OBJECTIVE:
  To compare attention-deficit hyperactivity disorder (ADHD), bipolar spectrum disorders (BPSDs), and comorbidity in the Longitudinal Assessment of Manic Symptoms (LAMS) study.

METHODS:
  Children ages 6-12 were recruited at first visit to clinics associated with four universities. A BPSD diagnosis required that the patient exhibit episodes. Four hypotheses were tested:
(i) children with BPSD + ADHD would have a younger age of mood symptom onset than those with BPSD but no ADHD;
(ii) children with BPSD + ADHD would have more severe ADHD and BPSD symptoms than those with only one disorder;
(iii) global functioning would be more impaired in children with ADHD + BPSD than in children with either diagnosis alone; and
(iv) the ADHD + BPSD group would have more additional diagnoses.

RESULTS:
  Of 707 children, 421 had ADHD alone, 45 had BPSD alone, 117 had both ADHD and BPSD, and 124 had neither. Comorbidity (16.5%) was slightly less than expected by chance (17.5%). Age of mood symptom onset was not different between the BPSD + ADHD group and the BPSD-alone group. Symptom severity increased and global functioning decreased with comorbidity. Comorbidity with other disorders was highest for the ADHD + BPSD group, but higher for the ADHD-alone than the BPSD-alone group. Children with BPSD were four times as likely to be hospitalized (22%) as children with ADHD alone.

CONCLUSIONS:
  The high rate of BPSD in ADHD reported by some authors may be better explained as a high rate of both disorders in child outpatient settings rather than ADHD being a risk factor for BPSD. Co-occurrence of the two disorders is associated with poorer global functioning, greater symptom severity, and more additional comorbidity than for either single disorder.

So what does that mean? It means that if your child has both ADHD and Bipolar Disorder, yes, they are more at risk of having more severe symptoms of mania, they are more likely to have additional comorbid disorders, and their overall functioning is likely to be more impaired. That doesn’t mean they will be necessarily be severely impaired, however. It does mean, however, that your child is more likely to need treatment and that without it, they may be at significant risk of school problems and other problems.

Reference:
Arnold LE, Demeter C, Mount K, Frazier TW, Youngstrom EA, Fristad M, Birmaher B, Findling RL, Horwitz SM, Kowatch R, Axelson DA: Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample. Bipolar Disorder, 2011, 13(5-6), 509-21.

Background

Little is known about patterns of participation in social activities among adolescents with an autism spectrum disorder (ASD). The objectives were to report nationally representative (U.S.) estimates of participation in social activities among adolescents with an ASD, to compare these estimates to other groups of adolescents with disabilities, and examine correlates of limited social participation.

Methods and Findings

We analyzed data from wave 1 of the National Longitudinal Transition Study 2, a large cohort study of adolescents enrolled in special education. Three comparison groups included adolescents with learning disabilities, mental retardation, and speech/language impairments. Adolescents with an ASD were significantly more likely never to see friends out of school (43.3%), never to get called by friends (54.4%), and never to be invited to social activities (50.4%) when compared with adolescents from all the other groups. Correlates of limited social participation included low family income and having impairments in conversational ability, social communication, and functional cognitive skills.

Conclusions

Compared with prior research, our study significantly expands inquiry in this area by broadening the range of social participation indicators examined, increasing the external validity of findings, focusing on the under-studied developmental stage of adolescence, and taking an ecological approach that included many potential correlates of social participation. There were notable differences in social participation by income, a dimension of social context seldom examined in research on ASDs.

The complete research report is available as a free resource online, here (pdf).

Having done a first reading of it, it confirmed my guess that a lot of the significant social impairment they noted was limited to those with more severe communication deficits and lower IQs. Indeed, their overall findings are likely to somewhat overestimate the extent of socialization problems in teens with an ASD because their sample was drawn from those who are classified for special education under the Autism category. As many of us know, students who are high-functioning (e.g., students with Asperger’s Disorder) are often not categorized under the Autism category and are categorized under “Other Health Impairment” or some other category. That said, if your child has severe communication deficits and an IQ <85, these results are likely to be applicable. Not surprisingly, perhaps, families with greater financial resources have children who participate in more social activities.

When thinking about why teens with ASD engage in less socialization outside of school, one factor that I want to mention here is that there are likely fewer opportunities in communities for youth with ASD than for youth with other challenges. As part of advocacy efforts, parents can help their children by working with community agencies to create more opportunities for socialization. Stuck for ideas? Try contacting the child psychiatry department at a large hospital and ask them if they will work with you to create some programs. And try contacting the special education program at a nearby university and see if you can get their staff and students to work with you creating a camp or outings or other opportunities for socialization.

