Abilify: Anti-Psychotic Medications Overview, Uses

What Is the Medication Abilify?

Abilify (generic name: aripiprazole) is an anti-psychotic medication primarily used to treat symptoms of schizophrenia in patients over age 13, bipolar disorder in patients over age 10, depression in adults, irritability associated with autism in children over age six, and Tourette’s Syndrome in children over age six. Studies suggest that aripiprazole may have a dopamine-stabilizing effect on patients with ADHD¹; some clinicians include it in ADHD treatment plans for both adults and children, particularly those who do not respond to stimulants².

The safety and effectiveness of taking Abilify to treat depression or the agitation associated with schizophrenia or bipolar mania in children has not been established. Abilify can be dangerous for elderly people with dementia.

How to Use the Medication Abilify

Before starting or refilling an Abilify prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage for Abilify

As with all medications, follow your Abilify prescription instructions exactly. The optimal dosage varies by age and condition treated. Abilify is available in several formulations:

• Abilify Tablets are available in 2mg, 5mg, 10mg, 15mg, 20mg, and 30mg dosages. Tablets should be swallowed whole with water or another liquid.
• Abilify DISCMELT (Orally Disintegrating Tablets): To keep it from dissolving before you place the tablet in your mouth, leave it contained in its blister package until you are ready to take it. When opening the medication, make sure your hands are clean and dry so as not to accidentally trigger dissolution. Peel back the blister package backing to take out the tablet, instead of pushing it through the foil. Place the tablet on your tongue to dissolve. Do not crush or chew the tablet. Orally disintegrating tablets are available in 10mg and 15 mg dosages. It is recommended they are taken without liquid.
• Abilify Oral Solution: Colorless, orange-flavored liquid. The liquid should be measured with the included device and swallowed entirely with water or another liquid. The oral solution is available in a concentration of 1mg/mL.
• Abilify Injection: The intramuscular injection is available in 9.75mg/1.3mL single dose vials.

The oral formulations are taken once daily, with our without food. Oral formulations are indicated for every condition except the agitation associated with schizophrenia or bipolar mania.

The injection should be taken no more than once every two hours, with a maximum daily dosage of 30mg. The injection is only indicated to treat the agitation associated with schizophrenia or bipolar mania.

If you miss a dose, you should take it as soon as possible, unless it is already time for your next dose. You should not take two doses of Abilify at the same time. Contact your doctor if you have questions about skipped pills.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping Abilify suddenly can create new, serious symptoms.

Side Effects Associated with Abilify

The most common side effects of Abilify are as follows:

Children and Adolescents (ages 10 to 17): sleepiness, headache, vomiting, fatigue, changes in appetite, increased saliva, insomnia, nausea, stuffy nose, weight gain, uncontrolled movement, and muscle stiffness.

Adults: nausea, vomiting, constipation, headache, blurred vision, upper respiratory illness, dizziness, anxiety, insomnia, and restlessness.

Elderly people with dementia-related psychosis are at increased risk of death from stroke when treated with Abilify.

Medications like Abilify can increase risk of suicide and suicidal thoughts, especially at the start of treatment. Report to your healthcare provider any sudden changes in mood, including depression, anxiety, restlessness, panic, irritability, impulsivity, or aggression.

Other serious side effects include low white blood cell count, seizures, dyslipidemia, problems regulating body temperature, and pathological gambling or other compulsive behaviors.

Taking Abilify may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.

Most people taking this medication do not experience any of these side effects.

Abilify can increase a patient’s risk of neuroleptic malignant syndrome (NMS). This is a rare, but serious condition that can cause a stroke resulting in death. If you experience high fever, sweating, rigid muscles, confusion, or changes in breathing or heartbeat, these could be warning signs of NMS and you should seek medical help at a hospital immediately.

Tell your doctor if you have diabetes or difficulty managing your blood sugar. Taking Abilify can increase blood sugar which, when untreated, can cause ketoacidosis, coma, or death. Warning signs of hyperglycemia include: excessive thirst, frequent urination, feeling very hungry, weak, tired or nauseous, fruit-scented breath, and nausea. If you experience these, contact your healthcare provider.

Some people experience tardive dyskinesia, a condition which causes uncontrollable movements in the face, tongue, or other body parts. This may not go away, even if you stop taking Abilify.

While taking Abilify, your doctor should regularly monitor the fat levels in your blood (cholesterol and triglycerides), weight, and blood pressure. Abilify can increase blood fat levels, cause weight gain, and create sudden changes in blood pressure, especially in children and teenagers.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions Associated with Abilify

Store Abilify in a secure place out of the reach of children, and at room temperature. Do not share your Abilify prescription with anyone, even another person with schizophrenia or bipolar disorder. Sharing prescription medication is illegal, and can cause harm.

