By: James Parles, MD, Three Village Behavioral Medicine (Three Village, New York)
A recently published article raised concern about starting stimulant medicines in the treatment of ADHD. Children who were stable on stimulant medications did not have similar problems and there is no reason for anyone currently on ADHD medications to stop them.
In the study, the authors analyzed insurance claims and found that a tiny number of patients (0.1-.0.2%) 12 to 25 years old developed symptoms of psychosis, such as hallucinations, soon after beginning stimulant treatment. Here are important take-home points for patients and families:
• Only patients who are new to stimulants were included in the study. There was no concern raised about patients who are already on stimulants for some time.
• The authors used insurance claims without access to other clinical information about the patients. This type of study is a useful starting point to help direct researchers who study actual patients. It is not designed to tell doctors and patients what treatments are safe or effective.
• Any treatment for any illness involves some risk. If the risks from the untreated illness are greater than the risks of treatment, then it makes sense to take the medication. The long term risks of untreated ADHD include higher rates of depression, smoking, substance abuse, unintended pregnancy, school failure, conduct problems, unemployment and law enforcement interaction. Stimulant medication is proven to safely and significantly decrease those risks.
If you have concerns about this topic, or about anything related to the treatment of your child’s ADHD, please discuss them with your prescribing doctor. Together you will be able to make fully informed treatment decisions which integrate knowledge gained from medical science with what you and your doctor know from experience with your child.
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York)
It has been a scary week for our country. First, days of hearing about bombs being sent to many of our leaders as well as people who broadcast the news. Then on Saturday, we hear about the senseless shootings at a house of worship in Pittsburgh.
Our thoughts go out to the families that lost loved ones in such a senseless way. We are humbled by our first responders, running into the gunfire to save the innocent. Our prayers go out to those who were injured and wish all a speedy recovery.
Our country was founded on the principle of political and religious freedom. It is simply unconscionable for people to be targeted during worship, and unthinkable that it would happen in the United States in this day and age. This violence occurs at a time when there is an increase in religious harassment on college campuses and online. But how do we this explain to our kids, how do we reassure them that their house of worship they will be safe? What’s next?
First thing is to reassure our children they are safe. Listen to their fears, validate what they are feeling, and let them ask questions. Keep your explanations age appropriate. Early elementary school need simple concrete answers. Take them to schools and houses of worships to show them they are safe. Ask principals, ministers, rabbis priest and imams to talk with them about the safety of the buildings. Schools are already doing drills to prepare students. Ask your house of worship if they are prepared as well. Suggest or run a program for students to make them comfortable.
Older elementary and middle school students need to ask more detailed questions. They are just developing opinions and are able to understand more. Ask them open-ended questions. Remind them they are safe and encourage them to talk with their school and religious leaders. Let them hear how the community is working to keep them safe.
Older middle school and high school students will have varying opinions and are developing political and religious views that might be different than their parents. Encourage the students to talk, if not to you but to people they respect. Listen and ask what can you do for them. They might have different views than you, validate them and discuss with them how to be civil with those that hold different views.
Observe your kids. Look for changes in behavior, appetite and sleeping patterns. Limit your younger children’s television viewing and try to limit their online news. Watch your conversations with your spouse and friends in person and the phone. Maintain your normal routines. The more normal life appears for your kids the better. Do enjoyable things as a family.
Martin Luther King said, “Darkness cannot drive out darkness; only light can do that. And hate cannot drive out hate; only love can do that.
Update: Season 2 of 13 Reasons Why returns, May 18th. It picks up in the aftermath of the Hannah Baker’s death. In this season the other characters start their journeys toward healing and recovery. However, a series of ominous Polaroids lead the characters to uncover a sickening secret and a conspiracy to cover it up.
Netflix said season 2 will carry a warning at the beginning of each episode pointing viewers to resources on their website, 13reasonswhy.info.
The Netflix series 13 Reasons Why, based on a book of the same title, has brought the topic of teen suicide front and center. You may not know about the show, but your teen likely does. While many parents, educators and health professionals have concerns about the show’s graphic nature and portrayal of suicide, teenage depression is an important topic that should be discussed in the open.
The Netflix series covers some of the very intense issues of bullying, teenage sex, alcohol, and drug use that are part of the complicated equation of teenage depression. Your teen needs your help in learning how to navigate these topics, hopefully, way before they ever happen.
