Psychiatric Disorders: Current Topics and Interventions for Educators


Paul C. McCabe & Steven R. Shaw

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  • Dedication

    To the children and families who persevere and thrive despite battling the medical conditions described in this volume.

    And to our families.

    P.C.M. & S.R.S.


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    This book exists for two primary reasons: (1) the incredible pressures on educators to address children's medical issues in school settings and (2) the rapid pace of news and information delivery, which often occurs despite safeguards that try to ensure credibility and verifiability. Educators are charged with making policies; differentiating instruction; providing educational accommodations; managing the physical plant; providing special education services' collaborating with families; and working with the community in response to children's medical, physical, and psychological issues. However, educators often have little training, support, or information to address these important issues. When faced with a medical question, many people (including us) turn to the Internet. Although much information from the Internet is high quality, much is not. Peer-reviewed scientific papers of high quality are often given the same weight in search engine results as advertisements for the latest snake oil. Information about medical issues is presented (1) in esoteric medical science journals with little relevance to schooling, (2) as part of encyclopedic but cursory overviews of many topics, and (3) in summarized and simplified form on Web sites with questionable accuracy and oversight. We developed this book to give support and information to educators based on a critical review of scientific research that is credible, in depth, and practical.

    Psychiatric Disorders is the third book in a three-volume series titled Current Topics and Interventions for Educators. This series presents detailed reviews of recent scientific research on a variety of topics in pediatrics that are most relevant to schools today. Current Topics and Interventions for Educators is intended to provide not only detailed scientific information on pediatric issues but also glossaries of key medical terms, educational strategies, case studies, handouts for teachers and parents, and discussion questions. Readers are presented with critical reviews of scientific medical research, including discussion of controversial issues. The authors of each chapter have completed scholarly reviews of the extant research and carefully considered the quality of research design, methodology, and sampling in determining what can be considered empirically valid conclusions versus conclusions based on hyperbole, conjecture, or myth. We believe that this information will help educators address the pediatric issues that affect schoolchildren and better equip educators to discuss these issues with parents, staff, and medical teams.

    This book has its origins in a regular feature in the National Association of School Psychologists (NASP) publication Communiqué called “Pediatric School Psychology.” We edited and published many detailed research articles that provided depth of information and critical evaluation of research to keep school psychologists current on medical knowledge that could impact their practice in the schools. We found that school psychologists shared this information with policy makers, administrators, social workers, teachers, therapists, and families. This feedback told us that there is wider audience for this information.

    Educators, students, school nurses, administrators, policy makers, and school psychologists can use this book in a variety of ways. It can serve as a reference tool, textbook for a course, or a basis for continuing education activities in schools. The literature reviews are critical, challenge popular understanding, and often present controversial information. We would also like the information in this book to serve as grist for discussion and debate. More than ever, educators are charged by law, regulation, or circumstance to address medical issues despite lacking medical training. Therefore, consultation, reasoned discussion, debate, and consensus building can lead to improved educational services for children with medical and psychiatric issues.

    Psychiatric Disorders is a 13-chapter volume divided into three sections: (1) neuropsychiatric conditions affecting schoolchildren, (2) psychopharmacology, and (3) dietary control and supplement use. Section I on neuropsychiatric issues affecting schoolchildren includes some of the psychiatric issues receiving the most media coverage and affecting the most children and addresses the questions about psychiatric issues that educators often hear. These conditions include Tourette syndrome, bipolar/mood disorders, and separation anxiety disorder. Section II on psychopharmacology discusses the use of atypical antipsychotics and autism, treating tardive dyskinesia in children, medical management of attention deficit/hyperactivity disorder (ADHD), polypharmacy prescription practice, and side effects of common health medications. Section III on dietary control and supplement use includes dietary treatments for autism, identification and treatment of eating disorders, and use of steroids in adolescence. Although not inclusive, this volume covers topics that are among the most urgent and current in pediatrics in the schools.

