The Journal of Clinical Psychiatry just came out with a large study showing a correlation between ADHD medications and reduction in height in teenagers, however, the issue is very complicated. The study appears to have a lot of potential flaws. Since I work with so many children and teenagers with ADHD, I want you to know I stay on top of the latest research. This moonth's front page article definitely makes headlines, but if you read the fine print, there's more than meets the eye. Here are just some of the issues I've found. 1) pg 7. “Our sample included only male patients and their relatives, and might not generalize to female patients.” 2) pg 7. “A full mechanistic understanding of why...individuals with ADHD are shorter than expected is currently lacking.” The authors don't know WHY ADHD and height is correlated. 3) pg 7. Unclear hypothesis. “There are indications that children with ADHD have an increased risk of growth hormone stimulations...(but) the etiology (is not) fully known.” 4) pg 8. Only yes/no answers were permitted, so they only asked if the child took ADHD medication or not. They did not record length of time on ADHD medication, dosages, or which types. 5) pg 8. Other contributing factors. “The associations between ADHD and shorter height were partly explained by socioeconomic status (financial stability, net worth, etc), prenatal care, and other psychiatric factors.” 6) pg 6. Improper end point. The authors didn't know when to stop measuring height. They did not take into account puberty and growth spurts. The cut-off age was arbitrary, in other words, the children may still have been growing. 7) pg 6. Generalization. The study was only done in Sweden and only with males. One has to be careful generalizing those results to females and to the rest of the world could be problematic. It's just one country, and one gender. 8) Pages 6-8. Many other studies have proven no correlation. Lastly, to reiterate, no proven causation was found, just a correlation. And the max correlation was about 1 cm. That's 0.39 inches. When all is said and done in this study, it’s not even that much.

Researchers from Amsterdam conducted a study to see whether running therapy could be as helpful as antidepressants for treating depression and anxiety symptoms. The researchers found that both groups experienced similar improvements in their depression symptoms. However, the running group also saw improvements in physical health, while the antidepressant participants experienced slightly worse physical health.

Are Screens Negatively Impacting Kids' Brains and Fueling the ADHD Epidemic? Experts Weigh In The overreliance on screens for mental health diagnoses in children is a growing concern among experts. With the increasing prevalence of depression and anxiety in children and adolescents, many healthcare providers use digital tools and apps to screen for these conditions. However, the accuracy and reliability of these screens have been called into question, with concerns being raised about the potential negative impact on children's brains. Overreliance on screens for mental health diagnoses can lead to misdiagnosis, overdiagnosis, and inappropriate treatment, negatively impacting children's psychological and physical health in the long term. The effects of screen time on brain development in children are well documented. Studies have shown that excessive screen time can lead to changes in brain structure and function, particularly in areas related to attention, language, and social cognition. Prolonged screen exposure can also lead to decreased gray matter volume, associated with lower IQ scores and poorer academic performance. These changes in brain development can have significant implications for children's mental and physical health, including an increased risk of developing ADHD, depression, and anxiety. There is a strong correlation between screen time and mental health issues in children and adolescents. Studies have shown that excessive screen time increases the risk of depression, anxiety, and other mental health problems. The American Academy of Pediatrics recommends that children aged 2 to 5 years have one hour of screen time per day, while older children and adolescents should have no more than two hours per day. However, many children are exceeding these limits, with some spending up to seven hours per day on screens. This excessive screen time can contribute to the growing epidemic of ADHD, depression, and anxiety in children and adolescents. Limiting children's screen time and encouraging other activities, such as outdoor play, reading, and social interaction, is essential to promote healthy brain development and mental health.

Impact of Smartphone Addiction on Mental Health. In 2019, a study published in JAMA Psychiatry surveyed 6,595 American teenagers. The study found that compared to those not using social media, those using it for 30 minutes to 3 hours per day increased the risk of internalizing symptoms (including anxiety and depression) by 1.89 times. The risk increased to 2.47 times for 3 to 6 hours of daily usage and 2.83 times for more than 6 hours. The more time spent on social media, the stronger the feelings of anxiety, depression, and loneliness. A study published in the American Journal of Preventive Medicine, in July 2017, revealed that individuals who frequently check social media within a week were 2.7 times more likely to develop depression than those who checked it the least. Those spending the most time on social media had a 1.7 times higher risk of developing depression than peers spending less time. Researchers surveyed 750 young Canadians aged 16 to 30 and found that those who frequently accessed social media on their smartphones were willing to make various sacrifices to stay on social media. About 40 percent were willing to give up caffeine, alcohol, and video games; 30 percent preferred not exercising, watching TV, or dining at their favorite restaurant for a year; nearly 10 percent would accept infertility or give up a year of life; 5 percent and 3 percent were willing to lose 5 or 10 years of life, respectively; fewer than 5 percent were willing to contract sexually transmitted diseases or life-threatening conditions like cancer; and 10 percent to 15 percent were ready to gain 15 pounds, shave their heads, give up driving, stop traveling, or live without air conditioning rather than quitting social media.

