Tuesday, October 21, 2008

ADHD and Nature Walks

I was perusing the NY Times today when I came across an article on Tara Parker-Pope's blog on wellness about a small study conducted at the University of Illinois at Urbana-Champaign about nature walks for children with ADHD.

Here is a quote from her blog which can be found at http://tinyurl.com/5lqqhm

"A small study conducted at the University of Illinois at Urbana-Champaign
looked at how the environment influenced a child’s concentration skills. The
researchers evaluated 17 children with attention deficit hyperactivity disorder,
who all took part in three 20-minute walks in a park, a residential neighborhood
and a downtown area.

After each walk, the children were given a standard
test called Digit Span Backwards, in which a series of numbers are said aloud
and the child recites them backwards. The test is a useful measure of attention
and concentration because practice doesn’t improve the score. The order of the
walks varied for all the children, and the tester wasn’t aware of which walk the
child had just taken.

The study, published online in the August The
Journal of Attention Disorders, found that children were able to focus better
after the “green” walks compared to walks in other settings."
I did not find this discovery to be at all surprising. This was a suggestion given to me when I was diagnosed with ADHD, and it's one I always recommend to parents. Whether a child is on medication or not, I recommend twenty to thirty minutes of outside play immediately after school before homework. Unfortunately, not all parents seem to believe me that it works. I am happy to have a study, be it small, to quote, rather than only my own experience.

For myself, I have learned that I am able to focus much better when I get home when I have gone for a run, once I recover a little...To help motivate myself, I like to sign up for races, it gives me something to work towards; if I don't, then I can come up with one hundred excuses not to exercise on any given day! I cherish my runs outdoors, breathing in the fresh air, having quiet time without interruption, and working my muscles. I also get a mental boost from the sense of accomplishment.

On a different note, I worry about "kids these days," to sound like an old lady. Most of them have such busy schedules, going from school, to soccer, to music, home or out for dinner, then homework. Does anyone play kickball on the street anymore after school? Does this over-scheduling have something to do with the increase in the diagnosis of AHD? I also wonder what happens to some of these kids when they get to college, and suddenly they are in charge of their time after classes. Do they know how to allocate their time wisely? I don't know, but I'd love to hear from some readers!

Friday, October 17, 2008

last debate

Two nights ago, I watched the last debate, more out of curiosity than a notion that I might hear something new; I wanted to see how Sen. McCain behaved in light of his declining popularity. Sure enough, neither candidate said anything particularly new and exciting, and each one responded to the other in much the same way they had in the previous debates, one with an awkward chuckle, the other with utter calm and poise.

However, I, along with Orac, a fellow blogger (see http://tinyurl.com/4a695j), was puzzled by McCain's discussion of autism. Orac, along with others, felt that this was pandering to the "autism-vaccine" people, as well as an attempt to make up for previous incorrect statements about vaccines. I suspect that this is true. But what I found particularly strange was this focus on Gov. Palin's understanding of autism...because she has a child with Trisomy 21? Or does McCain get the two diagnoses confused? They couldn't be more different! I realize that children with autism and with Trisomy 21 both are considered to have special needs but to assume that a parent of one is an expert on the other just doesn't make sense. Maybe he didn't realize that this discussion which he inserted into a statement about reform (and again, how is this related???) would cause a negative stir.

Both as a pediatrician and as a former early interventionist, I am extremely interested in education, including early childhood, special education, and regular education (if you can call it that!). I have been listening carefully to what the candidates have been saying about this. Wednesday night, Sen. McCain proved again to me that he doesn't know much about the topic and that he doesn't really care much about it. Although Sen. Obama hasn't spoken a lot about special education, I am thrilled with his interest/belief in early childhood education. Sadly, with a rotting economy and the "war on terror" to pay for, I don't know how much can truly be done about it, but I think it is a wise investment, even in this economic state. I like Sen. Obama's idea of getting parents more involved, although I don't really know how he can enforce that. But, how can we continue to be a world leader if our educational system is in a similar state to our economy? Certainly, a spending freeze would do nothing for the state of education, it might even diminish Gov. Palin's ability to get early intervention services for her son....Now I'm rambling, so I'll stop. We all know that our future president has an enormous task in front of him (or her, heaven forbid) and will likely not be able to accomplish all his goals, I just hope that the vision of a brighter future will motivate people to go out and VOTE!!!!!

I thought this video from The Onion was quite amusing, helps lower the blood pressure after listening to these debates!!

Latest Poll Reveals 430 New Demographics That Will Decide Election

Monday, October 6, 2008

drug samples in pediatric offices

This morning, as I was catching up on the news in between patients, an article in the NY Times caught my eye: http://tinyurl.com/42ttru. Upon seeing the title, I immediately thought the article would address the issue that drug samples do not come in child-proof containers; however, it actually addresses another serious issue with drug samples which is drug safety.

The pharmaceutical industry gives samples to physicians generally of the latest, "greatest," most expensive drugs. These often have not been tested on pediatric populations yet. This is quite concerning when one considers some of the black box warnings which end up coming out, as happened with Elidel, among others. It is attractive, however, for physicians to use the samples they are given, but difficult for the family if the drug works and they then have large co-pays to cover. I have to admit that, working at a community health center, I don't see much in the way of pharmaceutical representatives, except for those representing immunizations. The majority of my patients have medicaid, so I stick with those formularies as much as possible.

I would like to bring up the point I made earlier, though, and that is patient safety of sample packages. Our pharmacy encourages us to put all samples in child-resistant containers, print out a label like with a regular prescription, which has exact dosing on it, and to print out the drug information to hand the family with the sample. Now, if that sounds like a lot of work, it is, especially when I am the pharmacist dispensing the sample while seeing a full load of patients. Yet, I think it's worth the time to prevent an accidental ingestion. For example, one of the few samples I have is chewable Singulair. This comes in a foil push-out packet (I don't know the official term for this type of packaging). If a child gets a hold of one of these packets, it would be very easy to play with it and pop out one of the yummy pills...chomp chomp. Fortunately, this is not a terrible dangerous drug, but nonetheless... Do most offices dispense samples using this tedious process? Or is there a simpler way of doing it? I am open to suggestions. It just strikes me as odd in this litigious world we live in and especially as safety-conscious pediatricians, we allow this to continue. Perhaps we need to start bugging our friendly pharmaceutical reps! Any takers?