Premier Kathleen Wynne and the Toronto Star were sent this letter by CADDAC recently in response to the Liberal party's promise for increased mental health funding, in particular for children and youth.
Hon Kathleen Wynne
Leader, Liberal Party of Canada
Dear Premier Wynne,
Additional funding in Ontario for mental health is certainly needed and very welcome. Resources are few, wait times are long and physicians are charging over OHIP for assessments. However, parents of children and youth with the most prevalent childhood mental health disorder, Attention Deficit Hyperactivity Disorder (ADHD), and adults with ADHD are wondering if they are going to be left out again. ADHD is never mentioned during metal health awareness campaigns, in press releases by mental health hospitals, or by national and provincial commissions on mental health. ADHD is not being addressed by our government. There are no working committees on ADHD in Ontario although significant socioeconomic costs result when we do not diagnose and treat this disorder. Abundant research has shown less academic achievement and fewer years of education leading to lower paying jobs, more accidents, an increase in additional mental health disorders, more substance use and abuse, less employment and a greater need for social assistance, more involvement in the justice system and a two-fold risk of early death. When we link these costs with the fact that ADHD is one of the most treatable mental health disorders, that students with ADHD can go on to post-secondary education when supported and become successfully employed in the career of their choice, it makes no sense that we are not giving this mental health disorder more attention.
Heidi Bernhardt
President, Centre for ADHD Awareness Canada
On December the 4th 2017 CADDAC met with Minister Fleming and his staff to discuss ADHD in BC schools, our recent policy paper, and rumours that the highly anticipated new BC Special Education guidelines, placing ADHD in a standalone category, would not be released.
Here is a summary of what the Minister and his staff shared with CADDAC.
The guidelines in special education have been delayed due the change in government and a full review going forward in K to 12 funding. CADDAC was assured many times that changes to the new Special Education Guidelines, incorporating the changes in DSM 5 resulting in the inclusion of ADHD as a standalone category, are not being considered for removable. They are not looking at preventing this due to the restoration of old language of class composition in the teachers’ contract. There has been no conversation on their part regarding limiting designations of special needs students. They have been focusing on hiring more educators to meet these students’ needs.
During the process of reviewing funding they will be reaching out to stakeholder groups after they complete their financial consultation. They will be informing CADDAC on a timeline for submissions.
Deputy Minister Laura Sampson will be staying in touch to up-date CADDAC on these issues.
The Ministry is aware that their web site information on ADHD for educators is out-dated. They are in the process of developing up-dated information.
Children with neurodevelopmental disorders like ADHD have been excluded from general guidelines on screen use by the Canadian Pediatric Society because children with these disorders are at greater risk for internet addiction. Dr. Umesh Jain, a Child and Adolescent Psychiatrist specializing in ADHD, believes that children with ADHD should only be in front of a screen for educational purposes. He believes that screen time can be addictive for children with ADHD with the same cravings and withdrawal effect as other addictions. He also believes that it deteriorates social skills of children with Autism since they quickly become dependent on the Internet for their social interaction. Dr. Jain states that screen time is altering the brain of children with ADHD by “softening and altering cortical structures”. He’s basing his recommendations on studies out of South Korea pointing to ADHD as the most common reason for Internet addiction under the age of 12.
Dr. Randy Kulman, a child clinical psychologist from Rhode Island, believes screen time for children with ADHD and ASD should be tailored to their learning challenges, but does recognize the increased risk to those with ADHD. Children with ADHD crave stimulation that these online interactions provide.
Access the entire article by Patricia Tomasi HERE
A new Huffington Post article is talking about changes coming to the BC Special Education Guidelines that will allow students with ADHD, who present learning needs, to be identified under the learning disability (LD) category. This may not seem like a huge change, but parents of children with ADHD in BC and CADDAC have long been advocating for this change. In fact, CADDAC has been advocating for this change to occur in Ontario since our inception in 2005.
What does this change mean and why did it come about?
In the past system, students with ADHD in BC, who were struggling at school, were denied recognition as exception students (learners) because ADHD was not listed under a category. This recognition allows students access to special education resources and an Individual Education Plan (IEP). By placing ADHD under the LD category the Ministry of Education in BC has acknowledged recent changes in the DSM 5 (the document that defines mental health and neurological disorders) which now categorizes ADHD as a neurodevelopmental disorder, rather than a behaviour disorder. Learning disabilities have long been recognized as neurodevelopmental disorders. Although ADHD is not an actual learning disability it can significantly impair learning even without an LD being present.
Unfortunately, CADDAC continues to receive countless calls from parents in Ontario frustrated that their children are still being barred from being recognized as exceptional learners, many also being denied an IEP. Although a 2011 Ontario Ministry Memorandum states that a student with ADHD presenting learning needs should not be barred from being recognized as an exceptional learner, this is still routinely occurring.