You should not take Abilify if you have an allergy to aripiprazole or any of the ingredients in Abilify. Before taking Abilify, tell your doctor if you have a personal or family history of diabetes, abnormal blood pressure, low white blood cell count, or heart problems.

Do not become overheated or dehydrated while taking Abilify. This includes avoiding extremely strenuous exercise, spending time in the sun, or wearing too-heavy clothing.

If you’re thinking of becoming pregnant, discuss the use of Abilify with your doctor. Especially when taken in the last three months of pregnancy, it is suspected to cause fetal harm. It is recommended that mothers do not nurse while taking Abilify, as it is unsafe for infants, and Abilify passes into breastmilk.

Interactions Associated with Abilify

Before taking Abilify, discuss all other active prescription medications with your doctor.

Medications that inhibit or induce CYP2D6 or CYP3A4, enzymes that metabolize certain drugs, can increase or decrease how the body absorbs Abilify. Physicians may need to increase or decrease Abilify dosage when taken with prescriptions like itraconazole, fluoxetine, carbamazepine, rifampin, and lorazepam.

Share a list of all vitamin or herbal supplements, prescription, and non-prescription medications you take with the pharmacist when you fill your prescription, especially any drugs that cause drowsiness. Let all doctors and physicians know you are taking Abilify before having any surgery or laboratory tests.

The above is not a complete list of all possible drug interactions.

¹Robert L Findling, MD. “The Cognitive Effects of Aripiprazole in Children.” University Hospital Case Medical Center. 2005-2014
²Dr.Yannick Pauli. “Abilify for ADHD: An Antipsychotic with Worrisome Side Effects” Dr. Yannick Pauli’s UnRitalin Solution. (2010). Web. (http://www.unritalinsolution.com/adhdblog/2010/06/28/abilify-for-adhd/)

Sources:

https://www.abilify.com/

Aripiprazole for schizophrenia, bipolar disorder and tics

Aripiprazole for schizophrenia, bipolar disorder and tics

This leaflet is about the use of aripiprazole for the treatment of schizophrenia and bipolar disorder (sometimes called psychotic disorders) and tics, such as seen in Tourette’s syndrome.

This leaflet has been written for parents and carers about how to use this medicine in children. Our information sometimes differs from that provided by the manufacturers, because their information is usually aimed at adult patients. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Do not stop giving aripiprazole suddenly, as your child is likely to get withdrawal symptoms.

Name of drug

Aripiprazole (AR-i-PIP-ra-zole)
Brand name: Abilify®

Why is it important for my child to take this medicine?

Aripiprazole changes the levels of some important chemicals in the brain such as dopamine and serotonin. 

• For children with schizophrenia or bipolar disorder, aripiprazole can reduce your child’s symptoms and help their mood and behaviour to be more stable.
• For children with tics, aripiprazole will help to reduce the severity and frequency of tics.

Read more about what a ‘tic’ is here: www.nhs. uk/conditions/tics/

What is aripiprazole available as?

• Tablets: 5 mg, 10 mg, 15 mg, 30 mg; these contain lactose
• Orodispersible tablets: 10 mg, 15 mg; these contain a small amount of aspartame
• Liquid medicine: 5 mg in 5 mL

When should I give aripiprazole?

Aripiprazole is usually given once a day. This is usually in the morning.
Give the medicine at about the same time each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of aripiprazole (the dose) that is right for your child. The dose will be shown on the medicine label. 

Your doctor may suggest that your child has a low dose to start with. They may then increase the dose as your child gets used to the medicine and depending on how your child responds to it.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it? 

Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablet.

Orodispersible tablets: Ensure your hands are dry before removing the tablet from the pack. Put it on your child’s tongue straight away. The tablet will dissolve rapidly. You can also dissolve it in a glass of water. Your child should drink it all straight away.  

Liquid medicine: Measure out the right amount using an oral syringe or medicine spoon. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

When should the medicine start working?

This depends on what your child is being treated for. 

• If your child has been agitated as part of their illness, this should decrease after taking an adequate dose of aripiprazole for a few days.
• If your child is being treated for elated mood (being extremely happy), they should seem calmer after about a week of reaching the adequate dose. 
• If your child gets hallucinations (seeing or hearing things that are not there), these should start to get better after about 2 weeks. It may take longer than this for delusions (believing something to be real that is not) to stop. It may take 6–8 weeks before your child’s mood and behaviour seem more normal. 
• If your child is being treated for tics or Tourette’s syndrome, it is likely to take 4–6 weeks for symptoms to get better.

