Health Tip: Don't Drive When Drowsy

(HealthDay News) -- If you've got a case of heavy eyelids while you're driving, pull over as soon as possible and get some rest.

The National Sleep Foundation mentions these warning signs that you're too sleepy to drive:

• Having difficulty staying focused or blinking eyelids frequently.
• Finding yourself daydreaming.
• Having difficulty seeing traffic signs or exits, or forgetting the last few miles that you drove.
• Having difficulty keeping your head up, yawning frequently or rubbing your eyes.
• Weaving between lanes or onto the shoulder, or tailgating the next car.
• Feeling irritable or restless.

New ADHD Guidelines Include Preschoolers, Older Teens

SUNDAY, Oct. 16 (HealthDay News) -- In new guidelines released Sunday, the American Academy of Pediatrics has expanded the age range for the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) to children as young as 4 and as old as 18.

For the youngest children, the academy is emphasizing the use of behavior treatments over medication in most cases.

"I think the most significant changes are expanding the ages from preschool through adolescence. The original guidelines were from 6 to 12, because that's where the evidence was. We've been able to broaden the scope of the guidelines because there was more evidence available for preschoolers and adolescents," said the lead author of the new recommendations, Dr. Mark Wolraich, CMRI Shaun Walters Professor of Pediatrics and the Edith Kinney Gaylord Presidential Professor at the University of Oklahoma Health Sciences Center in Oklahoma City.

Wolraich added that the new guidelines also give pediatricians advice on managing inattention or hyperactivity problems that don't quite meet the definition of ADHD.

The new guidelines will be presented at the academy's annual meeting in Boston and will be published in the November issue of Pediatrics.

More than 5 million children in the United States have been diagnosed with ADHD, according to the U.S. Centers for Disease Control and Prevention. Children with the disorder show signs of inattentiveness, impulsivity and hyperactivity. They may be unable to pay attention in class, or may spend a lot of time fidgeting in their seats or talking nonstop. Although most kids may display this type of behavior at one time or another, it becomes a problem when it occurs most of the time, according to the U.S. National Institute of Mental Health.

Treatment for ADHD may include medications or behavior therapy, or both. In fact, Wolraich said that "the combination of both medication and behavioral therapy is probably the best choice when possible."

A recent study, published online on Sept. 28 in the American Journal of Psychiatry, found that the use of ADHD medication is on the rise, with 5 percent of American children now taking stimulant medications such as Ritalin or Adderall to treat the disorder. Those researchers suggested that the increase might be due to a greater recognition of ADHD as a chronic condition, leading to children staying on medications for longer periods.

The new guidelines recommend that unless a child in the 4- to 6-year-old age group has a serious problem, that behavior therapy should be the first treatment tried. If necessary, medications can be added later.

"Although there is less evidence [on outcomes for this age group], the hope is that starting treatment in preschool if a child has serious problems will lead to better outcomes," said Wolraich.

Dr. Richard Gallagher, director of special projects at the Institute for Attention-Deficit Hyperactivity and Behavior Disorders at the NYU Child Study Center in New York City, said, "Medications should be used very carefully. I'm admittedly biased since I primarily do behavioral work, but behavioral work does have its limits. If a child is getting into dangerous situations or presenting with problems interacting appropriately with peers and adults, medications can be very useful. When monitored carefully, medications are safe for the vast majority of kids."

The guidelines also emphasize the need for pediatricians to recognize that ADHD is a chronic condition, and while treatments are available to control symptoms, there is no cure for the disorder.

Wolraich said that one of the reasons the AAP expanded the age up to 18 is because there have been more studies showing that ADHD continues into late adolescence, and even into adulthood.

"ADHD is a chronic condition. We can provide symptomatic treatment, but it doesn't cure the condition. Treatment has to be an ongoing process. Symptoms may change over time, and there needs to be consideration for change in treatment as a child develops," said Wolraich.

"Kids usually stay on medications for about three years. For some, that's enough. It gives them time to become better at compensating for their deficits. But, for many kids, the need for treatment is ongoing," he added.

