Child and Adolescent Psychiatry Consulting

Researchers under  Dr. Matthew State, an associate professor of child psychiatry, psychiatry and genetics at Yale University School of Medicine. have been studying the genome of  a family in which the father and all eight of his children have Tourette Syndrome  and have identified a mutation on the HDC gene that encodes the enzyme L-histidine decarboxylase, which is involved in regulating levels of the neurotransmitter histamine in the central nervous system.

This research provides clues to treating Tourettes Disorder, a neurological disorder that can cause debilitating, involuntary motor and verbal tics.

While the variant itself is likely very rare — meaning most people with Tourette syndrome don’t have the precise mutation — what’s known about the gene’s function in the body hints at new treatments, researchers explained.

Previous research in mice has shown that manipulating brain levels of histamine by decreasing activity of HDC makes mice more likely to have repetitive behaviors, such as biting, rearing and chewing, which may be similar to tics in humans.

Drugs that increase the release of histamine in the brain, but don’t affect histamine levels in other parts of the body, are in the latter stages of development. Previous research has shown that when given to mice, these drugs decrease the repetitive behaviors. It’s possible those drugs could also help people with Tourette syndrome.

Genetics may point to the function of the gene, which points to what kind of mechanisms might be involved in the disorder.

The study is published in the New England Journal of Medicine.

Tourette syndrome tends to run in families. The disorder usually emerges in childhood and, for some, improves in adulthood. Although the causes of the syndrome are unknown, previous research suggests abnormalities in certain brain regions and in the neurotransmitters dopamine, serotonin and norepinephrine may play a role.

Children who see doctors for Tourette syndrome often have other disorders as well, including depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or learning disabilities.

Many cases of Tourette syndrome are mild and improve over time. But severe cases can be debilitating — socially and physically — and current treatment options are limited.

In addition to behavioral intervention, first-line medications include antidepressants and anti-anxiety medication. More severe symptoms of the syndrome can be treated with antipsychotic medications such as risperidone (Risperdal) or neuroleptic medications, such as haloperidol (Haldol), but long-term side effects can be serious.

The mutation identified in this family may be unique to them, but suggests the likelihood that functional differences in the  HDC gene or in the histamine biochemical pathway would play a role in other families affected by Tourettes.

SOURCES: Matthew State, M.D., Ph.D., associate professor, child psychiatry, psychiatry and genetics, Yale University School of Medicine, New Haven, Conn.; Francis J. McMahon, M.D., chief, Genetic Basis of Mood and Anxiety Disorders, National Institute of Mental Health, Bethesda, Md.; May 5, 2010, New England Journal of Medicine, online

The Campaign for a Commercial-Free Childhood Reclaiming Childhood from Corporate Marketers

• 40% of 3-month-old babies are regular viewers of screen media[1]
• Preschoolers spend an average of 32 hours a week outside of classrooms engaged with screens?[2]
• 36% of center-based child-care programs include TV, for an average of 1.2 hours a day
• 70% of home-based child-care programs include TV for an average of 3.4 hours per day?[3]
• Excessive screen time for children is linked to negative outcomes such as childhood obesity[4] and poor school performance?[5][6]

This week, we have an important opportunity to help reverse these troubling trends.

• The National Association for the Education of Young Children (NAEYC) is updating its position statement on Technology and Young Children for the first time in 14 years and has issued a call for public comments.
• Because NAEYC is the nation’s premier professional organization for early childhood educators, the statement will have a profound effect on young children’s media use both in and out of classrooms.

Today, CCFC sent a letter signed by 70 leading early childhood educators, pediatricians, and child development experts urging NAEYC to join the American Academy of Pediatrics and the White House Task Force on Childhood Obesity in taking a strong stand for limiting screen time in the lives of young children.

• The letter includes a list of research-based recommendations CCFC hopes the NAEYC will adopt, including that young children have little or no exposure to screen technologies in child-care, preschool or kindergarten settings.
• You can read the CCFC letter here.