It is important that you continue to give the medicine every day, as your doctor has told you to. However, as the medicine may not work sufficiently in some children, if you are concerned about whether it is working, contact your doctor..

What if my child is sick (vomits)? 

• If your child is sick less than 30 minutes after having a dose of aripiprazole, give them the same dose again.
• If your child is sick more than 30 minutes after having a dose of aripiprazole, you do not need to give them another dose. Wait until the next normal dose.

If your child is sick again, seek advice from your GP, nurse, pharmacist or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

What if I forget to give it?

Give the missed dose when you remember during the day, as long as this is at least 12 hours before the next dose is due.

Never give a double dose of aripiprazole. 

What if I give too much?

It may be dangerous to give too much aripiprazole.

If you think you may have given your child too much aripiprazole, contact your doctor or your local NHS services (111 in England and Scotland; 0845 4647 in Wales) or take your child to hospital.
Take the medicine container or packaging with you, even if it is empty. This will be useful to the doctor. Have the medicine or packaging with you if you telephone for advice.

Are there any possible side-effects? 

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Side-effects you must do something about

Contact your doctor straight away if your child has any of the following:

• muscle spasms (stiffening of the muscles), twitching in the face and body, or uncontrolled movements of the tongue or jaw
• they become restless and cannot control their movements
• fever, sore throat, rash or mouth ulcers.

Other side-effects you need to know about

• Your child may feel sleepy, tired or weak when they first start taking this medicine. These effects usually wear off as your child’s body gets used to the medicine If they are still a problem after 2 weeks, contact your doctor.
• Your child may get stomach ache and feel sick. They may also get constipated (have difficulty doing a poo). Make sure they eat food that contains fibre (e.g. bran, wholemeal bread, rice, pasta, fruit and vegetables) and that they drink plenty of fluid. If this is still a problem after 2 weeks, contact your doctor. 
• Your child may feel light-headed or dizzy when they stand up, or may faint. This is because aripiprazole may lower the blood pressure. They should stand up slowly, and should lie down for a while if they feel dizzy. If this becomes a problem, contact your doctor, as your child’s blood pressure may be too low.
• Your child may find that their eyesight seems blurred. If this carries on for longer than 2 weeks, contact your doctor. 
• Your child’s appetite may increase and this may result in weight gain.
• Your child’s skin will be more sensitive to sunlight and they are more likely to get sunburn. When outdoors they should keep their skin covered, use high-factor sun screen and wear a hat, especially in the summer.
• Rarely, your child may feel very low (depressed) or have thoughts about suicide. Contact your doctor if this happens.

Can other medicines be given at the same time?

• You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
• Aripiprazole should not be taken with some medicines that you get on prescription. Tell your doctor and pharmacist about any other medicines your child is taking before giving aripiprazole. 
• Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Is there anything else I need to know about aripiprazole?

Do not suddenly stop giving your child aripiprazole, as they may get withdrawal symptoms (difficulty sleeping, tremor, anxiety, nausea and vomiting).

• If you or your child wants to stop aripiprazole, discuss this with your doctor. They may want to reduce the dose slowly so that your child doesn’t get withdrawal symptoms.   

Do not change the dose without talking to your doctor first.

• Teenagers should be aware that if they drink alcohol while taking aripiprazole, the effects will be stronger. Ideally, they should not drink alcohol.
• Aripiprazole can affect the ability to do skilled tasks such as driving. 

General advice about medicines

• Try to give the medicine at about the same time each day, to help you remember.
• Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm. 

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

• Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
• Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

• Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.
• Make sure that children cannot see or reach the medicine.
• Keep the medicine in the container it came in.
• The liquid medicine does not keep for long once it has been opened. Write the date that you start it on the bottle.

Who to contact for more information 

Your doctor, pharmacist or nurse will be able to give you more information about aripiprazole and about other medicines used to treat psychotic disorders and tics.

What Parents Should Know About Risperdal

Risperdal is a medication that’s widely used to treat children who are aggressive or excessively irritable. Though it was originally approved to treat psychosis, its use in children, including those with autism or ADHD diagnoses, has grown dramatically over the last two decades. That’s because Risperdal can successfully calm down kids with severe behavior problems, enabling them to function in school and within their families. Without it, some would require residential treatment.