    PaulC.McCabe and StevenR.Shaw, Editors


    A large-scale project like this cannot take place without the assistance of many people. Jennifer Bruce and Sarita Gober provided many hours of editorial assistance in this project. Their support, skill, and good humor made this project possible. In addition, external reviewers read chapters and provided valuable comments. All chapters were improved because of the efforts of these students, educators, and scholars. The reviewers are Tiffany Chiu, Ray Christner, Jason Collins, Janine Fisher, Sarah Glaser, Sarita Gober, Terry Goldman, Michelle Harvie, Tom Huberty, Susan Jones, Robin Martin, Tawnya Meadows, Tia Ouimet, Mark Posey, Sara Quirke, Amira Rahman, Shohreh Rezazadeh, Jennifer Saracino, Christopher Scharf, Khing Sulin, and Jessica Carfolite Williams. Of course, the authors deserve the lion's share of appreciation, because their expertise, hard work, talent, and timeliness made this work possible. Many thanks for their expertise and generosity.

    We would also like to thank the NASP publishing board and the editorial staff of NASP and Corwin for their encouragement and expertise in improving the content of this book and believing in the project, and we would like to acknowledge Andrea Canter, former editor of Communiqué, who supported the “Pediatric School Psychology” column from its inception and encouraged the dissemination of this work.

    Paul McCabe would like to thank his colleagues at Brooklyn College of the City University of New York for their logistical support and encouragement of this project. He would also like to thank the many talented, hard-working graduate students who have worked with him over the years to contribute to the “Pediatric School Psychology” column and this project. Finally, he would like to offer grateful thanks to friends and family for their love and encouragement, especially to Dan.

    Steven Shaw would like to thank the physicians from the Greenville Hospital System, South Carolina, who shaped his views of how education and pediatrics interact. Most notable of these physicians are Desmond Kelly, Nancy Powers, Mark Clayton, Lynn Hornsby, Curtis Rogers, and William Schmidt. And, of course, thanks to Isabel, Zoe, and Joyce for their love, support, and patience.

    About the Editors

    Paul C. McCabe, PhD, NCSP, is an Associate Professor of School Psychology in the School Psychologist Graduate Program at Brooklyn College of the City University of New York. Dr. McCabe received his PhD in Clinical and School Psychology from Hofstra University. He holds undergraduate degrees from University of Rochester and Cazenovia College. Dr. McCabe is a New York State–certified school psychologist, New York State–licensed psychologist, and a Nationally Certified School Psychologist (NCSP). Dr. McCabe serves on the editorial boards of several publications in school psychology and developmental psychology and has consulted at state and national levels on issues of early childhood assessment and best practices, pediatric issues in schools, and training in school psychology. Dr. McCabe conducts and publishes research in (1) early childhood social, behavioral, and language development and concomitant problems; (2) pediatric school psychology and health issues addressed by schools; and (3) social justice issues in training, especially training educators to advocate for gay, lesbian, bisexual, and transgendered youth.

    Steven R. Shaw, PhD, NCSP, is an Assistant Professor in the Department of Educational and Counselling Psychology at McGill University in Montreal, Quebec. Dr. Shaw received a PhD in school psychology from the University of Florida. He has been a school psychologist since 1988 with clinical and administrative experience in schools, hospitals, and independent practice. He is editor-elect of School Psychology Forum and serves on the editorial board of several professional journals. He has conducted workshops and consulted with educational policy makers to address the needs of children with borderline intellectual functioning in the United States, Canada, Pakistan, Moldova, Poland, India, and Egypt. Dr. Shaw conducts and publishes research in (1) the behavior and language development of children with rare genetic disorders; (2) resilience factors for children with risk factors for school failure, especially borderline intellectual functioning; and (3) pediatric school psychology and health issues addressed by schools.

    About the Contributors

    Larry M. Bolen, EdD, is a Professor of Psychology and Associate Dean of Planning in the Department of Psychology at East Carolina University. He received his doctorate from the University of Georgia and completed his BA and MA at West Georgia College. His research interests include psychometric properties of intelligence tests, CHC (fluid-crystallized) intelligence theory, acute and chronic health conditions affecting school learning, and visual-motor functioning.

    Tara Brinkman is a graduate student in the School Psychology Program at Michigan State University. Her interests include research and clinical issues in assessment and psychological issues of children with ADHD.