• To submit your own thoughts or support CCFC’s recommendations, please visit http://www.naeyc.org/positionstatements/tech.
• Be sure to indicate if you’re a NAEYC member, an early childhood educator, or a parent of a young child.  And feel free to use CCFC’s core recommendations as a basis for your comment.

CCFC urges NAEYC to:

Recommend that children have little or no exposure to screen technology in child-care, preschool, and kindergarten settings.

Expand the focus of its position statement to include children younger than 3 and recommend that child-care settings for infants and toddlers be completely screen free.

Endorse the recommendations of the American Academy of Pediatrics (AAP) and the White House Task Force on Childhood Obesity of no screen time for children under the age of 2 and limited screen time for older children.

Review the research on children and technology with a critical eye, asking who funded it and whether any reported gains can also be achieved through hands-on experiences proven to be beneficial to children, without the potentially negative consequences associated with screen media.

We realize the comment process is a little more work than signing your name to a pre-written letter, but we hope you’ll take the time.  Reducing young children’s screen time is an important step toward a commercial-free childhood.

[1] Zimmerman, F., Christakis, D. & Meltzoff, A. (2007). Television and DVD/video viewing in children younger than 2 years. Archives of Pediatric and Adolescent Medicine, 161(5), 473-479.
[2] The Nielsen Company (2009). TV viewing among kids at an eight-year high. Retrieved July 19, 2010 fromhttp://blog.nielsen.com/nielsenwire/media_entertainment/tv-viewing-among-kids-at-an-eight-year-high/
[3] Christakis, D. (2009). Preschool-aged children’s television viewing in child care settings. Pediatrics, 124(6), 1627-1632.
[4] Jordan, A., Kramer-Golinkoff, E., & Strasburger V. (2008). Do the media cause obesity and eating disorders?Adolescent Medicine State of the Art Review, 19(3), 431- 449.
[5] Sharif, I. & Sargent, J. D. (1996). Association between television, movie, and video game exposure and school performance. Pediatrics, 118(4), 1061-1070.
[6] Shin, N. (2004). Exploring pathways from television to academic achievement in school age childen. Journal of Genetic Psychology, 165(4), 367-382.

Does your husband or wife constantly forget chores and lose track of the calendar? Do you sometimes feel that instead of living with a spouse, you’re raising another child? Your marriage may be suffering from attention deficit hyperactivity disorder.

Is ADHD affecting your marriage?  Mental health experts note that attention problems can take a toll on adult relationships.

In a marriage, the common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness, and a lack of love and concern.

It is estimated that at least 4 percent of adults have ADHD; about 10 million U.S. adults, with only about 1.2 million of affected adults in treatment, and with many adults having never received the diagnosis as children.

As many as half of all children with A.D.H.D. do not fully outgrow it and continue to struggle with symptoms as adults.

Symptoms can include trouble with maintaining employment or completing schooling, marital difficulties,  financial challenges, repeated driving violations/tickets,

Adults with attention disorders often learn coping skills to help them stay organized and focused at work, but experts say many of them struggle at home, where their tendency to become distracted is a constant source of conflict.

Some research suggests that adults with ADHD are  twice as likely to be divorced; another study found high levels of distress in 60 percent of marriages where one spouse had the disorder.

Spouses of adults with ADHD often feel they cannot count on their partner. They may feel that the spouse is not dependable such that the unaffected spouse must take responsibility for everything.

Sometimes the unaffected spouse can become chronically angry, frustrated that they dont help around the house, that they are inconsiderate, or that they cannot count on the spouse to complete simple tasks such as running to the bank, paying bills on time, or picking up the kids. They may feel they have no choice but to constantly nag to make sure things get done.

