. Schoenfelder said, "My hope is that this research can help inform our efforts to prevent negative outcomes for kids with ADHD, including cigarette smoking. This population hasn't been targeted for smoking prevention efforts, despite the well-known connection between ADHD and smoking." (Read more)

Kentucky leads nation in percentage of children who have been diagnosed with attention deficit hyperactive disorder

Kentucky leads the nation in the percentage of children who have been diagnosed with attention deficit hyperactive disorder, according to the latest available data, which "showed that ADHD levels have risen steeply in the past decade across the nation," Laura Ungar reports for The Courier-Journal.

Ungar writes that "19 percent of Kentucky children ages 4-17 have been diagnosed with ADHD at some point, compared with 11 percent nationally and 16 percent in Indiana." Almost 15 percent of Kentucky children had the diagnosis in 2011, based on polling by the U.S. Centers for Disease Control and Prevention.

"We're probably over-diagnosing it to a certain extent," Dr. Christopher Peters, a psychiatrist and assistant professor of pediatrics at the University of Louisville, told Ungar. "But these numbers indicate a problem. There are many kids in need."

The high numbers could "reflect the state's rampant poverty, since ADHD is identified more frequently in the poor," Ungar writes. "Others say more children here may be genetically prone to the disorder or face other risk factors. . . . Studies show that at least a third of parents who had ADHD as children have kids with the diagnosis."

Any over-diagnosis may stem from "overworked primary care doctors who aren't experts in the disorder" and may be over-diagnosing — and possibly over-prescribing — both locally and nationwide," Ungar writes. "Roughly 8 percent of of school-aged boys nationally and nearly 4 percent of girls took ADHD medications in 2012, according to data from the pharmacy benefit management firm Express Scripts."

There are "financial incentives" for an ADHD diagnosis, Ungar notes. "A diagnosis may translate into disability payments if a child has measurable and serious problems, and students with ADHD can get extra help in school. . . . Experts say the higher numbers may also indicate greater awareness of the disorder, meaning the truly needy are getting the medication, therapy and support they deserve."

However, Dr. Carmel Wallace, pediatrics chairman at the University of Kentucky, "said parents rarely push for a diagnosis to get a disability check," Ungar reports. "And the threshold for disability is high."

Still Kentucky has high rates of children and adults getting Social Security disability payments, and ranks high in some risk factors for ADHD.

"Scientists also have linked ADHD to alcohol and tobacco use during pregnancy — although doctors said it's unclear whether smoking is a cause or simply occurs more often in families with afflicted children," Ungar reports. "Kentuckians smoke at the nation's highest rate and also have high rates of substance abuse overall."

Ungar's example of an ADHD child was, in preschool, "a tiny tempest — at times defiant, other times bouncing distractedly from toy to toy at daycare, while other children were absorbed in play," but as a second-grader "is doing well . . . with a mild stimulant and counseling." Here's a C-J video of another ADHD child and her mother discussing how they deal with it:

At least one in eight teens, and perhaps one in five, have a mental-health issue; ADHD tops, substance abuse also high

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

Childhood obesity is linked to more immediate health problems than doctors formerly realized

While a plethora of research on childhood obesity has linked it to long-term health problems, a new UCLA study focuses on the condition's more proximate consequences, showing that obese children are at a greater risk for immediate health problems than previously thought. That's important for Kentucky, which ranks poorly in many health measures and is third highest in child obesity. (Photo by Tara Kaprowy)

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA.

Compared to kids who are not overweight, the study found that obese children have nearly twice the risk of having three or more reported medical, mental or developmental conditions. Specific medical conditions included bone, joint and muscle problems; asthma; allergies; headaches; and ear infections. Obese children also reported a greater tendency toward emotional and behavioral problems, higher rates of grade repetition, missed school days and other school problems, ADHD, conduct disorder, depression, learning disabilities, and developmental delays.

The study provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, a UCLA release said. Halfon said these findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for health conditions associated with childhood obesity. (Read more)