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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_473"
                     title="AAN: High Intake of Vitamin D Linked to Lower MS Risk (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18406?impressionId=1265817660696"
                     
      &lt;p&gt;TORONTO  --  Women whose mothers consumed high levels of vitamin D during pregnancy have a lower risk of developing multiple sclerosis, a large, observational study confirmed.&lt;/p&gt;
&lt;p&gt;Mothers who reported the highest intake during pregnancy were 45% less likely to have a daughter who subsequently developed the disease than those who consumed the least vitamin D (RR 0.55, 95% CI 0.35 to 0.88), according to Fariba Mirzaei, MD, MPH, a doctoral student at the Harvard School of Public Health.&lt;/p&gt;
&lt;p&gt;Mirzaei is scheduled to report the findings at the American Academy of Neurology (AAN) meeting in April.&lt;/p&gt;
&lt;p&gt;Lily Jung, MD, a neurologist at Swedish Medical Center in Seattle, said in an interview that the study &quot;adds more fuel to the fire that low vitamin D is important in the genesis of MS,&quot; which has been demonstrated in previous studies. (See &lt;a href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; mce_href=&quot;http://www.medpagetoday.com/Neurology/MultipleSclerosis/4738&quot; target=&quot;_blank&quot;&gt;High Blood Levels of Vitamin D May Lower MS Risk&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;She said it&apos;s unclear why vitamin D is associated with risk of multiple sclerosis.&lt;/p&gt;
&lt;p&gt;&quot;There&apos;s an idea that perhaps there might be receptors that are turned on by vitamin D levels that give some form of protection, but that is very preliminary information and we&apos;re still learning a lot about that,&quot; said Jung, who is also a spokeswoman for the AAN.&lt;/p&gt;
&lt;p&gt;Although the link between vitamin D and risk of multiple sclerosis has been demonstrated before, gestational exposure to the vitamin has not been studied.&lt;/p&gt;
&lt;p&gt;To fill that gap, Mirzaei analyzed data from the Nurses&apos; Mothers&apos; Study, which includes a subcohort of the two Nurses&apos; Health Studies that was restricted to nurses whose biological mothers completed a questionnaire in 2001 about their diet during pregnancy.&lt;/p&gt;
&lt;p&gt;The current analysis included 35,794 nurse-mother pairs.&lt;/p&gt;
&lt;p&gt;During the 16-year study period, 199 of the nurses were diagnosed with multiple sclerosis.&lt;/p&gt;
&lt;p&gt;In addition to a lower risk of disease among those whose mothers consumed the largest amounts of vitamin D, those whose mothers had the highest predicted serum 25-hydroxyvitamin D levels also had a reduced risk of having a daughter with the disease (RR 0.58, 95% CI 0.37 to 0.90).&lt;/p&gt;
&lt;p&gt;In an analysis of milk drinking alone, mothers who drank at least four glasses a day had a nonsignificant reduced risk of having a daughter who would develop multiple sclerosis compared with those who drank less than three glasses a month (RR 0.44, 95% CI 0.16 to 1.23).&lt;/p&gt;
&lt;p&gt;However, there was a significant trend for lower risk of multiple sclerosis with increasing milk consumption (&lt;em&gt;P&lt;/em&gt;=0.001).&lt;/p&gt;
&lt;p&gt;Jung noted that the study was limited by the use of questionnaires decades after a pregnancy to determine dietary intake of vitamin D.&lt;/p&gt;
&lt;p&gt;Nevertheless, she said, &quot;this is very consistent with what we&apos;re seeing elsewhere in terms of vitamin D in moms and the risk of MS in kids.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Mirzaei did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_437"
                     title="Autism Risk Linked to Maternal Age (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Pediatrics/Autism/tb/18341?impressionId=1265817660696"
                     
      Older women are more likely to give birth to a child who develops autism than younger women, but the father&apos;s age is a factor only when moms are younger, a large case-control study showed.&lt;br&gt;
