More ADHD drugs for kids – No national guidelines for the diagnosis

Source: Hongqi Zhang/Istockphoto

Every year, increasing numbers of Swedish children are being medicated with ADHD drugs. In some areas and age groups this amounts to one pupil in every school class. At the same time, the regional variations are huge.

 

The numbers of children prescribed ADHD medications can vary between 2 and 14 percent in different municipalities, for the same age and gender group. According to Peter Salmi, investigator at The National Board of Health and Welfare (Socialstyrelsen), the causes behind the regional differences remain unknown. The authority is investigating the subject and Salmi says they “are hoping to know more soon”.

Peter Salmi, investigator at The National Board of Health and Welfare

In contrast to other common psychiatric diagnoses “there are not yet any national guidelines for ADHD”, he adds.

Still, the Pharmaceutical Agency (Läkemedelsverket) have recommendations for medicating ADHD and the Children and Youth Psychiatry (BUP) has created their own guidelines.

Peter Salmi says that the regional variations might to some extent be explained by the lack of awareness and research on neuro psychiatric diagnoses, such as ADHD and Autism.

“You can speculate about the causes. ADHD might actually be more prevalent in some regions than in others and socioeconomic factors may be of importance,” he argues.

Ingemar Engström, child psychiatry professor

Ingemar Engström, professor of child psychiatry, doesn’t agree. “There is no reason to believe that the numbers of children in need of CNS-stimulants varies in different parts of the country.” He adds that the differences more probably are a result of varying local clinical traditions and sometimes affected by influential profiles in the regional child psychiatry.

In recent years, Gävleborg, Halland and Gotland counties top the list of prescribed ADHD medications for children and teenagers. And in some municipalities in Norbotten, Västerbotten and Örebro county, as many as 14 percent of the boys aged 10-17 take ADHD medications.

While in all of Sweden, boys use CNS-stimulants more than twice as often as girls, this difference don’t stand true for all counties. On Gotland, girls aged 15-19 are prescribed more than boys in the same age group. The teenage girls on Gotland stand out from the country average and use four times as much ADHD drugs as the corresponding population in Jönköping county.

Methylphenidate, a CNS-stimulant classified as a narcotic, is the first choice medication for ADHD. It is sold under various names, such as Ritalin and Concerta, and is given to around 80 percent of diagnosed children. According to The Swedish Agency for health technology assessment (SBU), there are no long term studies on the effects on children, but the medication is generally considered safe and efficient. However, an extensive South Korean study from 2016 showed an increased risk of heart arrhythmias in children and young adults using CNS-stimulants and previous research indicates that the medications may stunt children’s growth.

According to Peter Salmi, the huge regional variations for ADHD medications are unusual and not observed for other common psychiatric drugs, such as antidepressants or anxiolytics.

“There is something particular with the ADHD diagnosis and this patient group that makes these differences more pronounced”, he says.

Prescription of CNS-stimulants to children in Sweden
(Ages 5-19)

Source for numbers mentioned and data visualisations: The National Board of Health and Welfare (Socialstyrelsen)

 

BY SOPHIA TIBBLIN AND LILIIA MAKASHOVA

Sweden’s minorities miss out on millions while state grants are spent mainly “on administration”

By Fredrika, Lisha, Viktoriia

Year after year, Swedish municipalities pile up the state money allocated to support minorities while international community alarms about poor state of their rights in this Scandinavian country

Sari Ebesoh’s from Gothenburg is a mother of an international family: she’s Finnish, her husband is Nigerian, and their children are growing up in Sweden. With more than three languages spoken at home, Sari wants her kids to be fluent in Finnish as well. Despite this right provided by law, the woman is almost unable to count on schooling for it.

Her two young daughters, five and eight years old, didn’t have Finnish classes at their home school. So in order to attend afternoon mother tongue classes, they had to take a tram to Frölunda, a troubled area in the south of Gothenburg. “I cannot let them go during the afternoons by themselves. It was really a struggle”, Sari explains, adding that she wasn’t able to give children lifts due to her tight work schedule.

Swedish municipalities can’t afford sustainable mother tongue tuition, though the state costs for granting minorities rights are growing every year. Sweden is home to large populations of Finns, Sami, Tornedal, Romani, and Yiddish which constitute up to eight per cent of Sweden’s ten-million population. Council of Europe had been criticizing the country’s approach to its minority policy for the past decade and a half.

Since 2010, the Minority Act granted them enhanced rights including language learning, mother tongue pre-school tuition, and elderly care. The municipalities that have chosen to be part of administrative areas for the minorities receive an annual state grant based on their total population, which is 66 million SEK on average. Over the course since the Act came into effect, all Swedish municipalities have piled up 52 million SEK altogether.

Over a third of municipalities that provide enhanced minority rights had surplus in 2016

In 2016, more than a third of the municipalities included in at least one of the administrative areas had a surplus of the grant piled up. As can be seen in the chart above no conclusions of the numbers can be drawn from geographical location. 

In order to find out the reasons behind the money piling up, MIJ contacted the five municipalities with the highest surplus to find out how the money had been distributed between municipality-run services. These numbers were then compared to the corresponding numbers from previous years. Results are displayed in the pie chart below.

Swedish Lapland municipality Arvidsjaur with a little more than six thousand inhabitants and is home to Sami population didn’t find use for more than half of the grant. According to Mariann Lörstrand, Sami coordinator of Arvidsjaur municipality, the surplus occurred due to the lack of responsible staff.

