PER Survey

Clinical ShowCase™: Developing a Personalized Treatment Plan for a Patient with Sickle Cell Disease

Clinical Showcase Sickle Cell 

Childhood adversity increases risk of cardiovascular disease (CVD), according to a recent study.

CVD is currently the main cause of death worldwide, with rates of CVD in young adults rising over time. Genetic factors have been associated with CVD, but investigators hypothesized that environmental and behavioral factors also impact CVD risk.

Adversity has been linked to CVD in middle-aged and older individuals, but little data has been gathered on the effects of childhood adversity on CVD in young adults. Multiple internal systems develop throughout childhood, including physiological stress response. The development of this system could be affected by frequent exposure to adversity.

Overeating, excessive alcohol consumption, and smoking are all behaviors associated with CVD, and childhood adversity has been linked with higher risk of these behaviors. However, the effects of childhood adversity on congenital aetiology are still unclear.

To examine the impact of childhood adversity on CVD in individuals aged 16 to 38 years with a focus on ischaemic heart disease (IHD) and cerebrovascular disease (CD), investigators conducted a population-based cohort study. Data was gathered from the DANish LIFE coursecohort, containing information from multiple registers nationwide.

Information on childhood adversities, morbidity, and mortality of children born from January 1, 1980, to December 31, 2001, was taken for the study. Participants were alive and residing in Denmark until their 16th birthday without a CVD or congenital heart disease diagnosis. The final study population included 1,263,013 individuals.

Cadversities were divided into 3 categories: loss or threat of loss in the family, family dynamics, and material deprivation. Family poverty and parental long-term unemployment were cases of material deprivation, while parent and sibling somatic illness and death was loss or threat of loss in the family.

Family dynamics included: parental alcohol and drug abuse, foster care placements, parental and sibling psychiatric illness, and maternal separation.

CVD as cases of IHD or CD was the primary outcome. Covariates included year of birth, paternal age at birth, parental country of origin, and parental cardiometabolic illness. Adjustments were made for the effects of being small for gestational age at birth and parental education at time of birth.

The mean follow-up period for participants was 10.8 years after their 16th birthday. During this follow-up period, 4118 participants developed CVD, 966 of which developed IHD and 3152 CD. There were 5178 deaths from a cause other than CVD, and 96,812 emigrations from the study prior to the follow-up.

Participants were more likely to face adversity if they were born to teenage mothers, with persistent deprivation risk high among this group. Material deprivation was also common in children born to parents of a non-Western origin.

Parental cardiometabolic illness in was seen in 24% of participants with material deprivation, 36% with loss or threat of loss, 39% with high adversity, and 21% with low adversity. Low parental education was seen in 8% of participants in the low adversity group and 54% of the high adversity group, and small for gestational age was seen in 11% of the low adversity group and 22% of the high adversity group.

Individuals with high adversity had an increased risk of developing CVD, with 10 to 18 extra cases per 100,000 people. Men and women in the loss or threat of loss group had 15.6 and 9.7 more CVD cases per 100,000 people respectively. Individuals early in life or having experienced material deprivation were also more likely to develop CVD, but the risk was only modestly higher than average.

As high childhood adversity led to the greatest risk of CVD, investigators recommended that efforts toward providing affected families with support could reduce the rate of long-term cardio-protective effects.

Bengtsson J, Elsenburg LK, Stig Andersen G, Lytken Larsen M, Rieckmann A, Hulvej Rod N, Childhood adversity and cardiovascular disease in early adulthood: a Danish cohort study. 

Articles

Data from the DANish LIFE course cohort indicated that individuals with high adversity in childhood were at a greater risk of developing cardiovascular diseases than those with low adversity.

Childhood adversity increases risk of cardiovascular disease

In a Q&A, Bradley Warady, MD, pediatric nephrologist and researcher at Children’s Mercy Kansas City, discussed the rise in parental hesitancy toward vaccines, along with the effects this will have on public health.

How has vaccine hesitancy affected vaccination rates in the past 2 years? What health outcomes will this lead to?

