I knew it was coming--Drugging pre-schoolers

MothWrangler wrote:
MothWrangler wrote:

Max C. wrote:

Mark Probert wrote:

Vernon wrote:

Oh, come on QQQ. We can't have children running around acting like
children.


Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.



For anyone who wants to see the "diagnostic criteria" here you go:

The American Psychiatric Association uses the following criteria for
diagnosis of ADHD
1. Six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level


Yes, not that "maladaptive and inconsistent with developmental level."

But Nancy *meant* to write was: "Yes, note that "maladaptive and
inconsistent with developmental level."

I knew what you meant.

My biggest concern with these criteria is that it is almost completely
dependant upon a non-professional's opinion of the situation. Sure a
professional would have to diagnose ADD/ADHD and any related
prescriptions, but that professional will almost certainly have to
depend on a parent to make these decisions based on memory and overall
feeling. Given that, children could end up on meds for reasons like A)
the parent is lazy and doesn't want to deal with a *normal* child of a
given age. They'd rather deal with a zombie. B) The parent is a
hypochondriac and wants drugs for even the slightest sign of a problem.
C) The parent over emphasizes problems on the list because they think
they're being a good parent and reporting every little detail to the
good, trusted doctor.

Many people I've talked to personally about this have the misconception
that there is a 100% accurate, measurable test that can be done to say
"This child either has or does not have ADD." No such test exists.

Max.

Max C. wrote the following on 10/26/2006 6:52 PM:

My biggest concern with these criteria is that it is almost completely
dependant upon a non-professional's opinion of the situation. Sure a
professional would have to diagnose ADD/ADHD and any related
prescriptions, but that professional will almost certainly have to
depend on a parent to make these decisions based on memory and overall
feeling.

Prior to my child was diagnosed, we were given copies of a multi-page
questionnaire to be filled out by anyone who spent a significant amount
of time with her. Of course my DH and I filled them out, as well as her
teacher, her resource specialist, her gymnastics coach, and her
grandmother. On every one she scored close to the top of the scale for
inattentive ADD. The doctor was a bit surprised that her teachers also
scored her as very likable, as his experience was that children who
scored as high as she did tend to drive their teachers nuts. What can I
say? She's a likable person. :-)

Karen R.

Herman Rubin wrote:
In article wYR%g.12962$k63.3627@trndny06,
Mark Probert wrote:
Vernon wrote:

http://toronto.fashion-monitor.com/n...02304ADHD-Drug

ADHD Drug Safe and Effective for Pre-Schoolers

Excerpts:

...................

Oh, come on QQQ. We can't have children running around acting like
children.

Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.

Unless we have VERY strong evidence that there is a
mental problem which keeps a child from learning, and
later coping as an adult, and which can be treated in
such a way that their abilities, whatever they are,
are not adversely affected, do not treat for conditions
which are merely incompatible with sitting still in a
boring situation.

Correct. In such a case, that child does not have AD/HD.

Those who can tolerate long periods in boring situations
are unlikely to be good for anything which requires
original thinking, or real problem solving.

Disagree. Sometimes, there are people who get "lost" in their thoughts
and do some remarkable thinking.

Max C. wrote:
MothWrangler wrote:
MothWrangler wrote:

Max C. wrote:

Mark Probert wrote:

Vernon wrote:

Oh, come on QQQ. We can't have children running around acting like
children.

Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.


For anyone who wants to see the "diagnostic criteria" here you go:

The American Psychiatric Association uses the following criteria for
diagnosis of ADHD
1. Six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level

Yes, not that "maladaptive and inconsistent with developmental level."
But Nancy *meant* to write was: "Yes, note that "maladaptive and
inconsistent with developmental level."

I knew what you meant.

My biggest concern with these criteria is that it is almost completely
dependant upon a non-professional's opinion of the situation.

First, what non-professionals diagnose and prescribe? NONE.

Second, to properly diagnose AD/HD, a child should first have a thorough
physical. That would be followed-up with some behavior rating scale.
Connors, which had undergone rigorous testing testing prior to general
use, and post testing to see how it was working in real life, is a good
one.