Gallagher recommended that parents bring up any concerns they have about their child with their pediatrician. "This is a condition that can be recognized early," he said.

More information

To learn more about attention-deficit hyperactivity disorder, visit the U.S. National Institute of Mental Health.

Fewer Than Half of Kids Hurt in Car Crashes Wearing Seat Belts

SATURDAY, Oct. 15 (HealthDay News) -- Fewer than half of U.S. children injured in car crashes between 2002 and 2006 were wearing seat belts, and minority children had the lowest rates of seat-belt use, a new study finds.

Researchers examined data on car accidents involving nearly 40,000 children under age 16 and found that 47.5 percent were restrained. Black, Hispanic and Native American children had the lowest rates of seat-belt use.

The overall death rate among the children was nearly 6 percent and the injury rate was nearly 7 percent. Of the children who were injured, nearly 13 percent required emergency surgery.

The researchers also found that seat-belt use was associated with a lower injury severity score (ISS) and that a higher ISS was associated with a greater risk of emergency surgery, severe outcomes, longer hospital stay and death.

The study was slated for presentation Oct. 15 at the American Academy of Pediatrics' national meeting in Boston.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"After adjusting for the use of restraints, we found no differences in mortality among different ethnic groups. The major determinant of both morbidity and mortality is the severity of the injury as quantified by the initial injury severity score," lead author Dr. Rebecca Stark said in an academy news release. "Because the use of restraints decreases the ISS, we feel our results highlight the need for further education and outreach to the pediatric population about the benefit of seat-belt use."

Motor vehicle crashes are the leading cause of death among children in the United States.

More information

The U.S. Centers for Disease Control and Prevention has more about child passenger safety.

Too Many Kids Injured in ATV Crashes, Study Finds

MONDAY, Oct. 17 (HealthDay News) -- Fast speeds, lack of helmet use and multiple riders piling into the same vehicle are among the reasons why thousands of American children are injured in all-terrain vehicle (ATV) crashes annually, according to new research.

The findings were to be presented Monday at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

According to the AAP, children account for about one-third of the 130,000 to 150,000 ATV-related emergency department visits each year in the United States and one-quarter of the more than 800 ATV-related deaths.

More children are injured in ATV crashes in the United States than in bicycle accidents.

In one study, researchers reviewed University of Iowa data on 345 ATV-related injury cases and found that 80 percent of patients were male and 30 percent were 16 or younger. Fewer than 20 percent of riders wore helmets. Drivers were more likely than passengers to wear helmets and children were more likely than adults to wear helmets.

Rollovers accounted for 42 percent of injury-causing crashes, making this type of accident the most common cause of injury. Among patients older than age 15 who were tested for drugs and alcohol, 35 percent were positive for alcohol and 25 percent were positive for drugs.

Head injures were the most common cause of ATV-related deaths.

All the children treated for ATV injuries were driving adult-sized ATVs, noted lead author Dr. Charles Jennissen.

"The epidemic of ATV-related injuries can be attributed, at least in part, to the vehicles' increasing popularity," he said in an AAP news release. "In 2008, the number of ATVs in the U.S. was estimated to be 10.2 million, greater than triple the number a decade earlier. A major factor in the burgeoning sales has been the production of bigger and faster machines. Some ATV models now weigh over 800 pounds and are capable of speeds over 80 miles per hour."

In a second study, Jennissen focused on the potential impact of shortening ATV seats. The seats on the vehicles are meant for one person but are typically long enough to accommodate a passenger, particularly a child.

"We suggest that a shorter seat, starting further from the handle bar attachment is the preferred ATV seat design," Jennissen said. "This should discourage multiple passenger ATV use by reducing the space available for additional riders, and help decrease the number of ATV injuries."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

Concerned Families for ATV Safety has more about children and ATVs.

Shift Work May Put Teens at Risk for Multiple Sclerosis

MONDAY, Oct. 17 (HealthDay News) -- Working overnight or odd shifts may increase teenagers' risk of developing multiple sclerosis, according to the results of an observational study.