    Michael B. Brown, PhD, is a Professor of Psychology at East Carolina University. He completed his graduate and undergraduate work at Virginia Polytechnic Institute. His research interests include (1) pediatric school psychology, including educational and behavioral issues from chronic disorders with a special interest in mucopolysaccharide disorders (Hurler, Schaie, Hurler-Schaie, Hunter, San Fillipo, and Morquio syndromes), childhood cancer, and school-based health centers; (2) professional issues in school psychology; and (3) diverse issues affecting children and schools.

    John S. Carlson, PhD, NCSP, is an Associate Professor and Director of Clinical Training in the School Psychology Program at Michigan State University in East Lansing. Dr. Carlson received his PhD in School Psychology from the University of Wisconsin–Madison. He is a licensed psychologist in Michigan and has a private practice called Child and Adolescent Psychological Services, PLC. Dr. Carlson is on the editorial boards of several publications representing a diverse array of fields, including the Journal of School Psychology, Journal of Child and Adolescent Psychiatric Nursing, and Training and Education in Professional Psychology. Dr. Carlson publishes and conducts research on school psychopharmacology, treatment of selective mutism, dissemination and implementation of evidence-based interventions, early identification of behavioral problems in Head Start children, and issues associated with the prevention of preschool expulsion.

    Jason Collins, MS, CAS, NCSP, is a school psychologist working for the Newark Public Schools in Newark, New Jersey. Mr. Collins received his MS and CAS in School Psychology from the Rochester Institute of Technology with a focus on working with children who are deaf and hard of hearing. He holds an undergraduate degree in Psychology from St. John Fisher College in Rochester, New York. Mr. Collins is a New Jersey State–certified school psychologist and a Nationally Certified School Psychologist (NCSP). Mr. Collins serves on the School Leadership Council at Bruce Street School for the Deaf and consults at a district level on developing educational programs for students who are deaf and hard of hearing.

    Catherine Cook-Cottone, PhD, a Licensed Psychologist and Certified School Psychologist, is an Associate Professor in the Department of Counseling, School, and Educational Psychology at State University of New York at Buffalo and Director or the School Psychology MA/AC program. She teaches classes in counseling with children and adolescents, infant and preschool assessment, reading diagnostics, and the history of psychology. She also maintains a private practice with the East Amherst Psychology Group. Working with adults, adolescents, and children, she specializes in the assessment and treatment of anxiety-based disorders (e.g., post-traumatic stress disorder and generalized anxiety disorder), eating disorders (including other disorders of self-care), development of emotional regulation skills, and academic/reading difficulties. Her therapeutic approach includes constructivist therapies that facilitate neurological, emotional, and dialectic integration, including narrative, bibliotherapeutic, and creative approaches. Catherine's research has a neuropsychological focus and addresses two areas: (1) intervention for psychosocial disorders and (2) the development of reading.

    Tamara Dawkins, MA, OPQ, is a PhD student in the School/Applied Child Psychology Program and course lecturer in the Department of Educational and Counselling Psychology at McGill University in Montreal, Quebec. Ms. Dawkins completed her MA in Educational Psychology at McGill University and holds a BA from the same institution. She is a licensed school psychologist in the province of Quebec. Ms. Dawkins conducts research within a developmental psychopathology framework investigating visual attention skills in children with typical development, autism, and Down syndrome.

    Caryn R. DePinna, MSEd, received her graduate degree from the School Psychologist Graduate Program at Brooklyn College of the City University of New York and is currently a doctoral candidate in School-Community Psychology at Hofstra University. She holds an undergraduate degree in psychology from State University of New York at Geneseo. Caryn has published research on alternative treatments for autism and has several years of work experience with the autistic population. Caryn's other interests lie in treatments for childhood mental illness and classroom strategies to address children with ADHD.

    Daniel Farrell, MS, CAS, is a certified school psychologist in Peoria, Arizona. Daniel received his master's degree and Certificate of Advanced Graduate Study in School Psychology from Rochester Institute of Technology. He holds an undergraduate degree from St. Lawrence University.