Now, you may complain that merely having a teacher or parent complete
the rating scale is relying too heavily on a "non-professional". I'll
leave aside the fact that the testing in real life showed that there was
consistency between parents and teachers.

However, that, alone, should not constitute the sole basis for a
diagnosis. In addition to that, the child should undergo a battery of
psychological and educational testing, to ascertain if anything other
than AD/HD is present.

During that testing, a professional, i.e., a psychologist, is constantly
monitoring the child's behaviors, and, when rendering an opinion,
compare their professional observations with that of the parents and/or
teachers.

Finally, the child should be evaluated by a pediatric psychiatrist who
will also compare their observations with that of the parents, teachers
and psychologist.

At this point, inconsistencies should be evaluated and, if necessary,
further investigated. If no problems like that exist, then a diagnosis
is possible based on this three level screening.

Is this done all the time? No. Why? Most often, insurance companies are
tight with the $$ and will not pay for the psychological testing. There
a ways around that barrier, though. If you had attended a support group
meeting I held back in August, you would know.

Sure a
professional would have to diagnose ADD/ADHD and any related
prescriptions, but that professional will almost certainly have to
depend on a parent to make these decisions based on memory and overall
feeling.

Not at all.

Given that, children could end up on meds for reasons like A)
the parent is lazy and doesn't want to deal with a *normal* child of a
given age. They'd rather deal with a zombie.

Proper medication titration does not make zombies.

B) The parent is a
hypochondriac and wants drugs for even the slightest sign of a problem.

Or, the parent has Münchhausen Syndrome.

C) The parent over emphasizes problems on the list because they think
they're being a good parent and reporting every little detail to the
good, trusted doctor.

See my scheme above.

Also note that the American Academy of Pediatrics has published
guidelines, which are in addition to the DSM diagnostic standards"

http://aappolicy.aappublications.org...ics;105/5/1158

As for your concern about the parents, do note that the DSM requires
that there be a consistency of the abnormal behaviors observed in more
than one setting. (See above for comment on Connors). Therefore, your
concern is misplaced.

Read the AAP and look at the chart, and realize that I like mine better.

Many people I've talked to personally about this have the misconception
that there is a 100% accurate, measurable test that can be done to say
"This child either has or does not have ADD." No such test exists.

Correct. Like many conditions, e.g. fibromyalgia, chronic fatigue
syndrome, many psychiatric conditions, there is no simple test for
AD/HD. That is why both the AAP and I advocate for comprehensive testing
as outlined.

Max C. wrote:
Mark Probert wrote:
Vernon wrote:
Oh, come on QQQ. We can't have children running around acting like
children.
Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.

For anyone who wants to see the "diagnostic criteria" here you go:

The American Psychiatric Association uses the following criteria for
diagnosis of ADHD
1. Six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level
a) often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
b) often has difficulty sustaining attention in tasks or play
activities
c) often does not seem to listen when spoken to directly
d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions)
e) often has difficulty organizing tasks and activities
f) often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)
g) often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books or tools)
h) is often easily distracted by extraneous stimuli
i) is often forgetful in daily activities

2. Six (or more) of the following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months to a degree that is maladaptive
and inconsistent with developmental level: Hyperactivity:
a) often fidgets with hands or feet or squirms in seat
b) often leaves seat in classroom or in other situations in which
remaining seated is expected
c) often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
d) often has difficulty playing or engaging in leisure activities
quietly
e) is often "on the go" or often acts as if "driven by a motor"
f) often talks excessively; impulsively
g) often blurts out answers before questions have been completed
h) often has difficulty awaiting turn
i) often interrupts or intrudes on others (e.g., butts into
conversations or games)

The web site I originally got this from has moved their page, but you
can also find it he
http://www.add-adhd.org/attention_deficits_ADHD.html

Thanks, Max. Both Nancy and I are well aware of the DSM IV criteria.
However, as I pointed out in my other post, this is NOT the only thing
to be used. There is more, much more, to be considered.

