Postpartum depression may be a misnomer. A more accurate term might be postpartum neglect -- not by mothers, but of mothers. The human infant is uniquely helpless in the early weeks and months of life. His arms fly up over his head at random moments in a primitive “startle reflex.” His sleep patterns have no rhyme or reason. He eats and poops round the clock. Serving an evolutionary purpose, in part to achieve an upright ...

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The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut's Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its ...

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While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:

 A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains ...

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Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior. When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range ...

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When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s.  As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly ...

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At the recent gubernatorial candidates forum on mental health, Martha Coakley repeated the oft-heard phrase that depression is like diabetes. Her motivation was good, the idea being to reduce the stigma of mental illness, and to offer "parity" or equal insurance coverage, for mental and physical illness. However, I am concerned that this phrase, and its companion, "ADHD is like diabetes," will, in fact, have the exact opposite effect. A ...

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Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, "Are Children Overmedicated?" seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the "usual" explanations given for the increase prescribing of medication.  In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy ...

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A recent study, one that received relatively scant media attention (compared with a concurrent New York Times piece about a new psychiatric diagnosis termed "sluggish cognitive tempo" that may be the "new ADHD") showed that antipsychotics are being prescribed to nearly one third of kids (age 2-17) in foster care who are diagnosed with attention deficit hyperactivity disorder (ADHD). This disturbing statistic brought to mind a common complaint I hear from parents about ...

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"I know its my ADHD acting up," a mother of three young children recently said to me as an explanation for her inability to recall a particular piece of information. My observation, in the setting of mybehavioral pediatrics practice, of increasing numbers of mothers of young children being diagnosed with ADHD is in keeping with a recent report from Express Scripts. This report, based on pharmacy claims data, showed a 53% rise in writing of prescriptions for ADHD in ...

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A recent article in the New Republic, provocatively titled “ADHD Does Not Exist,” starts out well enough. The author, a psychiatrist with “over 50 years experience” points to the fact that ADHD describes a collection of symptoms, rather than their underlying cause. Using stimulants to control these symptoms, he argues, is analogous to prescribing pain medication for cardiac chest pain rather than addressing the underlying circulatory problem. But my ...

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