Follow these 13 suggestions to help navigate this issue:
1 If you have concerns, call your pediatrician for a consult, which can often be initiated with or without the child present. The normal ups and downs of teenage emotions can make it difficult to determine when depression should be addressed. All pediatricians will be a resource to parents on teenage depression. Many pediatricians are comfortable initiating a workup for depression/anxiety, and some will prescribe treatment medication.
2 Make sure your teen has a yearly well care visit. Well care is a time to mature and strengthen the relationship between your teen and his/her pediatrician. It also serves to model for your teen that you trust and value the pediatrician’s input.
3 During the well care visits give your teen the privacy to fill out any written questionnaires, and encourage your teen to be honest. Most doctors use a “Teen screen” to identify teens at risk for depression, among other things. In addition to being a validated way to determine depression risk, these screening devices show your teen that the doctor is interested in their mental as well as their physical health. They set the stage for further conversations. These screens are usually covered by insurance, but sometimes engender a small co-pay or co-insurance.
4 Ask your teen his/her understanding of the show and ask to watch it together. If your teen doesn’t feel comfortable watching with you, watch it alone and use each episode as an opportunity for discussion. Be open, non-judgmental and do more listening than talking.
5 Go beyond the standard sex talk and discuss issues of consent with your teen, including that consent can change within a sexual encounter. Respect and communication are key between partners.
6 Remind your teen that sex and alcohol don’t mix and that a person under the influence of drugs or alcohol cannot give consent.
7 Talk with your teens (and younger kids) about bullying in all its forms. Teens need to be reminded that gossip is hurtful – in person or online. Ask your child to share examples of bullying and discuss options for dealing with it.
8 Give your teen suggestions and use role play to prepare them to handle difficult situations related to sex, drugs, alcohol and bullying.
9 Encourage your teen to look out for friends. Watching out for others is being a good friend, and a quality to encourage in our kids.
10 Remember that you are a great influence on your teen. Share your views on difficult matters while recognizing that teens are forming their own views. Remind your teens that they can tell you anything and you will not judge.
11 Be available for picks up – no questions asked
12 If your child thinks a friend or acquaintance may be depressed, encourage them to notify a teacher or school counselor. These people can then evaluate the person your child is concerned about without revealing who tipped them off.
13 Keep the lines of communication open. Just by having this kind of conversation you are letting your teen know that you are open to discussing difficult topics and willing to help.
Links for information on Teen suicide
Warning Signs of Suicide – afsp.org
Talking Points for Families – SAVE.org
Talking Points for Families – commonsensemedia.org
Comments on 13 Reasons The program
By: Dr. Deborah Schwartz (Chester Pediatrics– White Plains, NY)
As your child is preparing to start or return to college, take time to discuss the stresses of college life. NAMI (National Alliance on Mental Illness), encourages families to start the conversation now about mental health challenges, including what the privacy laws are and how mental health information can be shared. Starting this conversation may not be easy, but it is a useful tool to keep channels of communication open between you and your child.
There are many colleges that require incoming freshmen to complete online courses about alcohol and drug use. There are also some families that have a family history of mental illness and substance abuse. Use this as a springboard to start the talk. These conversations may help your child to be proactive about their own physical and mental health.
The excitement of being out of the house for the first time, in a new environment with new people, may mean your child has not considered the other emotions they may experience. Not only are they having to deal with the pressures of living away from home, but they are navigating the task of that innovative but rigorous college academic schedule and the social pressures of fitting in with their new group of friends. This combined with poor eating habits, curtailed sleeping hours, and drug and alcohol use, all contribute to feelings of sadness. There will be days that they may feel down or overwhelmed. These feelings can be normal. However, sometimes these feelings of sadness can turn into more overwhelming emotions.
Mental health issues are common. NAMI reports that 1 in 5 young adults will experience a mental health condition. Thirty percent of college students report feeling so down the previous year that they found it difficult to function.
It is important that your child finds a good emotional outlet. When looking to unwind or clear their heads, they should try to take some time for themselves. Engaging in an activity that makes them feel good is always a great start. Whether it be taking a walk, going to the gym, FaceTiming a friend from home, or getting lost in a good book.
Sometimes it may be difficult to assess whether whatever your child may be feeling is an early sign of an emerging mental health condition or part of a normal response to a new situation. Make sure to educate yourself about the services that the school provides so you can help guide them to the best resources possible. Knowing that they have support at home and at school is essential and will provide ease to your family during this very exciting and new time!