You see, school boards are entitled to set the bar of learning impairment (how impaired a student must be to be recognized as an exceptional learner) wherever they like. There is no requirement for school boards to document this, so decisions are often quite arbitrary and difficult for parents to challenge. This is resulting in little consistency across boards or even within the same school board. Even though the Ministry’s 2011 memorandum exists, we continue to receive calls from parents who are told that their board does not recognize students with ADHD, period. The latest parent I spoke with, who also happened to be a teacher, just told me that their principal was totally unaware of the memorandum and when it was brought to their attention was sure that it must be out dated.
So here is my “ask” of you. If your child with ADHD is struggling at school and continues to be denied an IEP or recognition as an exceptional student in the Ontario School System and you would like to share your story with us to further advocacy efforts in Ontario, please contact heidi.bernhardt@caddac.ca
Access the article HERE
A recent study by the Institute for Clinical Evaluative Sciences found almost 12 per cent of children and youth with attention deficit hyperactivity disorder, or ADHD, were prescribed antipsychotics like Risperdal, Zyprexa and Seroquel. Since the study found that 5% of Ontario children have ADHD, this means that .06% of children may be receiving antipsychotic medications. The study went on to report that 20% of children with ADHD were also receiving antidepressants for depression or anxiety which the lead researcher Dr. Paul Kurdyak, head of the mental health and addictions program at ICES, did not find surprising since these disorders frequently coexist with ADHD. However, the researchers did find it surprising, that children with ADHD would be receiving antipsychotic medications when these medications have not been shown to treat ADHD.
Unfortunately the article implies that these medications are being used to treat simple ADHD, while at the same time conceding that these medications have a sedating effect and assist with disruptive behaviour. Unfortunately what the researchers did not mention is that some children with a more severe presentation of ADHD can also have extreme forms of emotional dysregulation, in some cases so severe that they are unable to attend school or be involved in normal family life without experiencing episodes of emotional “meltdown” and sometimes aggression. This would be the common profile of the majority of children who are receiving these medications. Normal levels of ADHD disruptive behaviour would not commonly warrant a prescription of antipsychotic medication.
In addition, it makes perfect sense that more people who see a psychiatrist have these medications prescribed. It is child and adolescent psychiatrists who generally see these more severe cases. General practitioners and paediatricians refer these more difficult cases to child and adolescent psychiatrists, when they have been unable to successfully treat the child themselves. Of course, better education for front line physicians on how to assess, diagnosis and treat ADHD appropriately may be helpful as well. We know that the sooner we diagnose and treat ADHD the better chance we have of reducing co-existing disorders and the long term consequences of ADHD.
No one would argue that if there is a choice antipsychotic medication should never be given to children and that psychotherapy should always be the first choice of treatment. Unfortunately it is also true that affordable family, child and youth mental health therapy is very difficult to access across this country resulting in a two tier mental health system. However, after speaking with many of these families and the physicians who treat these children it is clear that even when parents do everything right and therapy is implemented, for some children and youth it is still not enough.
Also, no one would disagree that many of these medications have significant side effects and should not be a first line treatment. However, at this time there are no medications that have been approved to specifically treat these symptoms in children and youth so physicians are forced to use these medications off label. Obviously more research is required.
One new medication, Intuniv, has been approved by Health Canada for treating children and youth with ADHD and has been found to be very helpful for many children with emotional dysregulation and aggression issues. This medication is not an antipsychotic medication and can be prescribed along with ADHD stimulant medication or on its own for those who have difficulty tolerating stimulant medication, or have not found stimulant medication to be effective. While Intuniv does have some mild side effects, as do all medications, they seem to be far fewer than those of antipsychotic medications.
For this reason CADDAC is currently asking the Ontario Public Drug Program to include this medication on their list of approved medications making it accessible to families receiving their medication through this program. Advocacy on this issue in other provinces is also on the agenda. As this study indicates not many children will require this medication, and while it will not work for all children with these symptoms, I have spoken to many families who have indicated that it has changed their child’s life and their family’s quality of life.
Of course, better access to newer more easily tolerated once-a-day ADHD medications being covered on provincial drug programs would be helpful and may actually help to decrease prescribing of antipsychotic medication. Coverage across Canada is sporadic leaving vulnerable families unable to access a wide variety of ADHD medications. The more choices we have in ADHD medication the better chance we have of being able to achieve the best treatment options for each child and adolescents with mental health disorders. Unfortunately mental health medications are definitely not a one-size fits all scenario.