 In 2019, the World Health Organization listed vaccine hesitancy as one of the top 10 threats to global health. Vaccine hesitancy has always been a concern, but it has become increasingly prevalent and has continued to rise across the United States, especially with the COVID-19 pandemic. The pandemicsparked conversation about vaccine hesitancy in general, and the low vaccination rates across the country reflect a highly visible increase in vaccine hesitancy. 

Research has shown that parents who reported hesitancy to other general childhood vaccines or influenza vaccines were also less likely to vaccinate their child against COVID-19. Information from a phone survey conducted in May 2022 showed that 33% of parents reported that they would not give their child the COVID-19 vaccine.

Vaccine hesitancy as it relates to childhood vaccines has been linked to significant outbreaks, so it is a public health priority to increase trust in vaccines. Failure to vaccinate places children at risk for otherwise preventable infections, and a variety of associated complications. Vaccine hesitancy and refusal is of particular concern for immunocompromised children, such as transplant recipients or those with cancer, who are at an increased risk for serious infection because of the medications they must receive. 

 How has social media contributed to the increase in vaccine hesitancy?

 Social media facilitates the rapid spread of information. While it allows for the dissemination of useful and accurate information, it also allows for widespread misinformation regarding vaccine efficacy and safety, which has likely contributed to growing vaccine hesitancy and opposition. Thus, while there is overwhelming evidence that the COVID-19 vaccine is safe and effective, vaccine hesitancy persists.

 How has parents’ hesitance toward the COVID-19 vaccine affected their willingness to have their children vaccinated against other diseases, such as influenza?

There is strong evidence that COVID-19 vaccine hesitancy has affected parents’ decisions about other childhood vaccines. For example, data from the US Centers for Disease Control and Prevention (CDC) found that between 2020 and 2021, there was a decrease in influenza vaccine rates for children. This is particularly relevant today with the exceptionally high numbers of children that are currently being seen with influenza.

How can healthcare providers help reduce parents’ vaccine hesitancy?

 The main reasons behind parents’ vaccine hesitancy are concerns about vaccine safety, variation in recommendations provided by healthcare professionals, and the need for more information. In turn, health care providers should make every effort to share consistent, clear, and pertinent information about the COVID-19 vaccine with their patients and parents. Health care providers should also use all medical encounters as an opportunity to provide vaccine-related education and answer vaccine related questions. At the same time, the medical community can work together to further explore and identify barriers to vaccination so that those barrierscan be addressed in a thoughtful and effective manner.

Bradley Warady, MD, pediatric nephrologist and researcher at Children’s Mercy Kansas City, discusses the causes of vaccine hesitancy and the effects of vaccine hesitancy on public health. 

Effects of vaccine hesitancy

The American Academy of Pediatrics (AAP) has given guidance to pediatrician offices, urgent cares, and hospitals dealing with an influx of pediatric patients.

Respiratory infections have surged among the pediatric population in the United States. Respiratory syncytial virus (RSV) is one of these infectious diseases, and children are at high risk of suffering from complications after infection. The AAP released a set of guidelines on RSV prevention, along with management for the surge of infected pediatric patients.

The current surge has been compounded by an ongoing mental health crisis in youths, leading the AAP to offer guidance that helps avoid interruptions to continuous care for both physical and mental health in children within inpatient and outpatient settings.

Special attention was given to children with special health care needs, including those with medical complexity, who are often the most significantly impacted by surge events. The current surge includes influenza, COVID-19, and RSV, along with increasing mental health concerns.

To prevent RSV infections, the AAP recommends that infants in regions with high RSV circulation are given over 5 doses of palivizumab if eligible. The 2022 to 2023 RSV season began earlier than usual and will last longer than prior seasons. Palivizumab can be administered to eligible infants during the RSV season to prevent severe lung infection.

RSV can also be prevented by avoiding large groups, infected individuals, and smoking, as well as frequent and thorough hand washing. There is currently to medicine available for curing RSV.

According to Sean O’Leary, MD, MPH, FAAP, chair of the AAP Committee on Infectious Diseases, RSV and other respiratory illnesses can be safely managed at home, with most children recovering without external help. When children are struggling to breathe, O’Leary told parents to call their pediatrician immediately.