    Janine Fischer, EdS, is a school psychologist in the Peoria Unified School District, Peoria, Arizona. She received her master's and educational specialist degrees from the College of William and Mary and undergraduate degree from Virginia Commonwealth University. Ms. Fischer is an Arizona State–certified school psychologist. Her interests lie in the area of response to intervention and mental health disorders in the school system.

    Sarita Gober, MSEd, is a certified school psychologist who recently graduated from Brooklyn College of the City University of New York's School Psychologist Graduate Program. She is currently a doctoral candidate in School Psychology at Rutgers University. She holds a BA in Psychology from Yeshiva University's Stern College for Women. Sarita is currently working at Brooklyn Children's Center, an inpatient children's psychiatric state hospital. Sarita has published numerous research articles and presented in research forums on adolescent motivations to take anabolic steroids. Ms. Gober's other research interests include (1) children's school readiness skills (i.e., early literacy skills) and (2) attachment relationships and interactions between mothers and children.

    Betsy Chesno Grier, PhD, is a pediatric psychologist with the University of South Carolina Medical School. She is a South Carolina State—licensed school psychologist. Her clinical and research interests involve pediatric bipolar disorder and other mental health issues.

    Elizabeth H. Jeffords, MD, is a pediatric psychiatrist with the University of South Carolina School of Medicine. Her research interests include autism, pediatric bipolar disorder, and issues in intellectual disabilities.

    Erika E. Levavi, MSEd, is a Bilingual School Psychologist intern in the New York area. She received her MSEd in School Psychology and an undergraduate degree in psychology and philosophy from Brooklyn College of the City University of New York. Mrs. Levavi was a school psychologist trainee at a New York City Department of Education public school. Her professional interests lie in atypical childhood development and multicultural issues in school psychology.

    Angela Maupin is a graduate student in the School Psychology Program at Michigan State University. Her interests include research and clinical issues in assessment and psychological issues of children with ADHD.

    Sara Pollak-Kagan, BS, is a student in the School Psychologist Graduate Program at Brooklyn College of the City University of New York. She received her bachelor's degree in Graphic Design and Judaic Studies from Touro College in New York. Ms. Pollak-Kagan currently teaches art history at Manhattan High School for Girls and is interested in conducting research in art and creativity and how it relates to childhood development.

    Florence J. Schneider, PhD, is an Assistant Professor in the Behavioral Sciences and Human Services Department at Kingsborough Community College of the City University of New York. Dr. Schneider received her PhD in Education from Capella University. She received her MA degree in Educational Psychology from New York University and has an undergraduate degree in Psychology and Special Education from Brooklyn College of the City University of New York. Dr. Schneider holds New York State certifications and New York City licenses as a Teacher of Special Education and Teacher of Elementary Education. She has been a teacher of individuals with special needs for 20 years and, in her current position, has educated future teachers for 13 years. Dr. Schneider's research interests and publications are in the area of teacher education, especially preparation for the inclusive education of students with special needs.

    Megan L. Wilkins, PhD, is a pediatric psychologist with the University of South Carolina Medical School. Her clinical and research interests involve autism, developmental disabilities, and adjustment of children with medical issues.

  • Glossary

    Agonist—A drug or other chemical that mimics a naturally occurring neurotransmitter and facilitates increased transmission of a naturally occurring neurochemical pathway, such as dopamine

    Antagonist—Opposite of an agonist, an antagonist is a drug that interferes with transmission from one neuron to another by means of blocking its nerve receptor or reducing the amount of the neurotransmitter available to aid the transmission.

    Cerebral Cortex—Outer layer of gray matter of the brain largely responsible for higher brain functions, including sensation, voluntary muscle movement, thought, reasoning, and memory

    Comorbid—Diseases or disorders that occur at the same time. They may or may not be related to one another.