&lt;br&gt;In an analysis of nearly five million births and more than 12,000 autism cases, every five-year increase in maternal age at delivery was associated with an 18% greater risk of the child later being diagnosed with autism, according to Janie Shelton, MPH, a doctoral student at the University of California Davis, and colleagues.&lt;br&gt;
&lt;br&gt;Mothers who gave birth when they were 40 or older had a 51% increased risk of having a child with autism compared with those who were 25 to 29, the largest age group (OR 1.51, 95% CI 1.35 to 1.70), the researchers reported in the February issue of &lt;em&gt;Autism Research&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The effect of the biological father&apos;s age appeared to depend on the mother&apos;s. When the mothers were 30 and older, paternal age did not significantly increase the risk of having a child develop autism. In mothers younger than 30, paternal age did contribute to the autism risk.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;This study builds upon earlier work that has demonstrated associations between parental age and autism risk,&quot; commented Bryan King, MD, program director of the Seattle Children&apos;s Autism Center, in an e-mail.&lt;/p&gt;
&lt;p&gt;But previous studies have yielded mixed results on the relative contributions of the mothers&apos; and fathers&apos; ages.&lt;/p&gt;
&lt;p&gt;&quot;I think the size of the sample used in the present study (close to five million births) has resulted in a clear signal that both maternal and paternal age are involved,&quot; said King, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;He noted, however, that parental age &quot;does not account for the big increase in autism prevalence, although it may be contributing somewhat.&quot;&lt;/p&gt;
&lt;p&gt;Shelton and her colleagues calculated that the rising average maternal age during their study  --  covering 1990 to 1999  --  contributed to a 4.6% increase in autism incidence. That compares with about a six-fold increase in autism rates in that decade, Shelton said in an interview.&lt;/p&gt;
&lt;p&gt;&quot;I worry a little bit that in the media attention on this issue that mothers who had children at ages 37, 38, 39 might think that, &apos;Okay, well that&apos;s why my child had autism,&apos;&quot; she said. &quot;And so, I think it&apos;s important to stress that the increased number of cases that we&apos;ve observed can&apos;t be attributable towards women having children later.&quot;&lt;/p&gt;
&lt;p&gt;The researchers looked at data from 4,935,776 singleton births in California in the 1990&apos;s using records from the state Department of Development Services. Records identified 12,159 cases of &quot;Full Syndrome Autism&quot; diagnosed before age 6.&lt;/p&gt;
&lt;p&gt;That diagnosis may include autistic disorder, as well as Asperger&apos;s disorder and pervasive developmental disorder not otherwise specified. However, the breakdown of specific diagnoses could not be determined from this data set, Shelton said.&lt;/p&gt;
&lt;p&gt;Even after controlling for parental education, the year of the child&apos;s birth, the race/ethnicity of the parents, the mother&apos;s parity, and insurance payment type, older maternal age was associated with an increased risk of autism in the child.&lt;/p&gt;
&lt;p&gt;Nancy Minshew, MD, director of the Center of Excellence in Autism Research at the University of Pittsburgh, said in an e-mail that the results were not surprising because genetic errors are more common with older parents.&lt;/p&gt;
&lt;p&gt;King said genetics were one possible mechanism underlying the relationship.&lt;/p&gt;
&lt;p&gt;&quot;The mechanisms by which risk goes up might include a greater likelihood of chromosomal changes, a greater likelihood of problems at birth like prematurity, and many other factors,&quot; he said. &quot;The possibility of environmental exposures would also be expected to increase with age, and so this finding does not necessarily help narrow our focus on causes.&quot;&lt;/p&gt;
