UC Davis pediatric specialists find new approaches to troubling childhood conditions
Focusing attention on ADHD
While in graduate school, when Julie Schweitzer started to focus on children with attention-deficit/hyperactivity disorder (ADHD), a professor tried to steer her in other directions.
“‘Why worry too much about kids with ADHD?’ he asked me,” Schweitzer remembers. “‘They’ll just grow out of it.’”
But Schweitzer was undeterred. Now an associate professor of psychiatry and behavioral sciences and researcher at the UC Davis M.I.N.D. Institute, Schweitzer has established an active research program for children with ADHD — and the many adults who continue to have problems with the disorder.
Common psychiatric disorder
ADHD is the most common psychiatric disorder in childhood, affecting 3 percent to 5 percent of school-aged children in the United States. More than their peers, children with ADHD tend to act impulsively and to daydream. They find it difficult to stay on task and become easily sidetracked. Family life, school performance and social relationships often suffer as a result.
Schweitzer heads up a team that is trying to tease out exactly what makes children with ADHD different. Using novel experiments that challenge the thresholds of attention and judgment in children with ADHD, the group uses pupil-size measurements (an indicator of norepinephrine levels) and functional MRI scans to try to pinpoint differences in neurotransmitters that one day may be targeted for therapy.
In a recent study published in Child Neuropsychology, Schweitzer found that children with ADHD show more variable or inconsistent responses during short-term memory tasks when compared with typically developing peers. While previous studies suggested that children with ADHD might be slower at responding to tasks, her study shows that their inconsistent response times helps explain why working memory may be fine at one moment and poor at another, just as one day a child with ADHD seems to be able to learn and focus in class yet seems distracted and not paying attention on another.
Further research at the M.I.N.D. Institute is designed to improve behavioral therapy for ADHD. Parent and teacher training is a big part of it. As a result, children can often function as well with lower dosages of medication. Schweitzer and her team also are reaching out to schools and mental health facilities in the greater Sacramento area to increase recognition and care of this often frustrating disorder.
Schweitzer looks forward to using her research to expand clinical services at the M.I.N.D. Institute. Key is a thorough evaluation to rule out the many other disorders that can manifest symptoms of ADHD, she says. Next, patients need an individualized treatment approach that is monitored regularly for effectiveness and adjusted as needed.
“We look forward to offering a full spectrum of care,” says Schweitzer. “We want to address the needs of patients of any age with ADHD, based on solid clinical evidence of the most effective pharmacological and behavioral interventions.”
A cool treatment for the youngest patients
It’s a parent’s worst nightmare: after a normal pregnancy, a healthy baby is born with the umbilical cord wrapped around her neck. Within the first few hours after birth, clearly something is wrong with this otherwise beautiful infant — she is lethargic, not eating, and has had a seizure.
The doctor suspects that she is developing brain damage from a lack of oxygen during birth, a condition known as hypoxic ischemic encephalopathy (HIE). She will be at risk for deafness, mental retardation and cerebral palsy — if she survives.
In most hospitals, the treatment for HIE is supportive care and a wait-and-see approach. But UC Davis Children’s Hospital Neonatal Intensive Care Unit (NICU) will soon be taking a more proactive approach under the leadership of Ian Griffin, associate professor of pediatrics.
Reducing body temperature
Babies with moderate to severe HIE will be placed on a cooling blanket to lower their body temperatures about six degrees Fahrenheit below normal and will be kept at that temperature for three days before slowly being rewarmed.
Hypothermia therapy, which seems like a treatment borrowed from an episode of "Star Trek," is becoming the standard for treating HIE — when it is available.
Soon the UC Davis NICU — a level 3 NICU that offers the highest level of neonatal care — will be the only facility offering it in Northern California, outside of San Francisco.
Proximity to a hospital with this capability is critically important, according to Griffin, because the therapy must begin within six hours after birth to be effective.
Hypothermia treatment not only increases the chance of survival but reduces the likelihood that the baby will develop the disabilities often seen following HIE.
Griffin says that no one can explain exactly why hypothermia treatment works. It is possible that the lower temperature reduces metabolic rate, leading to less energy depletion, swelling and cell death.
“The normal responses to stress that are usually protective are probably just too much for a newborn brain to handle,” explains Griffin.
Hypothermia treatment also is being explored for other conditions, including for children and adults following an acute brain trauma such as from a car crash or stroke. NFL player Kevin Everett received hypothermia treatment immediately following a spinal cord injury on the field, which may have helped contribute to his recovery.
Helping premature infants thrive
UC Davis neonatologist Mark Underwood is searching for ways to prevent a potentially deadly intestinal disease called necrotizing enterocolitis (NEC) from occurring. The disease often strikes babies born too early.
“For premature infants, necrotizing enterocolitis is a common, devastating condition, and we have very limited options for treating it,” says Underwood, assistant clinical professor of neonatology.
No one knows what exactly causes NEC, though physicians believe the intestine’s inflammatory response is triggered by an imbalance in gut bacteria. So, Underwood has designed a clinical trial aimed at creating that healthy bacterial balance. The trial will determine the best mixture of pre- and probiotic supplements to give to premature infants to prevent NEC.
Probiotics are beneficial bacteria found in various foods. Common strains include the Lactobacillis and Bifidobacterium families of bacteria. Prebiotics are nondigestible foods that make their way through the digestive system and help good bacteria grow and flourish.
UC Davis Medicine
The summer 2009 issue of UC Davis Medicine explores the many ways that the innovative and compassionate experts at UC Davis are helping children grow up healthy and prepared to take on the challenges of tomorrow.
Underwood recommends that mothers of premature infants breastfeed (or pump their milk for NICU staff use to feed the babies). Studies have shown that pre-term infants are less likely to develop NEC and the life-threatening intestinal perforations associated with it if they have previously been fed breast milk.
“When we are talking life or death, even a few percentage points matter,” Underwood says.
Still, breast milk does not completely prevent NEC from developing in the first place. That may be, Underwood says, because mother’s milk is designed for term babies and may not have the healthiest percentage of prebiotics to support growth of healthy bacteria in pre-term babies’ intestines prone to developing NEC.
“It would be wonderful to be able to find a way to prevent this debilitating disease in infants and we believe that pre- and probiotics are a safe and effective way to do that.”