As parents, we tend to spend a vast amount of our energy on dealing with schools and doctors/therapists, but there is much to be done in the community. When my son was young, I routinely went to camps I had picked out for him and arranged to train all the staff so that they could understand him and so that he could attend a regular camp. It was a wonderful experience for him and the camps would subsequently be more available to other children with similar problems.

As one of the overheads Sherry Pruitt and I use in our workshops says: Everything in Life is Social. If your child’s life outside of school is not providing enough socialization opportunities, network with other parents and reach out to agencies and programs in your area to see what you can develop. If your child needs it, there are probably at least 10 other children around who need it, too.

Participants sought for a study exploring the possible benefits of aerobic exercise on children and adolescents with Tourette syndrome (TS) and Obsessive-Compulsive Disorder (OCD). The study has received Institutional Review Board approval from Hofstra University, New York.

Children and adolescents ages 8-16 diagnosed with both TS and OCD are eligible to participate in a 6-week, 12-session aerobic exercise program. All sessions will be conducted in the participants’ home for ease and convenience.

Each exercise session will take approximately 30 minutes. Two-three 15-minute interviews will be conducted prior to beginning the exercise intervention, and one interview will be conducted one month after the end of the exercise intervention. Participants who complete the study and follow-up will receive $250.

Participants can be on medication, but cannot be undergoing medication changes during the study.

Study Location: Long Island, New York

For additional information or to sign up, contact Loren Packer-Hopke, M.S. via telephone: 516-359-0859 or e-mail: lpackerhopke@yahoo.com

And yes, in the interests of full disclosure: the doctoral candidate is related to me, but the study is her own and has been approved by her university.

A 7-year-old boy is being investigated by his South Boston elementary school for possible sexual harassment after kicking another boy in the crotch.

The first grader’s mother, Tasha Lynch, says she was shocked by the school’s decision.

“He’s 7 years old. He doesn’t know anything about sexual harassment,” she said.

Lynch’s son, Mark Curran, said the boy that he kicked had been bullying him on the school bus ride home from Tynan Elementary last week.

“He just all of a sudden came up to him, choked him. He wanted to take his gloves, and my son said, ‘I couldn’t breathe, so I kicked him in the testicles,’” said his mother.

Read more on CBS.

Once again, it seems, a school may have gotten it so very very wrong – although to be fair, we are only hearing one side of the story.  Assuming that the parent’s reporting is correct, then instead of re-framing this as a “sexual harassment” issue, why doesn’t the school really deal with the issue that a child was left to his own instincts and 7-year-old judgement as to how to protect and defend himself from another child?   What would they have had him do in that situation?

And what would anyone of them have done in the same situation as an adult, if they were assaulted on a street?

Update: The Boston Globe has a fuller version of this news report.

“Real life doesn’t happen in a lab, but few research studies reflect that,” said Thomas R. Insel, director of the National Institute of Mental Health (NIMH), a part of NIH. “As this study shows, taking into account a person’s typical environment may improve treatment outcomes.”

The most common type of social skills intervention for children with ASD is direct training of a group of children with social challenges, who may have different disorders and may be from different classes or schools. The intervention is usually delivered at a clinic, but may also be school-based and offered in a one-on-one format. Other types of intervention focus on training peers how to interact with classmates who have difficulty with social skills. Both types of intervention have shown positive results in studies, but neither has been shown to be as effective in community settings.

Connie Kasari, Ph.D., of the University of California, Los Angeles, and colleagues compared different interventions among 60 children, ages 6-11, with ASD. All of the children were mainstreamed in regular education classrooms for at least 80 percent of the school day.

These children were randomly assigned to either receive one-on-one training with an intervention provider or to receive no one-on-one intervention. The children were also randomized to receive a peer-mediated intervention or no peer-mediated intervention. The two-step randomization resulted in four intervention categories, each with 15 children who had ASD:

• Child-focused: direct, one-on-one training between the child with ASD and intervention provider to practice specific social skills, such as how to enter a playground game or conversation
• Peer-mediated: group training with the intervention provider for three typically developing children from the same classroom as the student with ASD; the affected student did not receive any social skills training. The participating children were selected by study staff and teachers and were taught strategies for engaging students with social difficulties.
• Both child-focused and peer-mediated interventions
• Neither intervention.

All interventions were given for 20 minutes two times a week for six weeks. A follow-up was conducted 12 weeks after the end of the study. After the follow up phase, all children with ASD who had received neither intervention were re-randomized to one of the other treatment categories.