But Risperdal (generic name risperdone) can have serious side effects, and it’s important to make sure a child taking it is monitored carefully. Parents should know what the medical community agrees are the “best practices” to be followed by a doctor who prescribes Risperdal, to insure good treatment.
Here are the basics about Risperdal: what it’s used for, potential side effects, and how a child on Risperdal should be monitored.

What is Risperdal for?

Risperdal is what is called an atypical, or second-generation antipsychotic (SGA). It was a new kind of antipsychotic approved by the Federal Drug Administration in the 1990s to treat the symptoms of psychosis in schizophrenia and bipolar disorder.

Now it is more widely used to treat aggression and irritability in both dementia patients, often in inpatient facilities, and in children.

Many kids on the autism spectrum take Risperdal to reduce behavior problems like aggression or self-injury, and the FDA has approved it for that use. But it’s also prescribed to many kids who have ADHD (attention-deficit hyperactivity disorder), ODD (oppositional defiant disorder) or DMDD (disruptive mood dysregulation disorder).

When kids act out dangerously or are at risk of getting kicked out of school or removed from the home, they may be given Risperdal or another SGA to calm them down. For kids who do not have an autism diagnosis, these prescriptions are off-label — that is, they are not an FDA-approved use for the drug. But a substantial body of evidence suggests they are effective in reducing persistent behavioral problems.

Why is Risperdal controversial?

Risperdal is controversial because side effects that include substantial weight gain and metabolic, neurological and hormonal changes that can be harmful. Some experts are concerned that children are being treated with the drug in lieu of other treatment — including behavioral treatment — that could be effective without the risk of these side effects.

Risperdal has been in the news over the last several years because of thousands of lawsuits from families who say they were not informed about side effects that might adversely affect their kids, and the kids were not taken off the medication when problems developed. Many of the suits are on behalf of boys who, in a rare side effect, developed breasts because of an increase in a hormone called prolactin.

Problems in school and at home

Wendy Nash, MD, a child and adolescent psychiatrist at the Child Mind Institute, describes a common scenario in which Risperdal is prescribed because a child’s aggressiveness or irritability has become acutely problematic. This behavior often presents in early adolescence, says Dr. Nash. “These are kids who are very aggressive, meaning they might push, shove, punch, break furniture.”

When these kids can’t control their tempers, they may be a danger to other children, their parents and themselves. “Sometimes their parents are so desperate they have considered calling 911,” Dr. Nash notes. Or the child might already have been sent to the emergency room after an outburst at school.

For kids in crisis, Risperdal is often clinicians’ first choice for stabilizing the situation. If it’s not a crisis, they recommend that other treatments be tried first.

Behavioral therapy

Most experts, including Dr. Nash, stress the importance of thoroughly investigating the causes of aggressive behavior as part of the evaluation for medication. Behavior problems can have many different sources, including undiagnosed anxiety, ADHD, learning disorders, trauma and medical problems. Treating those problems may allieviate the behavior issues in a more effective (and lasting) way than giving the child antipsychotic medication.

For children with disruptive behavior problems that haven’t reached a crisis stage, experts’ first choice  for treatment is behavioral therapy, including parent training, to rein things in. Depending on the level of risk, Dr. Nash says she might recommend a first trial of behavioral therapy, or medication together with behavioral therapy.

Related: Choosing a Parent Training Program

Alternative medications

In a more stable situation, Dr. Nash also favors first trying more targeted medications with fewer side effects. For instance, in a child with ADHD, stimulants (Ritalin or Aderall) or non-stimulant ADHD medications like clonidine (Catapres, Kapvay, Nexiclon) or guanfacine (Estulic, Tenex, Intuniv) could reduce impulsive aggression. For a child with ODD, she says, antidepressants (SSRIs) can help with underlying depression or anxiety that could trigger outbursts.

If these attempts are not effective, Dr. Nash may try an SGA. Abilify (aripiprazole), which is also approved for irritability in kids on the spectrum and commonly used for aggression, is usually her first choice, because it has fewer side effects, than Risperdal, including lower weight gain and endocrine disruption. But medication treatment should always be in combination with behavioral therapy, she stresses, which could include parent training.

The medical community agrees. A survey of treatment recommendations from top experts emphasizes that medication should not replace behavioral therapy.

After kids are stabilized

Experts note that a child who’s been put on an SGA in a crisis might be transitioned to a different treatment after the situation is stabilized. In Dr. Nash’s experience, children who participate in behavioral therapy may later be able to stop taking the medication. “My preference is to use risperidone in a time-limited way, to settle the crisis,” she explains. “In the meantime, I’m setting up parent management training.”