    Complex Motor Tic—Sudden movement of longer duration than a simple motor tic

    Complex Phonic Tic—Syllables, words, or phrases, as well as odd patterns of speech, in which there are sudden changes in rate, volume, and/or rhythm

    Coprolalia—Type of tic that involves involuntary uttering of obscenities or socially inappropriate phrases

    Copropraxia—A sudden, ticlike vulgar, sexual, or obscene gesture

    Dopamine—One of the neurotransmitters involved in transmission of responses from one nerve cell to another that has been implicated in neuromotor pathways

    Echolalia—Complex phonic tic that involves repeating the last heard sound, word, or phrase

    Echopraxia—Complex motor tic that involves imitation of someone else's movements

    Neurotransmitters—Chemicals that the cells of the nervous system (i.e., neurons) use to communicate with one another

    Palilalia—Complex phonic tic that involves repeating one's own sounds or words

    Premonitory Urges—Sensations perceived by individuals immediately preceding an involuntary movement or vocalization

    Receptor—A protein on the surface of a neuron (or any other cell) that recognizes and binds with a molecule or chemical (such as dopamine), creating an electrochemical signal, which then causes the receiving neuron to act on that signal

    Antipsychotics—A class of psychotropic medication often used to treat bipolar disorder

    Hypersexuality—The exhibition of developmentally inappropriate sexual behaviors

    Mania—A severe condition characterized by extremely elevated mood, energy, and unusual thought patterns that interfere with daily functioning

    Mood—A state of mind and emotional feeling that normally fluctuates for all individuals. Two mood disorders exist (depressive disorder and bipolar disorder) wherein mood is impaired to the degree that life activities are disrupted.

    OHI—This stands for Other Health Impaired. It refers to a special education program allowing access to an IEP. Pediatric bipolar disorder is a medical condition that can fall under this program's supports if adverse affects on the child's learning are documented.

    Agoraphobia—An anxiety disorder characterized by anxiety about, or avoidance of, open spaces or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack or paniclike symptoms

    Environmental-Situational Phobia—A subtype of a specific phobia in which the fear is cued by a specific environmental situation

    Flooding—A therapy technique that places the client in the presence of an aversive stimulus without escape so that the client eventually accommodates to the stimulus

    Generalized Anxiety Disorder—An anxiety disorder characterized by excessive, uncontrollable worry and associated feelings of tension or restlessness

    Social Phobia—An anxiety disorder characterized by excessive and disabling fear of social or evaluative situations

    Bipolar Disorder—Bipolar disorder (manic-depressive illness) is a mood disorder involving episodes of both significant mania and depression. The person's mood swings from excessively “high” (excited, irritable, flight of ideas) to sad and hopeless.

    Cyclothymia—A mild bipolar disorder characterized by instability of mood and a tendency to swing between mild euphorias and depressions

    Dopaminergic—Relating to, involved in, or initiated by the neurotransmitter activity of dopamine or related neurotransmitters

    Dysthymia—A chronic mood disorder characterized by mild depression, or despondency or a tendency to be despondent, over a long period

    Euphoria—A feeling of happiness, confidence, or well-being sometimes inflated in pathological states as mania

    Hyperthymia—An abnormal decrease in the intensity with which emotions are experienced, such as flatness of affect

    Hypomania—A mild state of mania, especially as a phase of a manic-depressive cycle

    Mesolimbic—A central portion of the limbic system of the brain, including the ventral tegmental area, with high concentrations of dopaminergic neurons and innervations to the amygdala, nucleus accumbens, and olfactory tubercle mesolimbic system. The system plays a primary role in the control of memory and emotion.

    Atypical Antipsychotic Medications—Second-generation antipsychotics used to treat schizophrenia and other thought disorders. They have recently been used for children with developmental disabilities and behavior problems. They include these chemical classes: dibenzoxazepine (e.g., Clozapine), thienobenzodiazepine (e.g., Olanzapine), and benzisoxazole (e.g., Risperidone).

    Autonomic Dysfunction—A disorder of the autonomic nervous system, which controls heart rate, blood pressure, digestive functions, and responses to stress

    Dopamine—A hormone and neurotransmitter that has many functions in the brain, including important roles in behavior and cognition, motor activity, motivation and reward, and learning

    Dopamine (DA) Receptors—An important component of the central nervous system associated with the processing of dopamine. Disorders of the DA receptors are associated with ADHD, depression, and schizophrenia. DA receptors are a target of antipsychotic medications.

