Raj Persaud in conversation - the podcasts
What is a disorder of Attention? What is Attention Deficit Hyperactivity Disorder (ADHD)?

Raj Persaud in conversation with Heidi Feldman Professor of Psychiatry at Stanford University

Professor Heidi Feldman discusses her recent paper in the New England Journal of Medicine on ADHD

Attention Deficit--Hyperactivity Disorder in Children and Adolescents Heidi M. Feldman, M.D., Ph.D., and Michael I. Reiff, M.D. N Engl J Med 2014; 370:838-846February 27, 2014

ADHD is characterized by inattention, hyperactivity, impulsivity, or a combination of these symptoms, which compromise functioning. Management includes medications (shown to improve core symptoms but not necessarily functional outcomes) and behavioral therapies.

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Personal bio 

Heidi M. Feldman MD PhD holds the Ballinger-Swindells Endowed Professorship in Developmental and Behavioral Pediatrics at Stanford University School of Medicine and serves as the Medical Director of the Mary L Johnson Developmental-Behavioral Pediatrics Clinical Programs at Lucile Packard Children's Hospital. She earned a PhD at the University of Pennsylvania in Developmental Psychology and an MD at the University of California San Diego School of Medicine. She is currently combining neural imaging techniques and behavioral measures to understand the outcomes of children and adolescents born preterm. She has taught Developmental Disabilities: From Biology to Policy in Human Biology at Stanford University. Dr. Feldman is also a dedicated yoga enthusiast and yoga teacher. 

 

A related article first published in The Huffington Post which may be of interest

 

http://www.huffingtonpost.co.uk/dr-raj-persaud/childrens-mental-health_b_4068424.html

 

Is our children's mental health worse than ours? If so - why?

 

Raj Persaud and Professor Sir Simon Wessely (President of the Royal College of Psychiatrists)

 

Under a headline: 'Children as young as five suffering from depression', The Daily Telegraph Newspaper recently declared that the National Institute of Health and Clinical Excellence (NICE)  reported 80,000 children in the UK with severe depression, including 8,000 below the age of 10. Children as young as five can suffer from the psychiatric disorder; NICE affirms more identification of these children is needed.

 

A few days later The Daily Telegraph's new headline was: ''Toxic childhoods’ blamed for 22,000 self-harm cases' - beneath the headline was a byline: 'More than 22,000 children and teenagers were treated in hospital for self-harming in 2012, according to official figures which experts said showed the “toxic” effects of social media and a society obsessed with body image'.

 

Might it be more relevant that the UK currently has one of the highest divorce rates in Europe? At least one in three children here experience parental separation before the age of 16 years. Between a third and a half of all children in the UK have a non-resident parent, usually the father, during some part of their childhood?

 

A study entitled 'Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart', compared large samples of youth 20 years apartusing identical symptom screening in each survey. Twice as many young people reported frequent feelings of depression or anxiety in 2006 as in 1986.

 

Stephan Collishaw, Barbara Maughan, Lucy Natarajan, and Andrew Pickles from Cardiff University and the Institute of Psychiatry, London concluded was there has has indeed been a real and substantial increase in adolescent emotional problems in England over recent decades, especially among girls. The proportion of girls with five or more psychological symptoms doubled.

 

Published in the 'Journal of Child Psychology and Psychiatry', the study found that whether or not they were raised in an intact or socially advantaged family was associated with girls' mental health, but not boys'. 

 

Iryna Culpin from the School of Social and Community Medicine, University of Bristol led a team which conducted a major study entitled, 'Father absence and depressive symptoms in adolescence: Findings from a UK cohort', whose results are just about to be published.

 

This team of researchers, including J. Heron, R. Araya, R. Melotti and C. Joinson, followed up 5631 UK children, and found an association between father absence during the first 5 years of life and increased depressive symptoms at 14 years. But father absence experienced during middle childhood (5–10 years) was not associated with increased depressive symptoms at 14 years.

 

The study - to be published in the medical journal 'Psychological Medicine', found that the association between father absence during the first 5 years of life and depressive symptoms at 14 years was stronger in girls than boys.

 

But exactly why girls are more sensitive to father absence during early childhood remains a mystery. The authors of the current study point to previous work which found father absence during the first 5 years is associated in daughters with earlier timing of first period, increased rate of sexual activity and teenage pregnancy, which are, in turn, associated with increased levels of depressive symptoms in girls.

 

Dr Benjamin Baig, Clinical Lecturer, Department of Child and Adolescent Psychiatry at the Institute of Psychiatry, London, points out that the age of first period has become younger by one year over the last 80 years. He suggests that modern childhood appears to mean becoming biologically older at a younger age, and displaying adult type psychiatric symptoms, chronologically earlier.

 

Karen Schepman, Stephan Collishaw, Frances Gardner, Barbara Maughan, Jacqueline Scott and Andrew Pickles in another study, posed the specific question, 'Do changes in parent mental health explain trends in youth emotional problems?'” English adolescents in 2006 were considerably more likely to be exposed to maternal emotional problems than their counterparts in 1986. The study published in 'Social Science and Medicine' found maternal emotional problems increased across all socio-demographic groups between 1986 and 2006, mirroring increases in adolescent emotional problems over this period. 

 

So if it's not so much bad parenting - but poor maternal mental health - which could be a major culprit, should another favourite media whipping boy - new technology - also still be in the frame for rising childhood mental health problems?   

 

A study just published entitled 'Older Versus Newer Media and the Well-being of United States Youth: Results From a National Longitudinal Panel', followed 719 nationally representative young people, ages 14-24 years in the USA, and found use of older media was more related to school grades. Television was negatively, and book readingpositively related to academic performance. 

 

The authors of the study, Daniel Romer, Zhanna Bagdasarov, and Eian More from the University of Pennsylvania, conclude that despite concerns that excessive use of new media is harmful to adolescent development, it's actuallytelevision which most detracts from academic performance and book reading which most supports it. 

 

Heavy use of the Internet and video gaming may in fact be more a symptom of mental health problems than a cause. The authors of the study, published in the 'Journal of Adolescent Health' point out that withdrawal from social activity, which is a symptom of depression, leads many young people to turn to media use as a replacement for hanging out with friends.

 

Depression in adolescents is linked with clinical low mood in adults, strengthening the case for early intervention if possible  

 

Yet Child and Adolescent Psychiatrists at the country's largest mental health trusts point out they face 30% cuts over the next two years.

 

Jane Costello, Professor of Psychiatry at Duke University in the USA, comments on the predicament: 'The bottom line is that services are so scarce that it hardly matters how many kids need them—the gap between need and availability is so huge.'

 

Cycles of unhappiness repeat themselves. Parental depression is associated with child and adolescent emotional problems, via a variety of pathways, and certainly not just genetic.

 

Given that parental mental health problems are amongst the strongest predictors of child and adolescent emotional disordersthis raises the prospect of a ‘vicious cycle’ of inter-generational transmission of anxiety and depression.

 

More support for Child and Adolescent Mental Health Services, is an investment not just for the present, but for the future.

 

49th Maudsley Debate: ‘Sick Children or Sick Society?’

 

“What should we make of the seemingly inexorable rise in psychiatric diagnoses in children?” Tuesday 15th October 2013, 6pm to 8pm (refreshments served from 5.30pm) Wolfson Lecture Theatre, Institute of Psychiatry Main Building, De Crespigny Park, London SE5 8AF. All Welcome.

 

 


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