Michael Milham, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute, also uses SGAs to stabilize children in crisis situations. He notes that it’s critical to not take kids off the medications without other supports in place, such as behavioral therapy, including parent training.

“It’s important to know when to try to take kids off it — and it’s not as soon as things are going well,” explains Dr. Milham. “They need to be stable, and have other interventions in place. Otherwise you’re just going to recreate the problem, and the kids end up in the ER.”

Risperdal side effects

Weight gain

The most common side effect of Risperdal is weight gain, which can occur quickly. In one study, average weight gain after 10.8 weeks of treatment with Risperdal was 11.7 pounds, compared to just .44 pounds in children taking a placebo. In a study of children treated with Risperdal for 2.9 years, a third were either overweight or obese. Larger doses were associated with significantly greater increases in weight.

Metabolic side effects

Risperdal may also cause what are called “metabolic abnormalities,” including a rise in blood sugar, lipids and trygilicerides that increase the risk of diabetes and heart disease in later life. These are more common in overweight or obese children.

Of the SGAs, the risk of metabolic side effects is greatest with Zyprexa (olanzapine), followed by Clozaril (clozapine). Seroquel (quetiapine) and Risperdal fall into the middle. On the lower end is Abilify, Geodon (ziprasidone) and Latuda (lurasidone).

Neurological side effects

Another set of possible side effects include something called “tardive dyskinesia,” which is characterized by repetitive, involuntary movements, including facial grimaces. The risk of tardive dyskinesia increases with the dose and duration of the treatment, and it can be permanent. The risk of neurological side effects is greatest with Risperdal, Zyprexa and Abilify.

Hormonal side effects

The side effect that sparked the lawsuits against Johnson & Johnson, Risperdal’s maker, is an increase in a hormone called prolactin. Elevated prolactin is called hyperprolactinemia. Prolactin normally causes breast enlargement during pregnancy and milk secretion during breastfeeding. In girls, hyperprolactinemia can lead to breast enlargement, production of breast milk, and bone loss. In boys it can interfere with sperm production and cause breast growth, called gynecomastia.

Studies show that in kids taking antipsychotics, prolactin levels rise until around around 6 to 8 weeks (peaking at, in one study, four times higher than those treated with placebo), and then drop back toward normal. Higher doses of Risperdal — rather than longer use — appear to be linked to elevated prolactin levels.

But not all children who have elevated prolactin develop symptoms. Hyperprolactinemia is common (1.0 to 10 percent of patients develop it) but hormonal symptoms like gynecomastia are uncommon (0.1 to 1.0 percent).

Of the second-generation antipsychotics, Risperdal shows the greatest increase in prolactin levels, and Abilify the least.

Monitoring for side effects

Children taking Risperdal or another atypical antipsychotic should be monitored by their doctors regularly over the course of treatment. Before treatment begins, they should be tested to establish baselines for height, weight, vital signs, and levels of prolactin and blood fats and sugar.

Prolactin levels should be measured frequently during the first few months of treatment. If the child has elevated prolactin and shows symptoms of hyperprolactinemia, it’s recommended that the dose be tapered off and the child be switched to another SGA. If a child has elevated prolactin but shows no symptoms, it’s recommended that he continue to be monitored on a yearly basis if he is using the medication long-term, as prolonged effects of elevated prolactin on fertility and bone development are not known.

A group of Canadian researchers note that yearly lab tests with a physical exam for stable patients may seem like a waste of time to busy clinicians. But given the potential consequences, they add, “Clinicians who are unprepared to monitor children for side effects should choose not to prescribe these medications.”

Working with your doctor

As with any medication, it is important to talk to your doctor about any concerns you have. Your child’s clinician should be ready to discuss the symptoms you are seeing and explain potential options for changing dosage or medication. If you don’t feel that your child’s doctor is taking your concerns seriously, or your doctor is not following best practices for changing dosage, or adding new medications, you should get a second opinion.

If you believe your child should stop taking Risperdal, make sure you tell your doctor, and discuss the pros and cons. Don’t make adjustments or withdraw the medication without consultation. Antipsychotic medications should be reduced gradually, and the child should be monitored for side effects of withdrawing too quickly, including runny nose, diarrhea and cramping. And remember: The biggest concern to watch for is the return of dangerous behavior that the medication was prescribed to treat in the first place.

Antipsychotics, Weight Gain and Kids’ Health

Medications generally have side effects that can be mild, moderate, or severe. Most psychiatric medications can cause some weight gain. Antipsychotics that are being used now for a number of conditions are more on the higher end of causing weight gain, although not all antipsychotics cause the same degree of weight gain.