Children with ASD whose peers received training—including those who may also have received the child-focused intervention—spent less time alone on playgrounds and had more classmates naming them as a friend, compared to participants who received the child-focused interventions. Teachers also reported that students with ASD in the peer-mediated groups showed significantly better social skills following the intervention. However, among all intervention groups, children with ASD showed no changes in the number of peers they indicated as their friends.

At follow-up, children with ASD from the peer-mediated groups continued to show increased social connections despite some of the children having changed classrooms due to a new school year and having new, different peers.

According to the researchers, the findings suggest that peer-mediated interventions can provide better and more persistent outcomes than child-focused strategies, and that child-focused interventions may only be effective when paired with peer-mediated intervention.

In addition to the benefits of peer-mediated interventions, the researchers noted several areas for improvement. For example, peer engagement especially helped children with ASD to be less isolated on the playground, but it did not result in improvement across all areas of playground behavior, such as taking turns in games or engaging in conversations and other joint activities. Also, despite greater inclusion in social circles and more frequent engagement by their peers, children with ASD continued to cite few friendships. Further studies are needed to explore these factors as well as other possible mediators of treatment effects.

The study was supported by NIMH, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and the National Institute on Deafness and Other Communication Disorders through the Studies to Advance Autism Research and Treatment (STAART)network program and received additional funding from the Health Resources and Services Administration (HRSA).

Reference

Kasari C, Rotheram-Fuller E, Locke J, Gulsrud A. Making the Connection Randomized Controlled Trial of Social Skills at School for Children with Autism Spectrum Disorders. J Ch Psychol Psychiatry. 2011 Nov 28. [epub ahead of print]

Clinical Trials Number: NCT00095420

Source: National Institute of Mental Health

When I was in fifth grade, my brother Alex started correcting my homework. This would not have been weird, except that he was in kindergarten—and autistic.

She goes on to discuss how more attention is now being paid to what autistic individuals can do and not just what they can’t do. Discussing the failures of commonly used tests to provide accurate assessments of autistic children, she provides an example from her brother:

… the woman delivering the questions asked him, “You find out someone is getting married. What is an appropriate question to ask them?”

My brother’s answer: “What kind of cake are you having?”

The proctor shook her head. No, she said, that’s not a correct answer. Try again. He furrowed his brow in the way we have all learned to be wary of—it is the face that happens before he starts to shut down—and said, “I don’t have another question. That’s what I would ask.” And that was that. He would not provide her another question, and she would not move on without one. He failed that question and never finished the test.

A test does not have to be like this. Other measures, like Raven’s Progressive Matrices or the Test of Nonverbal Intelligence (TONI), avoid these behavioral and language difficulties. They ask children to complete designs and patterns, with mostly nonverbal instructions. And yet they often are not used.

Read more of this fascinating article on Scientific American.

The presentation will be by  Andrew Cohen, Esq. and Mitch Weisbrot, CLU, who have both personal experience as parents as well as professional experience in estate planning and the legal morass that confuses parents. Topics of discussion include:

•  Government benefits for individuals with disabilities
•  How to accumulate and preserve assets without disqualifying eligibility for benefits
•  Establishing guardianship
•  Estate planning and wills
• Special needs trusts – how they work and why they’re useful
• Strategies for funding trusts

WHEN: Thursday, December 15, 2011 – 6:30 p.m.
WHERE: Samuel Field Y
58-20 Little Neck Parkway
Little Neck, NY 11362
RSVP: Amanda Smith, (718)225-6750 ext. 204

Funding for this program made possible through New York State Office of People with Developmental Disabilities

New research from the US suggests that creative or original thinkers can be less honest and may be more likely to cheat than less creative people, perhaps because they are better able to invent excuses to “explain” their actions. Lead researcher Dr Francesca Gino of Harvard University, and co-author Dr Dan Ariely, of Duke University, write about their findings in the 28 November online issue of Journal of Personality and Social Psychology, a publication of the American Psychological Association.

Gino told the media that:

“Greater creativity helps individuals solve difficult tasks across many domains, but creative sparks may lead individuals to take unethical routes when searching for solutions to problems and tasks.”

Read more on Medical News Today.

Using functional magnetic resonance imaging (fMRI), researchers have identified abnormalities in the brains of children with Attention Deficit Hyperactivity Disorder (ADHD) that may serve as a biomarker (indicator) for the disorder.