Researchers from Sweden who uncovered the link said interruption of circadian rhythms and disruption of normal sleep patterns may be partially responsible for the added risk.

In conducting the study, published in the Oct. 18 issue of Annals of Neurology, researchers examined two population-based studies of Swedish residents aged 16 to 70 (one with incident cases and one with prevalent cases) to compare the number of cases of multiple sclerosis among those who did and did not work overnight or shift hours on a regular or alternating basis during their teens.

Among the incident cases, the investigators found those who worked overnight hours for three years or more before the age of 20 were twice as likely to develop multiple sclerosis as those who never worked night shifts. Among the prevalent cases, they noted, the teens who worked overnight hours were slightly more than twice as likely to develop the disorder commonly called MS.

"Our analysis revealed a significant association between working shift at a young age and occurrence of MS," Dr. Anna Karin Hedstrom, of the Karolinska Institute in Stockholm, said in a journal news release. "Given the association was observed in two independent studies strongly supports a true relationship between shift work and disease risk."

The researchers explained the sleep restriction associated with working the night shift has already been shown to increase the risk for certain health problems, including heart disease, thyroid disorders and cancer, likely by interfering with melatonin secretion and increasing inflammatory responses.

The authors pointed out that since MS is a central nervous system autoimmune inflammatory disorder that is linked to a person's environment, other lifestyle risk factors, such as sleep loss due to shift work, should also be considered.

The study authors noted that more research is needed to explain why the disruption of circadian rhythm and sleep loss increase teenagers' risk for developing MS.

More information

The U.S. Centers for Disease Control and Prevention provides more information on the health effects of shift work.

It's Easy to Mistake Medicine for Candy

MONDAY, Oct. 17 (HealthDay News) -- When it comes to telling the difference between candy and some medications, teachers are almost as likely to make an error as kindergartners, according to new research conducted by two enterprising elementary schoolers.

Casey Gittelman, who's now 12 years old, and her friend Eleanor Bishop showed a special medicine cabinet filled with medicine and candies to teachers and kindergarten students at Ayer Elementary School in Cincinnati, to see how well they could distinguish candy from medicine and vice versa.

"Neither of them could tell the difference between the medicine and the candy very well," said Gittelman, who's now in seventh grade. "The kids who couldn't read did worse," she added.

Gittelman is scheduled to present her findings Monday at the American Academy of Pediatrics' National Conference and Exhibition in Boston.

Thirty teachers and 30 kindergarten students were selected to participate in the study. Gittelman's father, Dr. Michael Gittelman, a pediatrician at Cincinnati Children's Hospital Medical Center, helped the girls with the study. The specially stocked medicine cabinet came from the hospital's Drug and Poison Information Center.

The young students were able to distinguish candy from medicine 71 percent of the time. Teachers did slightly better, picking out the medicine from the candy at a rate of 78 percent. Just 67 percent of the youngsters who couldn't yet read were able to correctly identify what was candy and what was medicine.

Sweet Tarts were commonly mistaken for Tums (53 percent) or for Mylanta (53 percent). Half the time, Reese's Pieces candies were mistaken for Sine-Off, a decongestant medication. And, M&M's candies were mistaken for Coricidin 43 percent of the time. Coricidin is another decongestant medication.

Circular drugs and candies that had similar colors and shine and no distinguishable markings were most likely to be mistakenly identified, according to the study.

"The FDA is working hard to try to make medicines palatable to kids. But, there's a fine line between making a medicine such that a child is willing to take it, but not making it so tasty that they want to take it all the time. It's not an easy science," said Dr. Robert Squires, clinical director of pediatric gastroenterology at Children's Hospital of Pittsburgh.

"I think that if companies that make medicines could make them to look less like candy, then less unintentional ingestions will occur in kids," said Gittelman.

She also said that it's important to lock up medications and keep them in their original packaging. Almost one-quarter of the teachers in the study said that medications weren't locked up or out of reach in their homes.

