Children, ADHD & China

sDiagnosis of mental retardation = IQ >2 Standard Deviations below the mean + impairment of function.

To get a sense of patitent’s IQ, ask about their education, ask about their parents education.

“socializing is like skiing, the better you get the better it gets”

average attention span 22 minutes.

ADHD is the #1 reason for pediatric outpatient referrals!!!!

Referrals – school, parents, pediatricians in that order

30-50% of cases of ADHD are co-morbid w/LD

First thing to do when kid has delayed language development – hearing test.

FAQ – Is my kid manipulative because s/he won't sit still for math homework but has perfect attention for the Xbox/nintendo video game?

No - ADHD kids are understimulated. Paper and pencil mathhomework sitting stil is not stimulating enough, but the lights and colors of video games are far more stimulating. This also underlies the reason the stimulant is given as treatment.

Children manifest psychological disorders uniquely to adults. School is normally the major stress in a child's life. When you think about what is going on with a kid, you have to always think in developmental terms as the kids change so rapidly, also think Family Context!! Family Context!! It effects children much more significantly. A child can either internalize or externalize a trauma/mental illness/medical condition. Internalizing results in depression and anxiety and is egodystonic whereas externalizing disorders manifest as conduct disorders and tend to be egosyntonic. The major externalizing disorders are:

ADHD, conduct disorder (this is typified by an absence of remorse), oppositional defiant disorder

Pediatrics can commit suicide, it has been found that the single greatest risk factor for suicide in a depressed child is a feeling of hopelessness.

From the mouth of a borderline, "I came here depressed and I'll be leaving suicidal" -individuals with borderline personality disorder often threaten suicide as way of leveraging, have to set limits!! w/borderline

ZyprexaZydis - an olanzapine wafer that dissolves instantly in your mouth, helps with compliance.

Suicide in Chinese vs US

US suicide rate 11.5/10^6, in '07 ~35,900 completed suicides

• males 4x females for successful suicides
• females 3x males for attempts
• 3rd leading cause of death for 15-24 year old, most common means FIREARM
• 90% of those who have committed suicide have some sort of psychological disorder

Risk Factors for suicide: past suicide attempt, having a specific plan, making an attempt without others being able to know (doing it in secret)

Chinese suicide statistics

• China has 1/3 of global suicides. Rate is 23/10^6 people.
• there are decreased rates of mental illness in China
• Chinese male suicides much much more common than female suicide
• Rural citizen has 3x the suicide rate than urban citizen
• low plan suicides (impulsive) more common among the young
• most frequent means, pesticide poisoning
• risk factors: low social status, lack of social support