Karen R. wrote:
Max C. wrote the following on 10/26/2006 6:52 PM:

My biggest concern with these criteria is that it is almost completely
dependant upon a non-professional's opinion of the situation. Sure a
professional would have to diagnose ADD/ADHD and any related
prescriptions, but that professional will almost certainly have to
depend on a parent to make these decisions based on memory and overall
feeling.

Prior to my child was diagnosed, we were given copies of a multi-page
questionnaire to be filled out by anyone who spent a significant amount
of time with her. Of course my DH and I filled them out, as well as her
teacher, her resource specialist, her gymnastics coach, and her
grandmother. On every one she scored close to the top of the scale for
inattentive ADD. The doctor was a bit surprised that her teachers also
scored her as very likable, as his experience was that children who
scored as high as she did tend to drive their teachers nuts. What can I
say? She's a likable person. :-)

Just for clarity, are you saying that in multiple settings, with
different observers, her behavior was consistent?

"Mark Probert" wrote in message
news:Iyb0h.12125$iM2.8983@trndny08...

Looky there, Mark is discussing what *I* posted.

Herman Rubin wrote:
In article wYR%g.12962$k63.3627@trndny06,
Mark Probert wrote:
Vernon wrote:

http://toronto.fashion-monitor.com/n...02304ADHD-Drug

ADHD Drug Safe and Effective for Pre-Schoolers

Excerpts:

...................

Oh, come on QQQ. We can't have children running around acting like
children.

Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.

Unless we have VERY strong evidence that there is a
mental problem which keeps a child from learning, and
later coping as an adult, and which can be treated in
such a way that their abilities, whatever they are,
are not adversely affected, do not treat for conditions
which are merely incompatible with sitting still in a
boring situation.

Correct. In such a case, that child does not have AD/HD.

Those who can tolerate long periods in boring situations
are unlikely to be good for anything which requires
original thinking, or real problem solving.

Disagree. Sometimes, there are people who get "lost" in their thoughts and
do some remarkable thinking.

"MothWrangler" wrote in message
...
Max C. wrote:

Mark Probert wrote:

Vernon wrote:

Oh, come on QQQ. We can't have children running around acting like
children.

Nancy didn't comment on me going form XXX to QQQ.

Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.


For anyone who wants to see the "diagnostic criteria" here you go:

The American Psychiatric Association uses the following criteria for
diagnosis of ADHD
1. Six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level

Yes, not that "maladaptive and inconsistent with developmental level."
That means if a child is acting "normally," that is engaging in behavior
that are typical for other children of the same age, the child cannot have
ADHD.

a) often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
b) often has difficulty sustaining attention in tasks or play
activities
c) often does not seem to listen when spoken to directly
d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions)
e) often has difficulty organizing tasks and activities
f) often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)
g) often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books or tools)
h) is often easily distracted by extraneous stimuli
i) is often forgetful in daily activities

2. Six (or more) of the following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months to a degree that is maladaptive
and inconsistent with developmental level:

Once again, "maladaptive and inconsistent with development level."
"Normal" typically developing children cannot fit the criteria.


Hyperactivity:
a) often fidgets with hands or feet or squirms in seat
b) often leaves seat in classroom or in other situations in which
remaining seated is expected
c) often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
d) often has difficulty playing or engaging in leisure activities
quietly
e) is often "on the go" or often acts as if "driven by a motor"
f) often talks excessively; impulsively
g) often blurts out answers before questions have been completed
h) often has difficulty awaiting turn
i) often interrupts or intrudes on others (e.g., butts into
conversations or games)

The web site I originally got this from has moved their page, but you
can also find it he
http://www.add-adhd.org/attention_deficits_ADHD.html

Max.


That isn't all that the diagnostic criteria for ADHD in the DSM-IV-TR
says, only the first part.

Additionally, the criteria requires that:

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings
(e.g. at school/work and at home).

IV. There must be clear evidence of significant impairment in social,
school, or work functioning.

[Nancy's note: this requirement that there be "clear evidence" that a
child has a "significant impairment" is simply ignored by those who claim
that "normal" children can be diagnosed with ADHD, or who claim that "all
children could meet the diagnostic criteria for ADHD."]