The Sami coordinator, she says, had been on a sick leave for five per cent of the time, and had taken a half-time leave of absence to work in another municipality during. Moreover, that person wasn’t replaced after resigning in the autumn of 2016. Marianne herself was employed in mid-August the following year, which left the coordinator spot vacant for nine months. Hence, money that was earmarked for the coordinator’s salary ended up unused.

2016 data for grant distribution within the top five municipalities with the highest surplus.

Since Sweden is rather decentralized, there is no state authority to control how municipalities spend costs, Anders Nilsson, advisor to Ekonomistyrningsverket explains. This agency monitors how the government agencies spend the state money and, according to Nilsson, no penalties are provided for the inefficient use of costs.

“If we suspect fraud, we report it to Swedish Economic Crime Authority. Otherwise, if someone makes a mistake, we let them try smarter next year. It’s all about trust in Sweden,” he says. In the recent years, however, Nilsson has seen “an emerging debate” regarding tighter control over municipalities from the state.

Flourish by Jessica and Lisha

Data visulaization of the passengers of Titanic,
Choose different categories to comapre and explore who were on the unfortunate ship.

What kind of data did you test it with?

We decided to use the Titanic dataset and chose the template “survey” where you can create an interactive dot visualization where the user self can click and choose what to compare.


What type of output? 

You can get the output of Flourish both embedded and in png, depending on what template you use. The interactive visualization which you get embedded does have a made with Flourish-icon, which does not look that good when published in a serious newspaper. However, you can pay for Flourish, and hopefully the icon then disappears.


Learning curve

Flourish is fairly user-friendly mainly depending on what template you choose to work with. When it comes to creating bar charts, for example, Flourish is really easy to use – if you have the right data for it.

With the template Survey (the one used at the top of the post),  which creates interactive visualizations, it took a little longer for us to understand how everything worked. We soon figured out how to get the data in the right columns, by selecting if the data/answer of the question was categorical, continuous, geographic or metadata. However, as you can see the geographic part did not work, probably because we need to sort the places into a language that Flourish understands, which probably is latitudes and longitudes of the places. 

Input

Flourish accepts excel files and you can clean and change the data in Flourish. However, what is really annoying is that once you choose to work with a Flourish template you do not get a clean sheet to work with, but the example sheet. This means that you have to delete all the earlier sheets, data and options to not mix them up with the new data you have uploaded. 

Output

The output does look very professional and advanced. However, the output may require a lot of time and interest of the user, which he or she might not have.

Flexibility and customizability?


When it comes to the flexibility, Flourish allow you to change colors and style by selecting from big set of options, you can do all these changes online without the need to download the tool to your computer, it allows to you publish and embed by getting a link to be used in your website of publication website, also you can download the and save the project to your server. Using flourish allows you to customize using easy functions such as selecting from drop-down list that includes the categories and variable in your data, filtering options, are Grouped by, Shade by, Size by and Compare.

Screenshots from your experiments (you can embed interactive vis if you want to)

 

What kind of data does it visualise?  

The data should be in column and rows formats and can be uploaded or copied/pasted from excel.

Is it useful for journalists? What kind of journalists?

The tool is a good tool in term of visualization of statistical data and allow you to explore the data by forming different connections between the data categories and variables in the statistics. Thus it is useful for journalism who want to build a data journalism stories and visualize it in a simple way to readers.


What is the cost? Is there a free account, and is it limited by time, features or non-profit?

Flourish has a three types of account, Free, Personal and Business.

Free account does not have a time limit, it allows you do use basic functions including the core templates, maps and charts, it also allows you to embed projects on your website, create stories and presentations, save images for offline use.

Private account cost 45 Euro per month, it has all the basic features available under the free account, but also allow the users to add privacy to their data, download and self-host projects, in addition to providing a customer service support.

Business account: The cost is not provided, we contacted them and they said that the business account cost is decided in link to how many users the company or the organization need to use. The business account allows the organizations to upload custom templates, collaboration and team management, provide additional training to the users and customized development solutions.

Piktochart

by Matthew Weaver & Felicia Bredenberg

What it does

Piktochart is an online application which allows users to create simple visuals, presentations and infographics using themed templates. The program is primarily for those without prior graphic design experience.

Input and output

Pictochart accepts image files, such as gifs and jpegs and tables such as excel files.

The pro version includes an html publisher that allows users to create visuals that can be embedded on a website and enable users to include interactive elements such as, charts, videos, map visualizations and animation.

In the free trial version you can only download your work in PNG-format with a watermark, but of course one can get around that with file converters.

Pros and cons

We tested with our own data at first, attempting to input an Excel file of Naloxone prescriptions by sex and region in Sweden and had some issues in that it seems to not be able to manage too large of datasets well—the graphs came out unreadable and we had some difficulty finding a legend. In this case it would benefit the user to pare down and simplify their datasets beforehand.

We tried the tool out by making a little infographic of our class. There we included a map where our classmates origin of birth are marked. To make a simple infographic was VERY easy and actually quite fun. With a shallow learning curve, and ideal for those in a hurry to produce simple visualizations, but it is not without its limitations—probably not the best tool out there if one desires more complicated charts and visualizations.

Prices are, for the basic, starting at 12 USD per month, to pro (24.17USD) and Pro Team (for businesses) at 85 dollars—the latter 2 include no watermark, more than 600 templates, HD exports, password protection, integrated Export Platforms. Whereas the light has watermarks and a limit of image uploads. 

To summarize – Piktochart is fairly handy for infographics and maps (albeit simple ones) but not for more advanced projects.  We don’t think it would be used by serious journalists, but rather bloggers, teachers, and for class projects, businesses and wedding invitations, for example.