&lt;p&gt;Sheldon and her colleagues wrote, &quot;It is plausible that multiple exposure types may increase the risk of autism through a common pathway or pathways (i.e., mitochondrial function, thyroid function, epigenetics, hormonal alterations) and be represented as a generalized increased risk with age.&quot;&lt;/p&gt;
&lt;p&gt;&quot;In this case,&quot; they continued, &quot;maternal or paternal age would serve as an index of lifetime exposure status and be a proxy for the true underlying etiologic agent.&quot;&lt;/p&gt;
&lt;p&gt;Shelton said further research is needed to determine why biological age is serving as a risk factor for autism.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute of Environmental Health Sciences and the Environmental Protection Agency and by the University of California Davis School of Medicine and Office of Graduate Studies.&lt;/p&gt;&lt;p&gt;The researchers did not report any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_425"
                     title="AAN: Industrial Cleaner Again Tied to Parkinson Risk (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18338?impressionId=1265817660696"
                     
      TORONTO  --  The degreasing agent trichloroethylene (TCE) has been linked to increased rates of Parkinson&apos;s disease among industrial workers in yet another study, this time involving a large, well-studied group of World War II veterans.&lt;br&gt;
&lt;br&gt;Parkinson&apos;s disease developed in individuals with occupational exposure to TCE at more than five times the rate seen in those without such exposure (odds ratio 5.5, 95% CI 1.02 to 30), reported Samuel Goldman, MD, of the Parkinson&apos;s Institute in Sunnyvale, Calif.&lt;br&gt;
&lt;br&gt;Goldman described the research in a phone interview with &lt;em&gt;MedPage Today&lt;/em&gt;. It&apos;s scheduled for presentation here in April at the American Academy of Neurology&apos;s annual meeting.&lt;br&gt;
&lt;br&gt;A previous study in 2008 had fingered TCE as the most likely culprit behind a cluster of Parkinson&apos;s disease cases afflicting workers at a single industrial plant. (See &lt;a href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; mce_href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; target=&quot;_blank&quot;&gt;Trichloroethylene Implicated as Risk for Parkinsonism&lt;/a&gt;)&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Also, Goldman said, animal studies have found that TCE is selectively toxic to nigral dopaminergic neurons, the same type of nerve cell that progressively dies off in Parkinson&apos;s disease. He said the chemical&apos;s activity in rodent brains is very similar to that of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), a dopaminergic neurotoxin commonly used to simulate Parkinson&apos;s disease in preclinical research.&lt;/p&gt;
&lt;p&gt;Goldman said the new study was the first population-based analysis to link TCE to the disease.&lt;/p&gt;
&lt;p&gt;It focused on 198 twin pairs in the National Academy of Sciences-National Research Council&apos;s World War II Twins Cohort, which comprises some 16,000 twin pairs overall.&lt;/p&gt;
&lt;p&gt;Members of the all-male cohort, who were born from 1917 to 1927 and served in the war, have been followed since the 1960s. Occupational histories for participants are available along with medical records from the VA healthcare system.&lt;/p&gt;
&lt;p&gt;In those pairs chosen for the current study, records showed that one twin had developed Parkinson&apos;s disease and the other had not. This design largely eliminates genetics as a confounding factor in the analysis.&lt;/p&gt;
&lt;p&gt;Goldman explained that occupational histories for each participant were reviewed by a blinded industrial hygienist and a preventive medicine physician to identify likely exposures to TCE and four other industrial chemicals: xylene, toluene, carbon tetrachloride, and tetrachloroethylene.&lt;/p&gt;
&lt;p&gt;As a single source of exposure, only TCE was significantly associated with development of Parkinson&apos;s disease, Goldman said.&lt;/p&gt;