    Extrapyramidal Symptoms (EPS)—Neurological side effects of antipsychotic medications. EPS can cause a variety of symptoms, including involuntary movements, tremors and rigidity, body restlessness, muscle contractions, and changes in breathing and heart rate.

    Limbic System—Subcortical brain structures that support a variety of functions, including emotion, long-term memory, and aggression

    Off-Label Use—The practice of prescribing drugs for a purpose outside the scope of the drug's approved label, most often concerning the drug's indication

    Serotonin—A hormone and neurotransmitter. Changes in the serotonin levels in the brain can alter mood. For example, medications that affect the action of serotonin are used to treat depression.

    Striatum—A subcortical structure that is rich in DA receptors. The striatum is associated with impulse control and aggression.

    Tardive Dyskinesia—Repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.

    Typical Antipsychotic Medications—Typical antipsychotics (sometimes referred to as first-generation antipsychotics, conventional antipsychotics, classical neuroleptics, or major tranquilizers) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia). Commonly prescribed typical antipsychotics include chloropromazine and haloperidol. They are generally being replaced by atypical antipsychotic drugs.

    Akathisia—An unpleasant sensation of inner restlessness. The patient may display an inability to sit still or remain motionless.

    Athetoid Movements—Slow, sinuous, and continual movements of the tongue, jaw, or extremities.

    Atypical Antipsychotics—A class of medication first used in the 1970s to treat mental illness. Because they are thought to have less serious side effects, they are being used to replace typical antipsychotics.

    Choreiform Movements—Rapid, jerky, and nonrepetitive movements of the tongue, jaw, or extremities

    Dopamine—A hormone and neurotransmitter that has many functions in the brain. It is implicated in motor activity, cognition, attention, motivation, mood, and sleep, among other functions.

    Dystonia—Sustained muscle contractions causing twisting and repetitive movements or abnormal postures. The involuntary movements may affect a single muscle, a group of muscles, or the entire body.

    Neuroleptic Medication—Medication used to treat psychosis, often having a tranquilizing effect

    Rhythmic Movements—Stereotypical movements of the tongue, jaw, or extremities

    Stereotypic Movements Disorder—Condition in which a person engages in repetitive, often rhythmic, but purposeless movements such as rocking, hand shaking or waving, and mouthing of objects

    Amphetamine-Based Stimulants—Drugs (amphetamines) that influence the levels of dopamine and norepinephrine in the brain and have been used to treat ADHD, narcolepsy, and other central nervous system dysfunction. Brand names include Dexedrine and Desoxyn.

    Attention Deficit/Hyperactive Disorder—A neurodevelopmental disorder with symptoms of inattention, hyperactivity, and impulsivity leading to impairment in functioning across multiple settings. This neurodevelopmental disorder is highly heritable.

    Dopamine (DA) Receptors—An important component of the central nervous system associated with the processing of dopamine. Disorders of the DA receptors are associated with ADHD, depression, and schizophrenia. DA receptors are a target of stimulant medications.

    Immediate-Release Stimulants—These medications are short-acting (3 to 4 hours) medicines that require multiple doses (2 or 3) throughout the day to see desired benefits.

    Long-Acting Stimulants—Referred to as extended-release (ER or XR), sustained-release (SR), or continuous delivery (CD). Found to be as efficacious in treating ADHD as short-acting or immediate release medications. Long-acting stimulants offer convenience via single daily dosing.

    Methylphenidate-Based Stimulants—Drugs (methylphenidate [MPH]) that influence the levels of dopamine and norepinephrine in the brain and have been used to treat ADHD, narcolepsy, and other central nervous system dysfunction. Brand names include Ritalin, Metadate, Focalin, and Concerta.

    Mixed Amphetamine Salts—Include medications such as Adderall or Adderall XR. Targets dopamine and norepinephrine levels within the brain synapses.

    Norepinephrine—Neurotransmitter implicated in depression, anxiety, and ADHD

    Prodrug—A drug that when administered is inactive or partially inactive until it becomes metabolized in the body. An example is lisdexamfetamine (brand name Vyvanse), which is considered an extended-release version of dextroamphetamine and has Food and Drug Administration (FDA) approval to treat ADHD.