A second study -- this one done by adults and scheduled for presentation at the same meeting -- found that in 24 homes with children between 2 and 6 years old, 22 percent of medications weren't stored safely. That included 30 percent of drugs containing acetaminophen (Tylenol).

That finding is particularly important because acetaminophen can be toxic to children when consumed in higher-than-approved doses.

But, said Squires, it's understandable that parents might underestimate the risk posed by acetaminophen. "When you can go to a big box store and buy enough acetaminophen to kill 30 people, it's hard to think that could be harmful," he explained.

"I wouldn't want people to be afraid of acetaminophen. Acetaminophen is a very good medicine when taken in a standard dose," said Squires. But, when taken in large quantities, the drug can cause liver failure. "Recent data suggests that about 12 percent of acute liver failure in kids is from acetaminophen. And, about one-third of kids attempting suicide between 10 and 17 years old take too much acetaminophen," Squires noted.

Combination cold and flu medications often contain acetaminophen, but people may not realize that, and then take another dose of acetaminophen on top of the cold medication. "It's not necessarily a single high overdose, but over an extended period of time, like when you have the flu," said Squires.

Because both studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

Learn more about preventing an accidental medicine overdose from the U.S. Food and Drug Administration.

Social Phobia in Teens Goes Beyond Shyness

MONDAY, Oct. 17 (HealthDay News) -- Social phobia is not simply shyness that has been exaggerated by psychiatrists and drug makers, according to a new study that compared rates of shyness and social phobia among American teens.

Social phobia, also called social anxiety, is a disabling condition characterized by extremely high levels of self-consciousness and anxiety. Some experts have suggested that the condition is a "medicalization" of a normal variation in shyness levels or that it has been publicized by psychiatrists and drug makers in order to increase sales of psychiatric drugs, especially among youth.

In the new study, researchers from the U.S. National Institute of Mental Health examined shyness and social phobia rates among more than 10,000 teens aged 13 to 18 who took part in a national survey.

About half of the teens said they were shy, but only 12 percent of the shy teens met the criteria for social phobia in their lifetime. The study also found that about 5 percent of teens who said they weren't shy met criteria for social phobia.

The findings indicate that the presence of social phobia may be independent of shyness in some cases, the researchers said. The two are not necessarily directly related.

They also found that teens with social phobia were consistently more likely than other teens to also have another psychiatric disorder in their lifetime, such as depression or drug use disorder.

Teens with social phobia also had higher levels of impairment at school or work and among family and peers, but were no more likely than shy teens to be receiving professional treatment.

Rates of prescribed drugs were low for both shy teens and those with social phobia. The antidepressant Paxil (paroxetine), which is commonly used to treat anxiety disorders, was being taken by 2.3 percent of teens with social phobia and 0.9 percent of shy teens.

Teens with social phobia were no more likely than shy teens to take any prescription psychiatric medication.

"The results suggest that social phobia is not simply shyness that has been inappropriately medicalized," according to a NIMH news release. "Rather, social phobia affects a minority of youth and only a fraction of those who consider themselves to be shy. In addition, despite the greater disability that youth with social phobia experience and the greater likelihood that they will have another disorder, they are not more likely to be getting treatment compared to their peers, questioning the notion that these youth are being unnecessarily medicated."

One expert agreed the condition needs to be taken seriously.

"Social phobia, or social anxiety disorder, is a serious disorder that is very different than normal human shyness," said Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City.

He noted that the condition can take different forms. "Social phobia can be limited to only one type of situation -- such as a fear of speaking in formal or informal situations, or eating or drinking in front of others -- or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people," Menevitz explained. "People with social phobia have a persistent, intense and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions."

This often manifests in physical symptoms such as blushing, sweating and nausea, he added.

"The importance of identifying and treating those adolescents with social anxiety disorder is important as they have higher levels of impairment in multiple domains, including school/work ability, social life and family relationships," Manevitz said.

The study was published online Oct. 17 ahead of print in the journal Pediatrics.

More information

The American Psychiatric Association has more about anxiety disorders.