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York) & Kerry Fierstein, MD, Pediatric Health Associates (Plainview, New York)
E-cigarettes or “vapes” have replaced traditional cigarettes as the nicotine delivery system of choice for teenagers and parents need to understand the appeal and the risk vaping represents.
Though marketed as a safer alternative to cigarettes, recent studies show that the vape liquid is laced with dangerous chemicals that build up in a teen’s body. Teens who smoke e-cigarettes have higher levels of cancer-causing chemicals in their bodies than nonsmokers, as a team at the University of California, San Francisco, recently published in the Journal of Pediatrics. Unlike what might be expected, the fruity flavors seem to produce the highest chemical levels. Although e-cigarettes do not produce smoke, breathing in the second-hand vapor is not harmless. The aerosol from e-cigarettes may contain many potentially harmful chemicals, including lead and other heavy metals.
In 2018, about 37% of high school seniors admit to vaping within the last 12 months with about 42% admitting to vaping at some point. Middle schoolers are getting into the act as well and vaping is a common occurrence in middle school bathrooms. Middle school use is rising. An increasing number of middle and high school students said they can obtain a vaping device ‘fairly easily” or “very easily” with this percentage as high as about 80% for high school seniors. In 2018, U.S. Surgeon General Jerome M. Adams officially declared e-cigarette use among youth an “epidemic” during a Dec. 18 press conference.
Our teens are using different types of vape pens with the JUUL being the hottest thing. JUUL pods hold the fluid and contain about as much nicotine as one pack of cigarettes. The JUUL looks like a flash drive so teens can carry it around openly and most adults have no idea what it represents. The JUUL device is rechargeable and can plug into the USB port of a teen’s computer. The device is about $35-$50 and each pod is about $4 and comes in flavors such as tobacco, mint, and fruit. Also, our teens are now vaping marijuana. This is quickly becoming an easy way to get high.
So what is a parent supposed to do? It is time parents and schools start educating themselves about vaping. Studies show that parental opinions on drugs will affect teen behavior. Include a talk on vaping as your child prepares for middle school. Teach your high schooler about the chemicals in vape. Talk to your children about vaping, but first, do your homework! Get involved. Nassau County is proposing a new law that would enact a new code regulating the advertisement of age-restricted vaping products within 1000 feet of schools, parks, playgrounds, and duly licensed day-care centers. Even if you live outside Nassau, contact your representatives, tell them we need to protect our kids.
By: Dr. Eric Levene, Chester Pediatrics (White Plains, New York)
The Tide Pod Challenge has become a viral social media sensation. Teenagers are eating these laundry pods and posting videos of themselves on social media. They are then daring one another to follow suit. There have been many discussions on how this trend developed, but the Tide pod meme has caught on.
In the first half of January 2018, there have been 39 reposts of intentional Tide Pod ingestions, which is an increase from 52 for all of 2017.
So, what happens when a teen eats a Tide Pod? The pods contain ethanol, polymers and hydrogen peroxide. First, there is a bitter taste and you may become nauseated. The pod’s coating dissolves in the mouth releasing the cleaning agents, causing a burning sensation. A chemical burn could occur in your mouth, lips, tongue and checks. In many cases the symptoms will dissipate in a few hours but you could end up hospitalized or worse. The burn could cause difficulty breathing and esophageal burns. These burns could require months of hospitalization and multiple surgical procedures. In the most severe cases patients may have had seizures and may require ICU care. As per Dr Michael Lynch a the Pittsburgh poison Center, the more you swallow the greater your risk.
In response, both YouTube and Facebook are trying to remove these posts from their sites. P&G, the makers of Tide, have taken to Twitter with a video of Super Bowl bound, New England Patriot, Rob Gronkowski to warn teens against this problem.
We recommend that you talk with your Tweens and Teens about this latest “Craze”. Review with them the possible injuries that can occur with eating laundry detergent. Discuss how to say “NO” to the challenge.
Please remember these laundry pods are attractive to younger children who think they are candy and they should be kept high or locked away or both.
If you may have consumed any toxic substance, call the Nation Poison Hotline 1-800-222-1222.
No one knows your child like you, and no one can take care of him or her medically like your pediatrician. An Allied doctor is on-call at all times and we want to hear from you. Learn why to call us first and how we can help you.