    Selective Norepinephrine Reuptake Inhibitors (SNRIs)—Class of medicines including the drug Strattera, which is FDA approved for treating ADHD in children and adults

    Stimulant—Sympathomimetic drug that increases the synaptic catecholamines (primarily dopamine) by inhibiting the presynaptic reuptake mechanism and releasing presynaptic catecholamines

    Titration—Process of gradually adjusting a medication dose to achieve the desired result

    Adjunctive Polypharmacy—The use of one medication to alleviate the side effects or secondary symptoms caused by another medication from a different medication class (e.g., clonidine to treat sleep problems in children being treated with a psychostimulant).

    Augmentation—The use of a medication at a lower dose than is typically prescribed in combination with another medication that is prescribed at a typical therapeutic dose for similar symptoms (e.g., the addition of fluoxetine to a partial response to fluvoxamine or the use of atomoxetine with a partial response to a psychostimulant)

    Combined Pharmacotherapy—The use of more than one medication to treat one disorder

    Concomitant Psychotropic Medication Therapy—The simultaneous use of two or more psychotropic medications for the same or different target symptoms/behaviors

    Contra-Therapeutic Polypharmacy—Unexpected or unintended negative outcomes that are associated with the use of two or more medications. This results in an evidence base against the use of those medications in combination. Sometimes referred to as “irrational polypharmacy.”

    Copharmacy—The use of two or medications to treat different disorders

    Monotherapy—The use of one drug or intervention to treat one or more conditions

    Multiclass Polypharmacy—The use of more than one medication from different medication classes for the same group of symptoms (e.g., the use of methylphenidate and atomoxetine for the treatment of hyperactivity and inattention)

    Off-Label Prescription Practices—The use of medications for conditions or with populations in which they have not been approved or thoroughly investigated

    Polypharmacy—The use of two or more medications for one or more conditions

    SAIL (Simple, Adverse Effects, Indication, List)—A mnemonic strategy used by physicians when making decisions regarding the appropriateness of drug therapy. Keep it simple and avoid complex drug regimens (S). Understand the adverse effects associated with each drug, individually and when used in combination with other drugs (A). Each drug should have a clear indication and a well-defined goal for improving the targeted symptom (I). Record and list the name and dose of any drug prescribed, as keeping accurate notes and logs is essential for close progress monitoring (L).

    Same-Class Polypharmacy—The use of more than one medication from the same class of medicines to treat a patient's symptoms. For example, both fluvoxamine and sertraline (two selective serotonin reuptake inhibitors) may be prescribed to target symptoms associated with obsessive-compulsive disorder.

    Therapeutic Polypharmacy—Use of multiple drugs to treat a disease based on evidence or research support (i.e., Food and Drug Administration approval). Within childhood mental health conditions, this has yet to be clearly established for any combination of drugs.

    Total Polypharmacy—The total count of medications used within a patient. This is also referred to as “drug load.” It includes all forms of biological treatments, including prescribed medicines, over-the-counter medicines, alternative medication approaches, and illicit drugs.

    Analgesic—Any of a diverse group of medications used to relieve pain

    Anticonvulsant—A drug used to control seizures, sometimes used to treat migraine headaches

    Antipyretic—Medication used to reduce fever

    Corticosteroid—A prescription steroid drug frequently used to treat inflammation

    Multisymptom Formula—Nonprescription medication that contains several different drugs to control a number of different symptoms

    NSAIDs—Nonsteroidal anti-inflammatory drugs, including ibuprofen, naproxen sodium, and related drugs

    Over-the-Counter (OTC)—Describes medicines sold to customers without a prescription

    Physician's Desk Reference(PDR)—A comprehensive list of all drugs available in the United States with description of use, dosage, interactions, and side effects

    Psychomotor Speed—The ability to perform fine motor tasks (such as writing or copying) quickly

    Side Effect—Effect that occurs beyond or in addition to the desired therapeutic effect of the drug

    Asperger Syndrome—One of the autism spectrum disorders characterized by impaired social interaction and restricted, stereotyped patterns of behavior, interests, and activities. Children display typical language and cognitive development.