V. The symptoms do not happen only during the course of a Pervasive
Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The
symptoms are not better accounted for by another mental disorder (e.g.
Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality
Disorder).


Nancy
Unique, like everyone else

Updated:

Study: Giving ADHD drugs to prechoolers ok - -Don't be fooled

http://www.canada.com/components/pri...8-384075902843


Study: Giving ADHD drugs to preschoolers ok

Excerpts:


[why am I not surprised, see my inserts below].

BALTIMORE - A new study by the top medical university in the U.S. has
concluded that carefully measured, low doses of methylphenidate, the key
ingredient in drugs used to treat attention-deficit and hyperactivity
disorder, is safe and effective for treating behavioural problems in
preschoolers -- a departure from FDA regulations preventing its prescription
to children younger than six.

http://www.gwu.edu/~bulletin/ugrad/univ.html

[The School of Medicine and Health Sciences has had continuous approval by
its accrediting body, which is currently the Liaison Committee on Medical
Education, sponsored jointly by the American Medical Association and the
Association of American Medical Colleges]

Methylphenidate is the most widely prescribed drug for the treatment of ADHD
in children but is not approved by the U.S. Food and Drug Administration for
use in children younger than six.

Results of the federally funded research, the first large-scale, long-term
study of the safety and value of the drug in younger children, will appear
in a special section of the November issue of the Journal of the American
Academy of Child and Adolescent Psychiatry.

[American Academy of Child and Adolescent Psychiatry 49th Annual ... These
materials and the related activity are not sanctioned by the American
Academy of Child and Adolescent Psychiatry or the commercial supporter of
the ...]

http://www.aacap.org/page.ww?section...me=Institute+8



Sponsored by the AACAP Work Group on Research Pediatric Psychopharmacology
Initiative and partially supported by an unrestricted educational grant from
Eli Lilly and Company