We have pretty good probabilities which have the highest degree of weight gain, and also which have the highest degree of metabolic abnormalities that are either related to the weight gain, or can occur just because of the medication. By “metabolic” I mean changes in blood sugar and blood fats that have a negative outcome on the risk for cardiovascular illness, similar to the weight gain, later on.

We’ve very concerned about this side effect cluster because of its potential negative effect on cardiovascular risk factors and illness like diabetes, heart attack, stroke, in the future. The worry is that if weight gain occurs early in life, these occurrences that happen usually late in life might happen in mid-adulthood and shorten people’s lives. So we’re really concerned about that.

But on the other hand, we’re also concerned about the mental illness that can also shorten and impair people’s lives. So we need to weigh the risk of the medication against the risk of the illness. But how can we reduce the risk of weight gain with antipsychotics?

Lower risk medications

First of all, we should use the lower risk medications first.

In terms of weight gain, the highest risk medications are Zyprexa (olanzapine) and Clozaril (clozapine). Clozaril is given for the refractory patients, and it’s more effective than others. But Zypreza has not shown to be that much better than others, and it has clearly more side effects.

Seroquel (quetiapine), which is used a lot for certain conditions even involving mood or anxiety or sleep, has similar weight gain as Risperdal (risperidone), but has more metabolic abnormalities.

On the lower end we have Abilify (aripiprazole), Geodon (ziprasidone), and also Latuda (lurasidone).

We don’t know exactly about Saphris (asenapine), but that might be somewhere in the middle. So it’s important to choose those lower risk agents first, see whether there’s a response, and only if people don’t respond then to move it up.

Healthy lifestyle

At the same time, healthy lifestyle instruction should always accompany psychotropic medication—prescribing and taking. Exercising ideally thirty minutes a day, even brisk walking, can be helpful. Eat healthily, replacing fast food with particularly vegetables and fruit. It’s very important to also have family meals.

It’s been shown that when families have meals together the diet is also improved.

If your child has a problem with weight, either originally even without medication or now accentuated or started through the medication, trying to diet can be very hard. Research shows in non-psychiatrically ill patients that kids succeed the most when parents do the same thing. Unless you help your kid, they will not succeed. You need to change the diet for the family, and you need to change the activity behavior for the family.

There is still the school meal that can be a problem, because in the US the school meals are not as healthy as they should be, but maybe you want to have a plan to bring some food to school with you—make it at home and then give it to your kid.

It should be fun to eat healthily and act healthily, so you should make it a family occurrence and have rewards built in, because it’s hard. It’s easier to gain weight than to lose weight, that’s clear for all of us, and if you have mental illness and if you take medication even more so.

So if you’ve done the healthy lifestyle instruction and it didn’t work, maybe then a weight management program. Go to a clinic and try to get guidance there. On the Internet, there is also the American Academy of Pediatrics weight management program that you should follow. One of the things it recommends is that parents shouldn’t be too stringent; diet should be somewhat flexible and kids shouldn’t always need to try to be super good because then they might give up.

Adding medications

So if you’ve tried the healthy lifestyle, the lower risk agent, and either you had to go to a higher risk agent or your child still gained weight, then there are also medications you can add to reduce the weight gain and reduce the metabolic problems even below the threshold of having a clear dyslipidemia or diabetes. There are two medications that can be added. One is Glucophage (metformin), which is originally an anti-diabetic medication, but it’s been shown in now 11 studies that when you add it to antipsychotics there is a reduction in weight of about three kilograms in three months. That’s not the world, but on the other hand, it’s a mean, meaning some lose less and some lose quite a bit more. In addition, there’s also an improvement in the metabolic abnormalities, particularly the blood sugar problems and insulin resistance.

The second medication is Topamax (topiramate). That is an antiepileptic medication that can be added and people can lose weight, again about three kilograms in three months. Sometimes kids can have word finding difficulties, so you should do this obviously only together with a doctor, and then monitor whether your kid has some cognitive problems.

Those are the two best-studied medications, then there are a couple of other medications that are approved for pediatric obesity, but they haven’t been studied enough in conjunction with antipsychotics or psychotropic drugs. But they can be tried, and you should discuss that with your doctor. There are novel approved combination treatments for obesity, but I think one should only go to that after the Glucophage or Topamax have been tried

Aripiprazole: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Abilify; Abilify Maintena; Abilify MyCite

Brand Names: Canada

Abilify; Abilify Maintena; APO-ARIPiprazole; Auro-ARIPiprazole; MINT-Aripiprazole; PMS-ARIPiprazole; RIVA-ARIPiprazole; SANDOZ ARIPiprazole; TEVA-ARIPiprazole

Warning

• Drugs like this one have raised the chance of suicidal thoughts or actions in children and young adults. The risk may be greater in people who have had these thoughts or actions in the past. All people who take this drug need to be watched closely. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur.
• There is a higher chance of death in older adults who take this drug for mental problems caused by dementia. Most of the deaths were linked to heart disease or infection. This drug is not approved to treat mental problems caused by dementia.