    Autism—A disorder appearing by age 3 that is characterized by lack of communication, lack of social skills, stereotyped and/or repetitive interests and activities, withdrawal, and developmental delays

    Casein—A protein in milk

    Gluten—A protein found in wheat, rye, barley, and oats

    Opiod-Excess Hypothesis—Hypothesis on which the gluten-free casein-free diet is based. States that when gluten and casein are not completely broken down during the digestive process, peptides remain in the digestive tract and are absorbed into the bloodstream. These peptides are hypothesized to become biologically active and be treated as neuropeptides by the brain. As neuropeptides, they stimulate an opiate-like effect on the brain and potentially cause and/or contribute to behaviors associated with autism spectrum disorders.

    Peptides—Short chains of amino acids that remain in the digestive tract

    Placebo Effect—A favorable response to an intervention, regardless of whether it is a true intervention or a placebo. The favorable response is attributed to the expectation of the intervention.

    Anorexia Nervosa (AN)—Individuals with AN pursue and/or maintain excessively low body weight (i.e., 85% of normal weight or a body mass index [BMI] of 17.5 kg/m2) through a reduction in food intake and, possibly, self-induced vomiting, misuse of laxatives or diuretics, and/or excessive exercise.

    Binge Eating—A binge is defined by the DSM-IV-TR as eating a large amount of food in a discrete period of time (i.e., definitely a larger amount than most individuals would eat within about 2 hours).

    Binge-Eating/Purging Type—This subtype of AN involves regularly binge eating, purging, or both. Notably, some individuals in this subtype do not binge eat. Rather, they regularly purge after consumption of small amounts of food.

    Body Image Distortion—Body image distortion involves a distorted experience of body weight and shape. This includes feelings of being globally overweight, as well as over-focus on and distortion regarding particular parts of the body (e.g., abdomen, buttocks, and thighs).

    Body Mass Index—Body mass index (BMI) is a measure of body fat based on weight and height typically used for adult men and women. Per the National Institutes of Health, the BMI categories include (a) underweight, <18.5; (b) normal weight, 18.5–24.9; (c) overweight, 25.0–29.9; and (d) obesity, ? 30.

    Body Mass Index-for-Age Percentile—A BMI-for-age percentile is considered the most appropriate weight comparison method for children. Per the Centers for Disease Control and Prevention, it is calculated by using the child's weight, height, age, and gender to compare to growth charts that demonstrate age-appropriate growth expectations.

    Bulimia Nervosa (BN)—Individuals with BN place an excessive emphasis on body shape and weight in their self-evaluations. There are two subtypes: purging type (regular engagement in the use of vomiting, laxatives, diuretics, or enemas) and nonpurging type (use of other compensatory behaviors, such as fasting or exercise).

    Compulsory Exercise (or Obligatory Exercise)—Compulsive exercise is the qualitative measure of exercise. Exercise is considered compulsive when it is marked by maintenance of a rigid exercise schedule, detailed record keeping, and priority over other daily life activities, as well as feelings of anxiety and guilt associated with missed sessions.

    Nonpurging Type—This subtype of BN presents with alternative, inappropriate compensatory behaviors (e.g., fasting and excessive exercise) without engagement in typical purging behaviors (e.g., self-indicted vomiting or misuse of laxatives, diuretics, and enemas).

    Purging—Purging behaviors include self-induced vomiting or the misuse of laxative or diuretics.

    Anabolic Androgenic Steroids—Manufactured substances related to male sex hormones, such as testosterone. Anabolic refers to muscle-building and growth properties, and androgenic refers to the increase in male sexual characteristics.

    Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR)—A manual published by the American Psychiatric Association that lists mental disorders and criteria for proper diagnosis of these disorders

    Muscle Dysmorphia—A disorder where individuals become preoccupied with their muscularity and, even if they are well built, view themselves as being undersized and inadequate. It is a specific subtype of body dysmorphic disorder.

    Performance-Enhancing Drugs—FDA-approved legal substances that have many of the same properties as steroids, such as creatine

    Testosterone—A sex hormone that is essential to maturation and sex differentiation. When derived from the ingestion of steroids, however, testosterone also contributes to the building of lean muscle mass.


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