O’Leary also recommended families get vaccinated against influenza and COVID-19, as this will prevent most cases of severe infection and hospitalization.

For additional guidance, the AAP stated that routine pediatric care, chronic disease management, and immunizations should not be delayed. Medical staff treating adults can also be trained for treating younger patients.

The AAP also noted that during a surge, children should only be referred to hospitals in cases of severe illness or associated medical disorders. This will prevent hospitals from overcrowding, keeping wait times manageable.

American Academy of Pediatrics offers guidance on RSV prophylaxis, handling surge of pediatric patients with respiratory infections. American Academy of Pediatrics. November 18, 2022. Accessed November 22, 2022. 

https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-offers-guidance-on-rsv-prophylaxis-handling-surge-of-pediatric-patients-with-respiratory-infections/

In a recent statement, the American Academy of Pediatrics discussed how patients with respiratory infections can be managed, along with guidance on RSV treatment.

AAP: How to manage the surge of respiratory infections

Flu season is here and that’s good reason for precautions against it as families gather this week for Thanksgiving.

The U.S. Centers for Disease Control and Prevention published its “Weekly U.S. Influenza Surveillance Report” with the statement: “Seasonal influenza activity is elevated across the country,” according to figures up to Nov. 12.

The message to patients is simple: “An 

 is the best way to protect against flu. Vaccination helps prevent infection and can also prevent serious outcomes in people who get vaccinated but still get sick with flu. CDC recommends that everyone ages 6 months and older get a flu vaccine annually. Now is a good time to get vaccinated.”

The American Academy of Family Physicians (AAFP) led a dozen medical groups in a 

 affirming the effectiveness of flu vaccines. Physicians should tell their patients to get vaccinated against the flu and COVID-19.

“A strong recommendation from a trusted clinician is one of the most effective strategies to increase vaccine uptake,” the joint statement said. “We encourage our members to use every interaction with patients as an opportunity to make strong vaccine recommendations, educate and answer questions about prevention and treatment options, encourage vaccination, and where feasible provide vaccination.”

The statement was endorsed by the American Association of Nurse Practitioners, American Academy of Physician Associates, American College of Emergency Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, American Geriatrics Society, American Medical Association, American Osteopathic Association, Council of Medical Specialty Societies, Infectious Diseases Society of America, and AMDA – The Society for Post-Acute and Long-Term Care Medicine.

The U.S. Department of Health and Human Services also has posted an online finder to look up locations of flu and COVID-19 vaccines at 

Across the nation, so far this flu season, there have been at least 4.4 million illnesses, 38,000 hospitalizations, and 2,100 deaths from flu. The most frequently reported viruses were influenza A(H3N2).

Across the nation, so far this flu season, there have been at least 4.4 million illnesses, 38,000 hospitalizations, and 2,100 deaths from flu.

There were 16 states with flu levels rated as “very high:” Alabama, Arkansas, Colorado, Washington, D.C., Georgia, Kentucky, Maryland, Mississippi, New Jersey, New Mexico, North Carolina, South Carolina, Tennessee, Texas, Virginia, and Wyoming. There is a “high” flu rate in Arizona, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Nebraska, Nevada, New York, Ohio, Washington, and Puerto Rico.

The flu warning comes as the nation deals with the spread of 

As of the first week of November, it appeared RSV 

 from a spike in the first week of October, but the rate still is higher than it has been for most of the last year, according to other CDC figures.

Avoid touching your face with unwashed hands.

, it appeared new cases, new deaths, were decreasing slightly in the time from September to now, and new hospitalizations were holding steady, according to CDC figures. Among those aged 5 years and older, 11.3% of people, or more than 35.27 million people, had received their updated booster doses.

This article was published by our sister publication Medical Economics.

Tell your patients to get their annual flu vaccines for best protection against illness.

Flu activity ‘elevated’ across more than half the U.S., according to CDC

According to recent data, adolescents and young adults who are transgender are 4 times more likely than their cisgender peers to have a sleep disorder. Specifically, this population is over 5 times more likely to experience 

 and 3 times more likely to be diagnosed with sleep apnea or another sleep condition.