What is this drug used for?

• It is used to treat schizophrenia.
• It is used to treat low mood (depression).
• It is used to treat bipolar problems.
• It is used to treat certain behavior problems in patients with autism.
• It is used to treat Tourette’s syndrome.
• It may be given to your child for other reasons. Talk with the doctor.

Tablets with sensor (Abilify MyCite):

• If your child has been given this form of this drug, talk with the doctor for information about the benefits and risks. Talk with the doctor if you have questions or concerns about giving this drug to your child.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.

This drug may interact with other drugs or health problems.

Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe to give this drug with all of your child’s other drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.

What are some things I need to know or do while my child takes this drug?

All products:

• Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
• To lower the chance of feeling dizzy or passing out, have your child rise slowly if your child has been sitting or lying down. Have your child be careful going up and down stairs.
• If your child has phenylketonuria (PKU), talk with your child’s doctor. Some products have phenylalanine.
• If your child is not able to break down sucrose or fructose, talk with your child’s doctor. Some products have sucrose or fructose.
• Have your child’s blood work checked often. Talk with your child’s doctor.
• Have your child avoid tasks or actions that call for alertness or clear eyesight until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
• Alcohol may interact with this drug. Be sure your child does not drink alcohol.
• Talk with your doctor before you use marijuana, other forms of cannabis, or prescription or OTC drugs that may slow your actions.
• Have your child be careful in hot weather or while your child is being active. Have your child drink lots of fluids to stop fluid loss.
• Have your child drink lots of noncaffeine liquids every day unless told to drink less liquid by your child’s doctor.
• Chance of seizures may be higher. Talk with the doctor.
• Low white blood cell counts have happened with drugs like this one. This may lead to a higher chance of infection. Rarely, infections have been deadly. Tell your doctor if you have ever had a low white blood cell count. Call your doctor right away if you have signs of infection like fever, chills, or sore throat.
• High blood sugar or diabetes, high cholesterol, and weight gain have happened with drugs like this one. These may raise the chance of heart and brain blood vessel disease.
• Have your child’s blood sugar checked as you have been told by your child’s doctor.
• Dizziness, sleepiness, and feeling less stable may happen with this drug. These may lead to falling, which can cause broken bones or other health problems.

If your child is pregnant or breast-feeding a baby:

• Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
• Taking this drug in the third trimester of pregnancy may lead to uncontrolled muscle movements and withdrawal in the newborn.

What are some side effects that I need to call my child’s doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
• Trouble controlling body movements, twitching, change in balance, trouble swallowing or speaking.
• Strong urges that are hard to control (such as eating, gambling, sex, or spending money).
• Very bad dizziness or passing out.
• Change in balance.
• Seizures.
• Blurred eyesight.
• A very bad and sometimes deadly health problem called neuroleptic malignant syndrome (NMS) may happen. Call your child’s doctor right away if your child has any fever, muscle cramps or stiffness, dizziness, very bad headache, confusion, change in thinking, fast heartbeat, heartbeat that does not feel normal, or is sweating a lot.
• Some people may get a severe muscle problem called tardive dyskinesia. This problem may lessen or go away after stopping this drug, but it may not go away. The risk is greater with diabetes and in older adults, especially older women. The risk is greater with longer use or higher doses, but it may also occur after short-term use with low doses. Call your child’s doctor right away if your child has trouble controlling body movements or problems with the tongue, face, mouth, or jaw like tongue sticking out, puffing cheeks, mouth puckering, or chewing.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:

All products:

• Feeling dizzy, sleepy, tired, or weak.
• Anxiety.
• Headache.
• Upset stomach or throwing up.
• Weight gain.
• Restlessness.
• Constipation.
• Trouble sleeping.
• Feeling more or less hungry.
• Nose or throat irritation.
• Dry mouth.
• Shakiness.
• Drooling.
• Stuffy nose.

Injection:

• Pain where the shot was given.

These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best given?

Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.

All oral products:

• Give this drug with or without food.
• Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.

Tablets:

• Have your child swallow whole. Do not let your child chew, break, or crush.

Liquid:

• Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.