My major concern about articles on this particular study such as this CBC article, and often articles on other ADHD topics, is that writing about these very complex issues superficially and with an aim to sensationalize only increases misunderstanding about childhood mental health and the way we treat it. They also result in increased stigma, confusion and fear for parents and care givers trying their best to make informed decisions on treatment for their children.
If you have ever wondered how to respond when your friends and family question the validity of ADHD? Or do you get hot under the collar whenever you read another article telling you that ADHD is due to bad or lazy parenting or unmotivated or defiant kids? If so, you need to read Patricia Tomasi’s response to an article in the Huffington Post by Alyson Schafer. Not only does Patricia correct many of the mistruths in Ms. Schafer’s article she calls out the Huffington Post for publishing the article. The Huffington Post will most likely hide behind the fact that this is a commentary and not a factual piece. But let me ask you this, would they have published a commentary questioning the validity of depression as a disorder? Of course not, they would be tarred and featured. But for some strange reason people still use the fact that there is no blood test that can be used to diagnose the disorder as justification to question its existence. Well there are many conditions in mental and physical health that do not have a particular test that validates their existence, but that is why we use experienced physicians to rule out other disorders that could be causing the symptoms and validate the occurrence and history of the symptoms of the disorder, just as we do with ADHD. So the next time someone brings up the issue with you and you start to feel your blood boil, pull out Patricia’s article and know that she has it covered.
Access Patricia Tomasi’s article Here
Some researchers around the world have been thinking about a different way to think about mental and neurological disorders. They have found that current diagnostic categories may not align with new genetic and neuroscience findings. A unique Ontario project, the province of Ontario Neurodevelopmental Disorders (POND) Network is studying multiple disorders at the same time looking for patterns that will lead to a better understanding of the underlying neurobiology. The hope is that this research will lead more effective treatments.
Researchers acknowledge that to date separating and classifying the disorders has helped them to distinguish between disorders and collect statistics aiding in the development of health strategies, but recent research into genetic mutations has been “the big poke in the eye, if you will – the thing that made it impossible to go any further,” he says.
Research found hundreds of possible mutations when looking at Autism, but also discovered that these mutations were not only seen in Autism, but also appeared in other neurodevelopmental disorders. Researchers now realize that there new goal is to figure out what is common among the disorders and what differs.
This new approach does not conduct separate studies but rather looks for traits. An excellent example is a recent study which looked at the ability of study participants with Autism, ADHD and OCD to read other people’s emotions by looking at their eyes. This has generally been thought to be an Autism trait, but researchers found the same trait in participants with ADHD. Therefore children with ADHD will also struggle with impaired social functioning.
Access the full article HERE
The title says it all. Access this great blog post in the Huffington Post by Dr. Diane McIntosh, psychiatrist and assistant clinical professor at the University of British Columbia Here.
If you have an interest in ADHD in females, how symptoms differ in girls, how we under diagnose and misdiagnose it and the consequences of this, you don't want to miss this recording. The interview features Anna, a every insightful 17 year old who was diagnosed with ADHD at the age of 15, and Katherine Ellis, a Pulitzer Prize winning journalist who was diagnosed at 48 and has since then authored three books on ADHD, talking about their experiences. In addition, Dr. Doron Almagor, a child and adolescent psychiatrist and chair of CADDRA, shares his extensive medical knowledge on the subject of ADHD in girls. Access the interview Here.
The subjective nature of tools used to assess ADHD, such as rating scales and feedback from parents and educators has long been criticized by media and naysayers even though all mental health disorders are diagnosed in this manner. For this reason a recent study’s findings may be are of interest to the ADHD community. Weidong Cai PhD, an instructor in psychiatry and behavioural sciences and the study’s lead author indicated that it would be very beneficial to have a diagnostic measure that uses more objective and reliable measures.
The team of researchers studied functional magnetic resonance imaging brain (MRI) scans from 180 children, half with ADHD and half without. The children were also assessed for ADHD with the usual diagnostic tools. The team focused on a set of brain regions that work together to help decide where one’s attention should be directed. They scored each brain according to its level of synchronization.
The study found that interactions between three brain regions that assist us with paying attention were weaker than normal in these children. Brain circuits that help us to stay focused and stop day dreaming had less influence on the brain activity of children with ADHD. Dr. Vinon Menon, the study’s lead author reported that issues with these three brain networks continuously showed up regardless of which cognitive task the children were asked to do.
The difference was significant enough that brain scans could distinguish between those children with ADHD and those without. In addition, the severity of their ADHD correlated with the degree of weakness.
Future research is required to assess whether functional MRIs can be used to differentiate between brains of children with ADHD and other conditions and as an ADHD diagnostic tool.
Access more detailed information Here