These findings revealed a distinct gap in care. Previous studies regarding transgender youth and adults have indicated a high prevalence of depression and anxiety, both of which have known impacts on sleep health.

Because of the lack of research regarding sleep disorders among these individuals, investigators called for more longitudinal assessments of sleep disorders to further understand the manifestation of the condition before and after gender-affirming therapy.

Understanding Sleep Health and Risks of Transgender Youth

Ronald Gavidia, MD, Division of Sleep Medicine, Department of Neurology, University of Michigan, and a team of investigators found that the presence of sleep disorders were lower in transgender and gender-nonconforming (TGNC) youth who were undergoing gender affirming therapy (GAT) compared with those who were not receiving therapy.

Transgender and gender-nonconforming individuals are much more likely to encounter sleep disorders compared with cisgender individuals, but because the role of gender-affirming therapy in sleep disorders is not well understood, investigators aimed to examine the relationships between TGNC identity, transition, and sleep disorders.

This large retrospective cross-sectional study focused on youth between the ages of 12-25 years who were diagnosed with transgender or gender-nonconforming identity.

Data were collected from a US-based administrative claims database and descriptive statistics estimated distributions of demographic and health characteristics according to gender identity. Unadjusted and age-adjusted logistic regression models were employed to assess identity, gender-affirming therapy, and sleep disorder associations.

Of the total 1,216,044 individuals identified between the ages of 12-25 years, 2603 (0.2%) were transgender or gender-nonconforming. From there, investigators identified 1387 individuals who pursued gender-affirming therapy; 868 were transmasculine and 519 were transfeminine.

The Relationship of Sleep Disorders and Gender-Affirming Therapy

Compared with cisgender youth, adjusted analysis showed TGNC youth were at increased risk of insomnia, sleep apnea, and other sleep disorders. However, the data also demonstrated that TGNC youth who were receiving gender-affirming therapy were at a significantly lower risk for any sleep disorder than TGNC youth who were not on gender-affirming therapy.

The majority of TGNC youth that pursued gender-affirming therapy showed half the risk for sleep disorders seen in those who did not pursue gender-affirming therapy. Investigators speculated that psychological stressors from prejudice and discrimination against the transgender community could impact the risk of poor sleep health and gender-affirming therapy may serve as a "protective" role.

"This study demonstrated a high burden of sleep disorders in TGNC youth in comparison to cisgender," investigators wrote. "However, GAT may confer a protective effect on sleep disorders among TGNC youth. Longitudinal assessments of sleep disorders prior to and post-GAT are needed to uncover their temporal relationships."

Gender identity and transition: relationships with sleep disorders in US youth

This article was published by our sister publication HCP Live.

The burden of sleep disorders is high among the transgender or gender-nonconforming population and this study evaluated the role of gender-affirming therapy on that relationship.

Transgender youth on gender-affirming therapy are less affected by sleep disorders

Maternal comorbidity is associated with greater risk of poor kidney function, according to a recent study published in 

While kidney functional capacity is low at birth, it doubles in 2 weeks and is near-adult levels in infants aged 1 to 2 years. Creatinine and urea are used to measure kidney function, making findings mainly based on preterm newborns or newborns with illness. This could cause difficulties in clinical decisions.

Maternal comorbidities have shifted over the past few decades, with diabetes, hypertension, obesity, and preeclampsia seeing increases. There is little known about how these factors affect kidney function in infants. 

Better understanding of kidney function could lead to easier detection of kidney disease and acute kidney injury (AKI), along with providing safe treatment. About 60% of drugs are eliminated by the kidneys, making treatment vital in neonates.

Fetal concentrations of creatinine and urea have been associated with greater kidney function. To examine the effects of maternal comorbidities on infant kidney function, investigators measured creatinine and urea concentration in infants aged 16 months or less.

Data were gathered from the Copenhagen Baby Heart Study (CBHS) and the COMPARE study. Umbilical cord blood samplesfrom newborns in the CBHS were evaluated, along with venous blood samples from newborns in the COMPARE study.

The CBHS examined cardiac structure and function in newborns born from April 1, 2016, to October 31, 2018, at participating hospitals. Umbilical cord blood samples were collected immediately after birth, and participants were categorized based on sex and gestational age (GA).