&lt;p&gt;People working as aircraft mechanics, machinists, plumbers, and electricians likely had regular exposure to TCE, Goldman said. The chemical was commonly used as a &quot;spot&quot; cleaner to remove grease and oils from metal surfaces. It was also used for a time as a dry cleaning solvent, although tetrachloroethylene was more common for that purpose.&lt;/p&gt;
&lt;p&gt;Goldman said no increased risk was seen with xylene or toluene, but there were near-significant trends toward increased Parkinson&apos;s disease risk from carbon tetrachloride and tetrachloroethylene: &lt;ul&gt; &lt;li&gt;Carbon tetrachloride: OR 2.8 (95% CI 0.97 to 7.8)&lt;/li&gt; &lt;li&gt;Tetrachloroethylene: OR 9.0 (95% CI 0.78 to 103)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Twins exposed to either TCE or tetrachloroethylene were at significantly increased risk, with an odds ratio of 8.1 (95% CI 1.43 to 43) relative to individuals with no exposure to either chemical.&lt;/p&gt;
&lt;p&gt;Goldman said the analysis also examined whether duration of exposure was associated with increased risk. He said the results were in the same pattern as for the yes-no exposure analysis, but the findings were very uncertain because of the relatively small sample size.&lt;/p&gt;
&lt;p&gt;Occupational histories were available for only 99 of the 198 discordant twin pairs and some of the information was obtained by proxy rather than from the participant himself.&lt;/p&gt;
&lt;p&gt;Because of the wide confidence intervals even for the yes-no exposure analysis, the findings need confirmation in a larger study, he said, noting that the best approach would be a cohort study involving people with known, long-term exposure to TCE, compared with well-chosen controls.&lt;/p&gt;
&lt;p&gt;&quot;The study wouldn&apos;t have to be large,&quot; Goldman said. He estimated that 1,000 to 2,000 participants would be adequate to determine if the connection to Parkinson&apos;s disease is real.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Neurological Disorders and Stroke, the Valley Foundation, and the James and Sharron Clark Family Fund.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_368"
                     title="Lancet Retracts 1998 MMR-Autism Paper"
                     score="0.011"
                     href="http://www.medpagetoday.com/Pediatrics/Vaccines/tb/18255?impressionId=1265817660696"
                     
      &lt;p&gt;Editors of &lt;em&gt;The Lancet&lt;/em&gt; have retracted the 1998 study that first suggested autism might be caused by the MMR vaccine, less than a week after an official rebuke to the paper&apos;s lead author, Andrew Wakefield, MBBS, and two co-authors.&lt;/p&gt;
&lt;p&gt;In a brief note posted on the journal&apos;s Web site, &lt;em&gt;Lancet&lt;/em&gt; editors wrote, &quot;It has become clear that several elements of the 1998 paper by Wakefield et al. are incorrect, contrary to the findings of an earlier investigation.... Therefore, we fully retract this paper from the published record.&quot;&lt;/p&gt;
&lt;p&gt;Evidence presented in a Jan. 28 hearing before the U.K. General Medical Council&apos;s Fitness to Practise Panel persuaded the journal that the paper had misrepresented how the study was conducted.&lt;/p&gt;
&lt;p&gt;&lt;span class=&quot;msgBody&quot;&gt;The council, which has no direct American equivalent, is an independent, nationwide regulatory body that registers doctors and enforces standards of medical practice in the U.K.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;Hospital records and other sources contradicted findings of a 2004 investigation by Wakefield&apos;s institution, the Royal Free and University College, that the study had been properly vetted by an institutional review board.&lt;/p&gt;
&lt;p&gt;&quot;The claims in the original paper that children were &apos;consecutively referred&apos; and that investigations were &apos;approved&apos; by the local ethics committee have been proven to be false,&quot; according to the &lt;em&gt;Lancet&lt;/em&gt; editors.&lt;/p&gt;
&lt;p&gt;The editor of Britain&apos;s other leading medical journal, &lt;em&gt;BMJ&lt;/em&gt;, congratulated &lt;em&gt;The Lancet&lt;/em&gt; for its action.&lt;/p&gt;