http://archpedi.ama-assn.org/cgi/con...tract/157/1/17

~~~

"We were able to confirm what many already suspected-that even lower doses
in preschoolers can safely achieve the desired therapeutic effect and indeed
that low doses are often optimal."

[ need to know more, I don't think so...]. Then there is:

http://www.medpagetoday.com/Psychiatry/ADHD-ADD/tb/4358

Excerpts:

Ritalin Less Effective for ADHD in Preschoolers Than Older Children

NEW YORK, Oct. 24 -- Ritalin (methylphenidate) appears effective in treating
attention-deficit hyperactivity disorder (ADHD) in preschoolers though less
than in older children and with more side effects, researchers said.

Despite lack of FDA approval for use in children younger than age six,
Ritalin is the most widely used stimulant medication for treating preschool
children with ADHD, they noted.

Only 21% of the preschoolers titrated to their best dose achieved remission,
a primary endpoint that did not reach significance compared with the 13% who
achieved remission on placebo.

Tolerability was lower than expected, found Tim Wigal, Ph.D., of the
University of California in Irvine, and colleagues. They reported that 11%
of the183 preschoolers discontinued due to adverse events compared to a
previously reported rate of less than 1% in school-age children.

Various authors reported financial disclosures for Cephalon, Pfizer,
Pyrogenics, Shire, Eli Lilly, New River Pharmaceuticals, McNeil, Celltech,
Novartis, Sanofi Aventis, Otsuka, Janssen, UCB, Wyeth, Bristol-Myers Squibb,
GlaxoSmith-Kline, Forest Laboratories, Eisai Inc., AstraZeneca
Pharmaceuticals, Johnson & Johnson, Abbott Laboratories, Organon USA, and
Amgen.

"Mark Probert" wrote in message
news:Iyb0h.12125$iM2.8983@trndny08...
Herman Rubin wrote:
In article wYR%g.12962$k63.3627@trndny06,
Mark Probert wrote:
Vernon wrote:

http://toronto.fashion-monitor.com/n...02304ADHD-Drug

ADHD Drug Safe and Effective for Pre-Schoolers

Excerpts:

...................

Oh, come on QQQ. We can't have children running around acting like
children.

Vernon, if they are merely acting like children, they do not have AD/HD.
If you knew the diagnostic criteria, you would know why.

Unless we have VERY strong evidence that there is a
mental problem which keeps a child from learning, and
later coping as an adult, and which can be treated in
such a way that their abilities, whatever they are,
are not adversely affected, do not treat for conditions
which are merely incompatible with sitting still in a
boring situation.

Correct. In such a case, that child does not have AD/HD.

Those who can tolerate long periods in boring situations
are unlikely to be good for anything which requires
original thinking, or real problem solving.

Disagree. Sometimes, there are people who get "lost" in their thoughts and
do some remarkable thinking.

But modern so called psych medicine says that ALL children MUST act alike,
never be hyperactive and NEVER be silent.

Yes, there are many children that cope with the stupid boredom of the
typical class environment by mentally going on other tracks. That is
"cured" with drugs.

Some children have problems, yes.

Updated:



http://www.canada.com/components/pri...8-384075902843


Study: Giving ADHD drugs to preschoolers ok

Excerpts:


[why am I not surprised, see my inserts below].

BALTIMORE - A new study by the top medical university in the U.S. has
concluded that carefully measured, low doses of methylphenidate, the key
ingredient in drugs used to treat attention-deficit and hyperactivity
disorder, is safe and effective for treating behavioural problems in
preschoolers -- a departure from FDA regulations preventing its prescription
to children younger than six.

http://www.gwu.edu/~bulletin/ugrad/univ.html

[The School of Medicine and Health Sciences has had continuous approval by
its accrediting body, which is currently the Liaison Committee on Medical
Education, sponsored jointly by the American Medical Association and the
Association of American Medical Colleges]

Methylphenidate is the most widely prescribed drug for the treatment of ADHD
in children but is not approved by the U.S. Food and Drug Administration for
use in children younger than six.

Results of the federally funded research, the first large-scale, long-term
study of the safety and value of the drug in younger children, will appear
in a special section of the November issue of the Journal of the American
Academy of Child and Adolescent Psychiatry.

[American Academy of Child and Adolescent Psychiatry 49th Annual ... These
materials and the related activity are not sanctioned by the American
Academy of Child and Adolescent Psychiatry or the commercial supporter of
the ...]

http://www.aacap.org/page.ww?section...me=Institute+8



Sponsored by the AACAP Work Group on Research Pediatric Psychopharmacology
Initiative and partially supported by an unrestricted educational grant from
Eli Lilly and Company

http://archpedi.ama-assn.org/cgi/con...tract/157/1/17

~~~

"We were able to confirm what many already suspected-that even lower doses
in preschoolers can safely achieve the desired therapeutic effect and indeed
that low doses are often optimal."

[ need to know more, I don't think so...]. Then there is:

http://www.medpagetoday.com/Psychiatry/ADHD-ADD/tb/4358

Excerpts:

Ritalin Less Effective for ADHD in Preschoolers Than Older Children

NEW YORK, Oct. 24 -- Ritalin (methylphenidate) appears effective in treating
attention-deficit hyperactivity disorder (ADHD) in preschoolers though less
than in older children and with more side effects, researchers said.

Despite lack of FDA approval for use in children younger than age six,
Ritalin is the most widely used stimulant medication for treating preschool
children with ADHD, they noted.

Only 21% of the preschoolers titrated to their best dose achieved remission,
a primary endpoint that did not reach significance compared with the 13% who
achieved remission on placebo.

Tolerability was lower than expected, found Tim Wigal, Ph.D., of the
University of California in Irvine, and colleagues. They reported that 11%
of the183 preschoolers discontinued due to adverse events compared to a
previously reported rate of less than 1% in school-age children.

Various authors reported financial disclosures for Cephalon, Pfizer,
Pyrogenics, Shire, Eli Lilly, New River Pharmaceuticals, McNeil, Celltech,
Novartis, Sanofi Aventis, Otsuka, Janssen, UCB, Wyeth, Bristol-Myers Squibb,
GlaxoSmith-Kline, Forest Laboratories, Eisai Inc., AstraZeneca
Pharmaceuticals, Johnson & Johnson, Abbott Laboratories, Organon USA, and
Amgen.