Mothers enrolled in the CBHS were given the chance to also enroll in the COMPARE study if they delivered at Copenhagen University Hospital–Rigshospitalet from May 3, 2017, to November 4, 2018. Infants were excluded if they had a GA of less than 37 weeks or 42 weeks and over, or if they had a birth weight of under 2500 grams.

Venous blood samples were collected from infants in the COMPARE study following the umbilical cord blood samples, along with sampling of venous blood from the mothers and fathers. This occurred about 2 hours after birth and was repeated at 2 months. A final sample was taken from infants and mothers when infants were aged 14 to 16 months.

Standard hospital clinical biochemistry equipment was used to measure creatinine and urea in umbilical blood and venous blood samples, which were recorded in milligrams per deciliter. Obstetric and fetal medicine databases were used to collect demographic and clinical data of participants.

Of the 12,938 infants in the study, about 49% were male and about 51% were female. GA was 37 to 39 weeks for about 41% of infants and 40 to 42 weeks for about 59% of infants. Maternal age had a median of 31 years, and maternal body mass index had a median of 22. About 79% of infants had at least 1 parent with Danish citizenship.

Similar rates were seen in the COMPARE study, and both studies had a low incidence of maternal comorbidities. A lower birth weight and birth length were seen in children born in the CBHS cohort with a GA of 37 to 39 weeks GA compared to those born at 40 to 42 weeks GA.

Children with a lower GA at birth also were at greater risk for placental insufficiency and were more often seen in cases of maternal diabetes, maternal preeclampsia, maternal hypertension, and maternal kidney disease. This caused lower concentrations of creatinine and urea compared to children born with a higher GA.

Maternal preeclampsia was most associated with high concentrations of creatinine and urea in infants, leading investigators to conclude that infants of mothers with preeclampsia should be closely observed for kidney function.

Mohr Lytsen R, Taageby Nielsen S, Kongsgaard Hansen M, StrandkjærN, Juul Rasmussen I, Axelsson Raja A, et al. Markers of kidney function in early childhood and association with maternal comorbidity. 

2022;5(11):e2243146. doi:10.1001/jamanetworkopen.2022.43146

A recent study found that infants born to mothers with maternal comorbidities, such as preeclampsia, had higher risk of poor kidney function.

Maternal comorbidities increase risk of poor kidney function in infants

The US Department of Agriculture (USDA) has called for updates to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), according to the California WIC Association (CWA).

These updates would improve the quality of foods provided to low-income families, supporting their nutritional needs. One change would be the April 2021 fruit and vegetable benefit which would provide food which meets guidelines from the Dietary Guidelines of Americans.

There would also be a greater range of food packaging, allowing for more choices that don’t cut nutrients. According to Karen Farley, RDN, IBCLC, executive director of the CWA, these expansions from the USDA will provide families with healthier and more culturally appropriate foods.

Prior to the April 2021 increase, families would receive $9 per month in fruit and vegetable benefits for children and $11 per month for parents. If the benefit increase is codified, families could receive 3 to 4 times this amount. This would decrease risk of childhood obesity and encourage healthier eating patterns, based on results from past studies.

A nationwide poll in September 2021 showed that 76% of voters supported further federal investment for helping WIC families receive a more nutritious diet. The increase in nutrients is also supported by the National Academies of Sciences’ recommended fruit and vegetable intake.

Package size variety will allow foods such as whole-wheat bread and yogurts to be ingested, further increasing nutritious options. Retailers and manufacturers will also benefit from not needing “WIC-only” sizes for packaging, improving the shopping experience.

"Improvements to the WIC food package are a must for families. A third of all children in Fresno are in poverty, and families are struggling with inflation, transportation, and food access," said Annette Thornton, RD, WIC Program Director for the Fresno Economic Opportunities Commission. "Not only is it necessary to increase the WIC benefit value, we also need more options in foods, package sizes, and online shopping to reduce barriers in feeding our children, especially in rural communities."