Spouses with attention deficit, meanwhile, are often unaware of their latest mistake, confused by their partner’s simmering anger. A lengthy to-do list or a messy house feels overwhelming to the A.D.H.D. brain, causing the person to experience paralysis, and they accomplish nothing, which further infuriates their spouse. This does not happen due to laziness or selfishness, it happens due to the difficulty with task planning and organization.

Although treatment often starts with medication, it typically doesn’t solve a couple’s problems. Talk therapy may be needed to unpack years of accumulated resentments.

Behavioral therapy and coping strategies — for both partners — are essential. Long, to-do lists given to the spouse with ADHD will not be productive. instead, asking that one task at a time be targeted is more helpful.

The United States currently has fewer than half the child psychiatrists it needs.

Although the Northeast and cities such as Los Angeles and San Francisco are adequately stocked, he said, rural areas face major shortages. Nebraska, for example,  has 32 child and adolescent psychiatrists, according to the UNMC-based Behavioral Health Education Center of Nebraska. It would need at least nine more to hit the average ratio as determined by the American Academy of Child and Adolescent Psychiatry. The University of Iowa lists neurology and psychiatry as the two medical specialties that the state needs most.

There are shortages in both adult and child psychiatry. Child and adolescent psychiatrists have more advanced training in diagnosing and treating kids with play therapy — using toys or dolls, for example — than do other mental health practitioners. Psychiatrists also may prescribe medications, which other mental health practitioners generally aren’t allowed to do.

Pediatricians often feel overwhelmed and frustrated when treating children with mental health. Many pediatricians see numerous children with mental illnesses and behavior problems.

The material below is excerpted from an article by Sarah Juon, Co-founder of news of the north.net:

Richard Immler, MD, is a child psychiatrist who works with clinics in northern Wisconsin. As a doctor providing subspecialist care, Immler is the only board-certified child psychiatrist in residence north of Merrill.

“There is an enormous need for child psychiatric services here,” Immler says. “I feel it’s a crisis. My waiting list at the Human Service Center in Rhinelander is up to two years. To have a two-year waiting list is extremely discouraging. Innocent children and their families are suffering, as they are waiting for months to get optimized care.” While waiting, many families drive to Green Bay, Wausau or Marshfield to receive services.

Immler also provides services for North Central Health Care in Wausau and Ministry Health Care in Rhinelander. At the former, he has a waiting list of three months, and at Ministry, “the caseload is saturated,” he says.

A shortage based on burn-out

The causes for the waiting period are nation-wide, Immler says. “There is a shortage of child psychiatrists everywhere.” One of the main reasons, he believes, is that the cost of medical school – involving four years of post-college training – is very expensive, and the compensation for child psychiatry is lower on the scale of subspecialties.

Psychiatric services are also emotionally and time-intensive, requiring long hours to achieve the best outcomes, Immler explains. “It’s not procedure-oriented,” he notes, “in a reimbursement system that compensates physicians by billable hours. There are medical students who are drawn to child psychiatry, but feel they can’t afford it and end up in another field.”

Immler is quick to clarify that he feels psychiatrists are not in the poorhouse, but when other factors are added in, the profession looks disadvantaged. “There is also a high burn-out rate,” he says. “Nine child psychiatrists in northern and central Wisconsin have come and gone in last 12 to 15 years. It’s a field that demands quite a bit of time and coordination with others involved in the child’s life.”

Immler has chosen to practice in rural northern Wisconsin “because I grew up in here and I love living here,” he says. “Otherwise, I wouldn’t be here. There’s a saying that we need to grow our own healthcare providers. It’s especially true now, with the looming shortage in all healthcare professionals as the baby boomers retire.”

Another factor contributing to doctor burn-out, Immler believes, is the isolation that psychiatrists may experience in a rural area. “If I’m working with a team, if we’re in this together, I can handle the stress, versus going it alone. We need a collaborative approach here, a wrap-around services model like Wausau has. Other cities, like Milwaukee and Madison, have adopted this too. We don’t have it up here, and we’re not nearly as effective as we could be.”