&lt;p&gt;&quot;This will help to restore faith in this globally important vaccine and in the integrity of the scientific literature,&quot; according to a statement from Fiona Godlee, MB, BChir, BSc.&lt;/p&gt;
&lt;p&gt;In the 1998 paper, Wakefield and colleagues reported on findings in 12 children who, they said, had developed intestinal inflammation and autistic symptoms following MMR vaccination. They suggested that the inflammation released gut proteins into the circulation that eventually migrated to the brain, causing permanent damage reflected in autism symptoms.&lt;/p&gt;
&lt;p&gt;The report and the ensuing mass-media publicity sparked consternation among parents and the medical community. Vaccination rates in Britain and the U.S. dropped sharply, and measles rates spiked in consequence.&lt;/p&gt;
&lt;p&gt;Although subsequent population-based research and other studies have failed to confirm a causal link between MMR vaccines and autism, a vocal group of parents of autistic children continues to insist that it is real. They call Wakefield a hero.&lt;/p&gt;
&lt;p&gt;However, a nearly decade-long investigation by a British journalist, Brian Deer, uncovered discrepancies between the &lt;em&gt;Lancet&lt;/em&gt; paper and hospital records and other sources. (See &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/Autism/12850&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/Autism/12850&quot; target=&quot;_blank&quot;&gt;Father of Vaccine-Autism Link Said to Have Fudged Data&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Whereas the &lt;em&gt;Lancet&lt;/em&gt; paper indicated that, in most cases, symptoms developed within days of vaccination, the records indicated that this was true only for one child, according to Deer&apos;s account in the &lt;em&gt;Times of London&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The patients&apos; records also indicated that five of the children had psychosocial problems before vaccination, said the &lt;em&gt;Times&lt;/em&gt;, but the &lt;em&gt;Lancet&lt;/em&gt; paper described them as &quot;developmentally normal.&quot;&lt;/p&gt;
&lt;p&gt;In addition, the &lt;em&gt;Lancet&lt;/em&gt; paper described abnormal intestinal pathology results in the children, but the hospital pathology reports showed no findings of inflammation, the &lt;em&gt;Times&lt;/em&gt; report said.&lt;/p&gt;
&lt;p&gt;At last week&apos;s hearing, the U.K.&apos;s General Medical Council panel heard evidence that Wakefield had taken blood samples from children attending his son&apos;s birthday party and performed spinal taps on other children in a hospital without due regard for their safety.&lt;/p&gt;
&lt;p&gt;The panel found Wakefield guilty of more than 30 charges that he had acted unethically in conducting the study. He could be stripped of his license to practice in Britain, but no ruling has been made yet.&lt;/p&gt;
&lt;p&gt;Two of Wakefield&apos;s 12 co-authors on the 1998 paper, John Walker-Smith, MD, and Simon Murch, PhD, were also found to have committed ethical violations. The other 10 co-authors had previously repudiated the paper&apos;s findings and were not charged.&lt;/p&gt;
&lt;p&gt;Wakefield was in London while the hearing took place but did not attend. Afterward, he told reporters he was innocent of wrongdoing and would continue his research.&lt;/p&gt;
&lt;p&gt;Wakefield is now based at Thoughtful House, a private autism research and treatment facility in Austin, Texas. After the panel&apos;s ruling, it issued a statement expressing disappointment and calling the charges &quot;unfounded and unfair.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_166"
                     title="APsaA: Are Physicians Too Quick to Medicate ADHD?"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/17991?impressionId=1265817660696"
                     
      &lt;p&gt;NEW YORK  --  Physicians may be too quick to medicate children suspected of having attention deficit hyperactivity disorder (ADHD), researchers said here.&lt;/p&gt;
&lt;p&gt;The etiology of the disease is not well understood, and while some cases may have neurological causes, children may respond to psychotherapy instead, Esther Fine, PhD, a psychoanalyst in private practice in Los Angeles, told attendees at the American Psychoanalytic Association meeting.&lt;/p&gt;