Great news for one million california infants, children and parents as USDA proposes new food options. Newswire. November 18, 2022. Accessed November 21, 2022. 

https://www.prnewswire.com/news-releases/great-news-for-one-million-california-infants-children-and-parents-as-usda-proposes-new-food-options-301682435.html

New updates to the Special Supplemental Nutrition Program for Women, Infants, and Children would provide more nutritious options to low-income families. 

USDA calls for improved food options for low-income families

 A lot of folks are given this diagnosis, and the risk factors extend beyond genetics. Tim, from your perspective and from what the data show, what’s the greatest risk factor for a child to develop ADHD [attention-deficit/hyperactivity disorder]?

 It’s family history. Heritability is derived from looking at twins. If 1 has ADHD, we determine the likelihood that the other one does. That gives you an estimate of the genetics. It’s about three-quarters. If a parent has ADHD, that’s unequivocally the biggest risk factor that their child is going to have ADHD. One thing we talk about with young parents with ADHD is that we watch their children very closely. You should be screening for it. When you pick up concerns that one of the younger children may have ADHD, start with things like behavioral interventions and environmental structure changes.

 That goes back to another related question. You talked about screening and being vigilant. Is ADHD an easy and simple diagnosis to make, considering how prevalent it is?

 That’s a great question. If you look at the core symptoms of ADHD—the 18 symptoms or derivations of symptoms—it isn’t that difficult to diagnose. It’s a clinical diagnosis. It’s sitting across from a pediatrician, a child psychiatrist, or a developmental psychologist. That part is going through the symptoms systematically and looking for a longitudinal track, looking for impairment within the entire cluster of symptoms, and being sure that what you’re looking at isn’t accounted for by an anxiety disorder, autism, a mood disorder, etc. The core diagnosis isn’t that difficult.

It gets a little more difficult because you can’t do a diagnosis of ADHD in isolation. You have to see what’s going on in the environment, developmentally with the child, educationally, and with peers in the family. Then you have to look at comorbidity or co-occurring issues, such as depression, anxiety, oppositional disorder, or conduct disorder. If they’re older, look at cigarette smoking and substance use. Do they have a learning disability? Do they have cognitive executive function deficits? You have to [look at] all of that. Before you think you’re done, you have to look at all the medical issues. Is there a tick disorder? Or is there a cardiovascular disorder or a neurological issue?

The core ADHD symptoms aren’t that difficult. It’s a clinical diagnosis, so you don’t need neuropsychological testing. Don’t order neuropsychological testing just to make a diagnosis of ADHD. But that’s what it comes with. That’s what’s taking a lot of your time, because you’re obligated to do a comprehensive evaluation.

 To your point, it’s one thing I spend a lot of time talking with folks about. Any of the 1, 2, or 3 symptoms are very nonspecific. It’s about the big picture of whether this is a pervasive issue across certain key domains that the symptoms come into play. Finding the symptoms is easy but making an accurate diagnosis and taking good care of a patient might not be.

 Case in point, if you look at distraction—one of the big symptoms—you can be distracted because you have obsessive thoughts because of anxiety or a trauma occurring at home. I absolutely agree. Any 1, 2, or even 3 symptoms in isolation aren’t helpful. You have to see a comprehensive picture. That’s why it takes time to do an evaluation.

Videos

Robert L. Findling, MD, MBA, and Timothy Wilens, MD, review specific risk factors of pediatric ADHD, focusing on family history.

Risk Factors Associated With Pediatric ADHD

 titled “Updates in the Management of Pediatric ADHD.” I’m Bob Findling, a professor and the chair of the department of psychiatry at Virginia Commonwealth University School of Medicine in Richmond, Virginia. I’m joined by my good friend Tim Wilens, the chief of the division of child and adolescent psychiatry and a codirector of the Center for Addiction Medicine at the Massachusetts General Hospital in Boston. We’re going to talk a little about updates on the management of pediatric ADHD, and particularly highlight a recent therapeutic approval and the practice implications this might have on patients and providers. Let’s begin. Tim, a good place to give context is the recent spike in the rate at which pediatric ADHD is diagnosed and the attention coming with it.