To see the full article: http://www.newsofthenorth.net/article.cfm?articleID=24547

TOY STORY 3: PLAY in 3-D Our high expectations of Pixar Studios are met right at thebeginning of this wonderful film. Cowboys, narrow escapes,train wrecks and speed fill the screen, and it’s all in 3-D. We, theaudience, soon realize that we are experiencing something evenmore remarkable than this cinematic feast set before us; we arelooking into the fertile mind of Andy, the owner of the belovedToy Story characters. He is PLAYING. His toys are acting ascatalysts for his creative imagination, fostering motor and languagedevelopment, while helping Andy tell his story.It is hard to believe that Andy is ready for college, but then again ithas been 15 years since the first Toy Story appeared. Like so manyincoming freshmen, he has to make decisions about what “stuff”comes with him. This certainly reflects a reality, as we all havewitnessed the numerous stuffed animals in dorm rooms whileon college visits. The film’s plot deals with the adventures andgrowth of the Toys, as they face a change of venue and function.Therefore, psychologically the film is about the various transitionsin the Life Cycle, including separation and meaning, as well asloyalty and individuation. The movie is also an allegory about ourdisposable culture, which discards toys as well as people..Toy Story 3 is an entertaining film for adults, as well as childrenwith several hilarious set pieces involving Ken’s wardrobe andBuzz as a Latin lover. However some of the scenes in the notsunny Sunnyside Daycare Center and the dark garbage dumpare a bit scary, thanks to an ego inflated Lots-o’-Huggin Bear(Ned Beatty), who seems to be suffering from Post-TraumaticStress Disorder. Because of the fast editing and quick thinking ofWoody(Tom Hanks),however, these frights didn’t seem to affectmy 5 year old nephew, Jonah, who seemed more focused on theheroics of the cute, space doll toys.The action in the film moves along and is spectacular from acinematic perspective with its vivid colors, attention to detail, andnon-intrusive 3-D.Special praise should go to the actors Tim Allen (Buzz Lightyear),Don Rickles (Mr. Potato Head), Jodi Benson (Barbie) and MichaelKeaton (Ken), who are quite convincing. But the real stars are thetwo big play sequences that take place at the film’s beginning andin Bonnie’s (Emily Hahn) bedroom. They are both remarkable forthe insight they provide into children and their play, which hereincludes mastery and control over impulses and the need for love.One doesn’t have to be a child psychiatrist to appreciate the peekwe are getting, from this PLAY into a child’s private world.The movie is rated G, with one or two frightening scenes.Michael Brody, Chair of the Media Committee AACAPmbrody@umd.edu

The United State Supreme Court, recognizes there are inherent differences between juvenile and adult criminals, recently abolished the sentence of life without parole for youthful offenders in nonhomicide cases, in a decision in the case of Graham v. Florida.

• The Supreme Court ruled that Graham’s sentence was “cruel and unusual punishment” because it gave the young man no hope of gaining freedom.
• The Court found that laws in eight states are too harsh and violate the Eighth Amendment’s ban on “cruel and unusual” punishment.
• This Supreme Court Ruling requires states to give youthful offenders the chance to prove they have been rehabilitated and could be candidates for release.

This ruling has prompted California lawmakers to look at more reforms needed in juvenile sentencing.

• California has about 250 lifers who as teenagers participated in crimes involving homicides.
• People serving Juvenile Life Without Parole sentences cost California $2.5 million each.
• SB 399 is new legislation that would give individuals sentenced as youths to return to their communities after:  1) serving at least 25 years and 1) a thoughtful review to determine if they still pose a threat.
• California lawmakers advocating for SB 399 say the legislation allows the state to revisit juvenile life without parole sentences in consideration for the changes a juvenile has experienced as they’ve become an adult.

Nearly as many American soldiers have died of suicide as have been killed in combat in Afghanistan.

• There were 197 Army suicides in 2008, according to the Army’s numbers. The total includes active- and non-active-duty soldiers.
• Last year, the number was 245.
• This year, through May, it’s already 163.