ADHD is one of the most common childhood disorders, affecting an estimated five to eight percent of school-aged children. Symptoms, which may continue into adulthood, include inattention, hyperactivity and impulsivity behaviors that are out of the normal range for a child’s age and development.

According to the National Institute of Mental Health, there is no single test capable of diagnosing a child with the disorder. As a result, difficult children are often incorrectly labeled with ADHD while other children with the disorder remain undiagnosed.

“Diagnosing ADHD is very difficult because of its wide variety of behavioral symptoms,” said lead researcher Xiaobo Li, Ph.D., assistant professor of radiology at the Albert Einstein College of Medicine in New York. “Establishing a reliable imaging biomarker of ADHD would be a major contribution to the field.”

For the study, Dr. Li and colleagues performed fMRI on 18 typically developing children and 18 children diagnosed with ADHD (age range 9 to 15 years). While undergoing fMRI, the children engaged in a test of sustained attention in which they were shown a set of three numbers and then asked whether subsequent groups of numbers matched the original set. For each participant, fMRI produced a brain activation map that revealed which regions of the brain became activated while the child performed the task. The researchers then compared the brain activation maps of the two groups.

Compared to the normal control group, the children with ADHD showed abnormal functional activity in several regions of the brain involved in the processing of visual attention information. The researchers also found that communication among the brain regions within this visual attention-processing pathway was disrupted in the children with ADHD.

“What this tells us is that children with ADHD are using partially different functional brain pathways to process this information, which may be caused by impaired white matter pathways involved in visual attention information processing,” Dr. Li said.

Dr. Li said much of the research conducted on ADHD has focused on the impulsivity component of the disorder.

“Inattention is an equally important component of this disorder,” she said, “and our findings contribute to understanding the pathology of inattentiveness in ADHD.”

Shugao Xia, Ariane Kimball and Craig Branch, Ph.D. co-authored the report.

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A local sixth-grader with special needs was pulled out of class and reportedly forced to mow the school lawn as a punishment.

Alice Ott Middle School student, 11-year-old Kyron Sloan, has ADD, Asperger’s and maybe a medical condition, which doctors are still trying to figure out, causing him to sleep.

Sloan’s mother, Kristi Sloan-Ceron, said her son’s counselor decided his punishment for falling asleep in class should be to mow the lawn. But the counselor never asked her first.

Read more on KOMO News.

As I have often cautioned, “Behavior Modification” is often misused in schools.  I’d love to have a conversation with the counselor as to what made her think this was reasonably calculated to be successful and why she thought it was appropriate – and ethical.

This is really unacceptable.

Thoughts about killing oneself and engaging in suicidal behavior may begin much younger than previously thought. While about one of nine youths attempt suicide by the time they graduate from high school, new findings reveal that a significant proportion make their first suicide attempt in elementary or middle school.

In a study published in the November issue of the Journal of Adolescent Health, nearly 40 percent of young adults who said they had tried suicide said that they made their first attempt before entering high school.

The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores of depression at the time of the attempts, validating for the first time that young adults can reliably recall when they first attempted suicide.

“Young adults who end up having chronic mental health problems show their struggles early,” said James Mazza, lead author and professor of educational psychology at the University of Washington. “This study suggests that implementation of mental health programs may need to start in elementary and middle schools, and that youth in these grades are fairly good reporters of their own mental health.”

Read more of this press release from  University of Washington  - Molly McElroy

Overwhelming, isn’t it?

With so much going on, it is somewhat understandable that teachers – and even parents – often overlook the presence of an anxiety disorder.  And yet anxiety may contribute to some of the worrisome behavior that they have been attributing to ADHD.   If a student becomes disruptive due to heightened levels of anxiety but their behavior is misunderstood as ADHD-related impulsivity or disinhibition, parents may think their child needs (more) medication for ADHD, when what they might really need is treatment for anxiety.  And increasing a stimulant medication to treat ADHD may make anxiety worse.

I came across an article online that may open some parents’ and teachers’ eyes about the relationship between ADHD and anxiety:

It’s not uncommon for individuals with attention deficit hyperactivity disorder (ADHD) to struggle with anxiety, whether it’s several symptoms or a full-blown disorder.

In fact, about 30 to 40 percent of people with ADHD have an anxiety disorder, which includes “obsessive-compulsive disorder, generalized anxiety disorder, phobias, social anxiety and panic disorder,” according to Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor at Harvard Medical School. The Anxiety Disorders Association of America even estimates the figure to be almost 50 percent.

Read more of this article on PsychCentral.

Geoff Redick reports:

Officials in the LeRoy School District are still uncertain what exactly is causing a number of students to display sudden symptoms, similar to Tourette’s Syndrome.