 First, welcome. Thanks, Bob. There has been an increase in not so much the prevalence of ADHD but the diagnosis of ADHD. That’s a good thing. We used to think we were missing over half the cases, and now it seems less. We miss between one-quarter and one-third of the cases. But that means we’re diagnosing the other group. The rate has gone from around 6% about 20 years ago to 10% of children who’ve been diagnosed with ADHD at some time in their lives.

The diagnosis of ADHD seems to be increasing in some areas that we like, like understanding inattentive ADHD and diagnosis in girls. We realize that adolescents have it in the continuation of treatment. Probably the biggest area of increase has been discrepancies in diversity in terms of the diagnosis in some groups, but we need to do more. We’re missing the diagnosis in underrepresented racial and ethnic minorities. In other groups, the diagnosis is coming in at or around what we’d expect. There’s room to get better at getting the word out.

 On some level, what you’re saying is that we’re picking up on people who previously might not have been given the diagnosis, even though they’ve suffered from it. Let me give you the flip side. I’m curious about your thoughts. Are more kids developing ADHD? Are there more kids out there with this? Or are we just getting better at recognition? Or is it maybe a little of both?

 It’s the latter: a little of both. There are some leads that increase the likelihood of having ADHD. For example, coming from a family with ADHD is going to increase it. We think 2 things are happening. There are higher rates because of people with ADHD marrying other people with ADHD…and having kids. No. 2, there’s a bit of anticipation every year. The rates go up with certain disorders and manifest earlier. Then we have issues with preventable forms of ADHD. A big chunk of it—three-quarters—is genetic. But up to 10% of ADHD may be from in utero exposure to cigarette smoke because of mothers who smoke during pregnancy. That’s still accounting for it. Then there are questions about marijuana. Does marijuana increase the likelihood for ADHD if the mother smokes during pregnancy? That remains unanswered.

Robert L. Findling, MD, MBA, and Timothy Wilens, MD, discuss the prevalence of pediatric ADHD and how diagnosis has spiked in recent years.

Prevalence of Pediatric ADHD

Government oversight on food marketing toward kids is lacking, according to a recent study by researchers from New York University.

Study author Jennifer Pomeranz, assistant professor of public health policy and management at NYU School of Global Public Health stated that industry self-regulation is used for food marketing, falling behind modern practices. The Federal Trade Commission (FTC) is meant to prevent deceptive marketing, but it has little impact on marketing for kids.

In 1980, the FTC attempted to regulate commercials with sugary food and drinks on children’s television, leading Congress to limit its effectiveness on marketing for children. Now, the FTC collects data on food marketing toward children and reports this data to food companies with deceptive marketing.

Without the FTC regulating food marketing for children, the United States relies on self-regulation from food and beverage companies. The Children’s Food and Advertising Initiative (CFBAI) created guidelines for marketing. According to researchers, these guidelines contain gaps which allow nutrition standards to be ignored.

CFBAI applies to children aged under 12 years, only affecting marketing in media meant for young kids. Packaging and stores are also unaffected, and companies can market their brands using healthier products to connect children with unhealthy brand lines.

Advertising has also expanded beyond television, reaching websites such as YouTube. On these sites, characters from shows children watch can market a product in an advertisement, which is not allowed on television.

“Research indicates that even adults have difficulty identifying sponsored content online, so children surely need some protection from these predatory practices,” said Dariush Mozaffarian, study author, dean for policy of the Friedman School at Tufts.

Much of the responsibility is put on parents to regulate what their children watch, but Pomeranz noted that this is less feasible with modern online marketing practices. Authors of the study encouraged Congress to give the FTC their prior authority over marketing toward children to prevent unfair and deceptive practices.

Food marketing and research on kids lacks government oversight. NYU. November 18, 2022. Accessed November 21, 2022. 

https://www.nyu.edu/about/news-publications/news/2022/november/food-marketing-and-research-on-kids-lacks-government-oversight.html

Researchers from New York University have found that children are vulnerable to deceptive marketing of unhealthy food because of a lack of government oversight.

Maternal comorbidities increase risk of poor kidney function in infants

USDA calls for improved food options for low-income families

Risk Factors Associated With Pediatric ADHD

Prevalence of Pediatric ADHD

Food marketing toward kids lacking regulation