&lt;p&gt;&quot;Unfortunately, it is now a prevalent notion that it is no longer necessary or relevant to understand the unconscious meaning of psychological symptoms,&quot; Dr. Fine cautioned during a scientific paper presentation. &quot;It&apos;s becoming a popular idea to consider psychoanalysis, and even psychotherapy, &apos;dinosaurs&apos; in the treatment of mental disorders.&quot;&lt;/p&gt;
&lt;p&gt;Fine said that between 1990 and 1998, the number of children and adults diagnosed with ADHD rose from 900,000 to nearly 5 million.&lt;/p&gt;
&lt;p&gt;The increase coincides with a broader trend toward prescribing stimulants for its treatment. Since 1990, prescriptions have risen by 700%, Fine said.&lt;/p&gt;
&lt;p&gt;On the other hand, the proportion of children referred to psychotherapy for ADHD fell from 40% in 1989 to 25% in 1996, and Fine said that number is even lower today.&lt;/p&gt;
&lt;p&gt;One reason is that teachers may be diagnosing children as having ADHD. Concerned parents then request medications from pediatricians, Fine said, and pediatricians may be too quick to comply.&lt;/p&gt;
&lt;p&gt;&quot;Teachers and parents are looking for a quick fix,&quot; added Mark D. Smaller, PhD, a psychoanalyst in private practice in Chicago who was not involved in the paper. &quot;They&apos;re reluctant to look at what&apos;s behind that behavior, at what&apos;s going on at home.&quot;&lt;/p&gt;
&lt;p&gt;On the other hand, psychoanalytic psychotherapy may provide patients  --  even young ones  --  with an opportunity to understand how their minds work, and why it works the way it does.&lt;/p&gt;
&lt;p&gt;For example, Fine said some disorders can have roots in abusive child-rearing patterns.&lt;/p&gt;
&lt;p&gt;&quot;Certainly, parental child abuse might well set the scene for an attention deficit disorder,&quot; she said.&lt;/p&gt;
&lt;p&gt;In a case report, Fine discussed working with a school-aged patient who had a troubled childhood. After a few sessions, she discovered the underlying reasons for the young patient&apos;s anxiety and aggression, and how they affected his relationships and his ability to learn in school.&lt;/p&gt;
&lt;p&gt;&quot;Clearly it did not indicate that his problems were due to some form of brain impairment,&quot; she wrote in the case report.&lt;/p&gt;
&lt;p&gt;Smaller said that if the therapist does &quot;a full evaluation of the child and the parents, you&apos;ll get a much better sense of what&apos;s going on,&quot; and a better idea of disease etiology so it can be treated.&lt;/p&gt;
&lt;p&gt;Fine said her patient began improving in school before his parents divorced, resulting in his mother moving away and not returning him to therapy sessions.&lt;/p&gt;
&lt;p&gt;She added that there may be other reasons parents avoid psychotherapy for their children.&lt;/p&gt;
&lt;p&gt;&quot;Parents prefer to believe there is a neurological basis for their children&apos;s behavior, as it relieves the guilt that the child&apos;s difficulties may be related to their inadequate parenting skills,&quot; she said. &quot;This tends to mask the family entanglements that might contribute to an overstimulating environment.&quot;&lt;/p&gt;
&lt;p&gt;She said ADHD certainly has many different symptoms and causes, so she doesn&apos;t mean &quot;to suggest that there are no children who suffer from a neurologically-based ADHD, or that medication should never be used.&quot;&lt;/p&gt;
&lt;p&gt;She does, however, caution against &quot;a rush to judgment.&quot;&lt;/p&gt;
&lt;p&gt;Other attendees stressed that, in some cases, medication may be the way to go. &lt;div class=&quot;MsoNormal&quot;&gt;&quot;I work with children a lot and I always try to get at the underlying mechanism for their behaviors,&quot; said Mirel Goldstein, MA, MS, of St. Mary&apos;s Hospital in Passaic, N.J.  &quot;But you really need to look at it on a case-by-case basis. Sometimes medication will be the appropriate treatment.&quot;&lt;/div&gt; &lt;/p&gt;

    </recommendedItem>
</recommendedContent>