The Army has instituted many programs to counsel and train soldiers  with a goal of suicide prevention. Several of them have failed. Often, as soldiers transitioned from one assignment to another, the new station was unaware of past mental health issues.

Source: U.S. military branches (2001-09) and Centers for Disease Control and Prevention (latest figures through 2006)

Credit: Adrienne Wollman

Young men who attempt suicide before age 18 are much more likely as adults to be aggressive toward their girlfriends or wives, including hitting and injuring their partners.

The Study, published online in Psychological Medicine is based on data from 153 males from higher-crime neighborhoods who were assessed yearly from ages 10 to 32, and their romantic partners who participated when the men were ages 18 to 25.

This  new research highlights the need for intervention with suicidal teens: 58 percent of youth in that study group who attempted suicide went on to injure a partner, compared to 23 percent of young men who did not attempt suicide.

The study began when the men were kids, and before anyone had data to predict who would become violent. David Kerr of Oregon State University and Deborah Capaldi of the Eugene-based Oregon Social Learning Center, controlled for other problems suicidal youth can have which are also linked to violence to partner, such as aggression, depression, substance use, and family abuse history.

The researchers still found that young men who attempted suicide were more aggressive toward their partners.

The researchers had data from official domestic violence arrest records, women’s own reports of injury, and live observations of the couples.

In the past, domestic violence has been primarily attributed to cold, controlling and calculating individuals.

This study supports a growing body of research indicating that both men and women who are physically aggressive toward a partner have histories of aggressive and impulsive  behavior.

This study is important for prevention and treatment as well:

If a man is told that domestic violence is due to a need to coldness, a need to control, and systematic battering,  he may dismiss his difficulties, since this pattern doesn’t apply to him. If clinicians explain to men that their difficulties are related to the need to control anger and impulsive  reactions while under stress, they may be more aware that they are at risk, and better able to take responsibility for treatment.

Scientists at the University College London  have produced data suggesting,  that our brains contain a highly distorted model of our own bodies

The study,published in Proceedings of the National Academy of Sciences,  focused on the brain’s representation of the hand.

The brain’s model of the hand is one in which our fingers are perceived to be shorter and our hands fatter than they are.

Neuroscientists suspect the reason for these distortions may lie in the way the brain receives information from different regions of the skin.

Participants in the study were asked to put their left hands palm down under a board and judge the location of the covered hand’s knuckles and fingertips by pointing to where they perceived each of these landmarks to be. A camera situated above the experiment recorded where the participant pointed. By putting together the locations of all the landmarks, the researchers reconstructed the brain’s model of the hand, and revealed its striking distortions.

People estimated that their hands were about two-thirds wider and about one-third shorter than actual measurements.

Participants were also accurate in picking out a photo of their own hand from a set of photos with various distortions of hand shape, suggeting there is clearly a conscious visual image of the body as well.
The research is attempting to understand how proprioception works–in other words, “how does the  brain know where all parts of the body are in space even when your eyes are closed”?

Neuroscientists think that “position sense” requires two distinct kinds of information. Signals that the brain receives from muscles and joints play an important role in position sense, but the brain also needs a model of the shape and size of each body part; to know where the fingertip is in space, the brain needs to know the angles of joints in the arm and hand, but also the length of the arm, hand, and finger.

Neuroscientists suspect that the brain’s distorted model of body shape  is related to how the brain represents different parts of the skin. For example, the size of the brain representation of the five fingers gets progressively smaller for each finger between the thumb and the little finger, mirroring the relative size of fingers in the body model reported in this study.

These findings may be relevant to psychiatric conditions such as Anorexia nervosa and other eating disorders. It is possible that people tend to perceive the body as being wider than it is.  Though the participants had an accurate visual image of their own body, it is possible that the distorted perception related to proprioception could dominate in some people, so that body image is distorted.