A physician is held responsible for a patient's outcome. But the patient cannot choose his physician. The patient must select from a limited list chosen by the health plan. The physician does not have adequate time to be with the patient. Providers must follow benchmark standards, viz., 15 minutes for an established patient. Failure to achieve the standards can produce a scorecard that could take away hospital privileges. The regulatory burden takes away even more patient time from a physician. Before electronic prescribing, it required less than one minute to write an Rx and give it to the patient. Now (unpublished data) it takes roughly ten minutes to get through all the screens, security protocols, and data input to use e-prescribing. Keep in mind that the efficient physician has only 15 minutes total with the patient, and the doctor still must fill out insurance forms and HIPAA compliance directives! The physician cannot choose the best drug for his patient — the pharmacy benefits manager chooses. During COVID, Washington decided medications for all Americans, one-size-fits-all. Physicians who tried to use their best judgment on a specific patient rather than follow Fauci edicts were stopped. Some were subject to disciplinary action, even firing. The doctor does not choose the patient's intervention. The health plan and/or insurer decides what procedure will be performed, where, who does it, when, and even if it is done. The patient or consumer does not pay the doctor or seller — the third party does. Washington dictates "allowable reimbursement" and then repeatedly reduces the amount. All of the above results in an M.D. shortage that, taken to its furthest-most outcome, could and probably has lead to death by waiting and regulations, like a human "queue." Hopefully, no Americans die waiting in line for technically possible care that does not arrive in time to save them. Those statistics are hard to track. Hopefully, enough American continue to become doctors not because of the paycheck, but because of the belief in the Hippocratic Oaths and the joy of helping others.

A fascinating article on the impact of treated vs untreated ADHD and social outcomes for young adults. Basically, NOT getting ADHD treated showed a much higher increase in unemployment, education, and overall satisfaction with life. Click here to access the PDF article that just came out in a prestigious psychiatric journal this month.

A recent CVS Health® survey found that young adults and physicians continue to see the country struggling with mental health, but most Americans aren't seeking care. But 85% agree digital health services like telehealth -- offered here! -- has made mental health more accessible. Six in 10 (60%) respondents aged 18-32 say they are concerned about their mental health, and two thirds (67%) say they know a lot of people in their community that are struggling with mental health issues. Most physicians (56%) also report declining mental health among their patients. However, only 1 in 10 (12%) Americans regularly see a mental health professional like a psychiatrist, psychologist, psychotherapist, or well-being therapist. About six in 10 (58%) respondents aged 18-32 report that social media has negatively impacted their mental health, compared to just 22% of respondents age 57+.

This link shows all the drug-company producers of ADHD meds, which doses are having supply problems, but most importantly, when the supply is expected to increase. The supply seems to be improving. Not sure how frequently this page is updated, but looks to be the most accurate source of information since it's coming from the FDA.

Written by Marc Siegel, MD, a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a TV medical analyst: "The COVID pandemic has created a perfect storm for this problem, by sequestering and isolating our kids to the point where they increasingly seek outlets on social media and become trapped inside a world they think they can orchestrate even as they feel less in control in the real world. Multiple studies have now shown that close to 20% of our teens are depressed, and TikTok may be one way to seek out freedom, even if it embroils you unwittingly in an addictive trap. One recent Center for Countering Digital Hate study found that when researchers posed as 13-year-old users and searched and liked mental-health videos, they received potentially harmful content (including about eating disorders and self-harm) from TikTok every few minutes or more. A Canadian Journal of Psychiatry analysis of highly sought TikTok videos about ADHD found that more than half were misleading."

The past 12 months have been the worst I've ever seen in terms of the supply of generic ADHD medications for my patients. I've never seen things this sparse in my 15 years or so. The problem is highlighted in this article, and presented further in the physician-led video.