Superintendent Kimberly Cox tells WBTA News today that medical personnel continue to investigate the case, in which several students are apparently displaying “tics” – twitches or vocal exclamations that the sufferer cannot control.

The “tics” are commonly associated with Tourette’s syndrome, though a neurologist tells WBTA News there many be many other causes for them.

[...]

In a statement on the LeRoy website today, Cox says no apparent connection has been found between the students.

Other coverage can be found on MPN and WKBW.

Curiouser and curiouser. The neurologist is quite right that there are a number of possible explanations, and I would be that they are all being pursued right now.

Earlier this year, a Stockton student was handcuffed with zip ties on his hands and feet, forced to go to the hospital for a psychiatric evaluation and was charged with battery on a police officer. That student was 5 years old.

Michael Davis is diagnosed with Attention Deficit Hyperactivity Disorder or ADHD. His mother says it has led to fights at school. But when the school district said it had a plan to change Michael’s behavior, his mother says things went wrong.

“Michael is energetic,” Thelma Gray said. “He is one big ball of energy.”

Gray calls Michael a comedian. She says his biggest problem is his ADHD stops him from thinking before he acts or speaks.

“He’s very loving,” Gray said. “He’s a good kid and he’s not the discipline problem that he was made out to be.”

Those discipline problems include fights with other students, even throwing a chair.

Gray says the school, Rio Calaveras Elementary of Stockton, wanted to change that behavior by having Michael meet with a school police officer.

“He could come out and talk to Michael and the kids are normally scared straight,” said Gray, describing how she says the school district proposed the meeting.

But the meeting didn’t go as planned.

You can read more of the news story on KCRA. In this case, the U.S. Department of Education reportedly did investigate and the news station obtained the report under Freedom of Information. I’m not sure why the department released the report and didn’t invoke FERPA like the district did, but the news station summarizes the report:

The report states that the Stockton Unified School District “delayed an evaluation of the student {Michael} which denied the student a fair and public education.”

They added that the school didn’t offer behavioral services to Michael or his mother, because “it would cost the district money.”

The report goes on to say that, whether or not funds are available through state or federal grants, the school district had an obligation to have Michael evaluated, which it failed to do.

The comments under the news story are also upsetting as the lack of understanding expressed by some people reminds me of how much ignorance still exists about ADHD.

But commenters aside, this case represents a total failure on the part of the school district, the building administration, and the state.

What the heck were the school personnel thinking if they thought a 5 year-old with ADHD could be “scared straight?” That they would even consider this approach demonstrates to me that they do not understand ADHD at all.

Would you want these people educating your child? I wouldn’t. This child might have (or may have?) been seriously psychologically harmed by their inappropriate handling.

I have often noted that schools fail to use research-validated or best practices in handling students with neurological challenges.  This is a case in point.  Have the school personnel received adequate training in how to educate students with ADHD (or other neurological disorders, for that matter)?  Are budgetary concerns an excuse for mishandling a student?

I am not a lawyer, but I hope that the family sues the district.  And I hope that as part of any settlement, the district is required to undergo training in best practices for educating students with neurological disorders – and is audited for compliance with I.D.E.A.

In various places around this country, parents have banded together to call for a halt to handcuffing young children. If you have not been involved in such advocacy efforts, you might want to look into what goes on in your area or state lest this happen to your child.

My kids are safe because they are out of school.  Are your children safe?

Carousel image credit: © Richard Nelson | Dreamstime.com

When it comes to the rate of comorbidity (co-occurrence of the two disorders), results from studies have been all over the place, with one study suggesting that 94% of youth with Bipolar Disorder also have ADHD. Studies demonstrating high comorbidity rates of 80% or higher are not unusual, although there have been some studies – usually from non-U.S. samples – that find significantly lower rates. Hence, the range of estimates has been from 4% to 94%.

If you pose the question the other way, though, i.e., what percent of youth with ADHD also have Bipolar Disorder, studies report that 11-22% of ADHD youth also have Bipolar. In 2010, I visually summarized the results in a presentation this way:

If you have only been hearing about the high estimates, here’s more food for thought:

A study conducted in the U.K. of 200 youth with ADHD aged 6-18 years found that only one child, a 9-year-old boy, met diagnostic criteria for both ICD-10 hypomania and DSM-IV bipolar disorder not otherwise specified.

The study was published in the March 2011 issue of the British Journal of Psychiatry.

So… are we overdiagnosing Bipolar youth in the U.S. or is there some other explanation?