Oral-disintegrating tablet:

• Do not push the tablet out of the foil when opening. Use dry hands to take it from the foil. Place on your child’s tongue and let it dissolve. Water is not needed. Do not let your child swallow it whole. Do not let your child chew, break, or crush it.

Injection:

• It is given as a shot into a muscle.

What do I do if my child misses a dose?

All oral products:

• Give a missed dose as soon as you think about it.
• If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
• Do not take 2 doses at the same time or extra doses.

Injection:

• Call your child’s doctor to find out what to do.

How do I store and/or throw out this drug?

All oral products:

• Store at room temperature in a dry place. Do not store in a bathroom.

Liquid:

• After opening, throw away any part not used after 6 months.

Oral-disintegrating tablet:

• Give oral-disintegrating tablet right after opening. Throw away any part of opened pouch that is not used.

Injection:

• If you need to store this drug at home, talk with your child’s doctor, nurse, or pharmacist about how to store it.

All products:

• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
• Do not share your child’s drug with others and do not give anyone else’s drug to your child.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Last Reviewed Date

2020-09-14

Copyright

© 2021 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

How Aripiprazole’s Promise for Treating Autism Fell Short

Even as a toddler, Jaymes Lesovoy was violent. He hit and bit his parents, and he tore apart his and his sisters’ toys. At 18 months of age, he was diagnosed with autism.

Jaymes’ pediatrician suggested behavioral and speech therapy, but neither approach reined in the boy’s aggression. In 2006, when Jaymes was 2, the doctor prescribed risperidone—an antipsychotic medication that had been approved earlier that year to treat irritability in autistic children aged 5 and older. A few years later, he added a second medication to the mix—the seizure drug valproic acid—although Jaymes does not have seizures.

Still, Jaymes acted out at home and at school, and continued to do so for years. When he was 10, another doctor suggested Jaymes try a different antipsychotic: aripiprazole. That drug had been approved in 2009 to treat irritability in autistic children aged 6 and older.

Jaymes’ mother, Amber Lesovoy, was familiar with aripiprazole. She had taken the medication herself a year earlier for her own autism and bipolar disorder, and she had experienced an unusual side effect: trouble urinating, which disappeared after she stopped taking the drug. She worried Jaymes might also experience side effects but felt she had few choices left. “I was a teen mom,” she says. “I didn’t have a lot of life experience, so all I knew to do was what the professionals told me.”

Jaymes was underweight when he started taking aripiprazole, but within a few weeks, he was always hungry: “He would sneak food; he would eat huge amounts at mealtimes. Any chance he got to get food, he would take it,” Lesovoy says. The pounds started to pile on.

There were other, more disturbing changes. When he started with aripiprazole, his mother says, he began to flail his arms, kick his legs, and scrunch up his face without warning—severe involuntary muscle spasms called tardive dyskinesia. (Jaymes was later diagnosed with Tourette syndrome, which his doctors say explains the leg-kicking.) After a year on the drug, Jaymes had gained 50 pounds. He had fewer angry outbursts, but Lesovoy decided the side effects were not worth it. Of all the drugs Jaymes had been prescribed, aripiprazole was “one of the worst,” she says.

It has been 11 years since the U.S. Food and Drug Administration (FDA) approved aripiprazole for children with autism. The drug, marketed as Abilify, initially had a reputation of having fewer side effects than risperidone, its only competitor in this population. But a decade’s worth of data suggest that is untrue. As with many antipsychotic medications, long-term use of aripiprazole can lead to tardive dyskinesia, as it did for Jaymes. It might also be linked to heart problems in autistic children. And perhaps most concerning, aripiprazole appears to cause just as much weight gain as risperidone, compounding a problem many children with autism already have.

“The weight gain is not subtle,” says Eric London, director of autism treatment research at the New York State Institute for Basic Research in Developmental Disabilities. He says he has discontinued the drug’s use in 15 to 20 percent of the autistic people he treats, one or two of whom have gained more than 100 pounds.

A string of lawsuits over the past several years have charged that aripiprazole’s developers, the pharmaceutical companies Otsuka Pharmaceutical and Bristol-Myers Squibb, did not adequately warn users of the drug’s potential side effects—including compulsive behaviors such as gambling, sex addiction and excessive shopping. Other lawsuits alleged that the companies marketed the drug illegally for conditions it may not help. Most doctors interviewed for this story were aware of the risks. One described aripiprazole as a “last resort” in his treatment arsenal—a drug intended only for children who harm themselves or others. Still, a few say they consider aripiprazole a cure-all that can ease minor behavioral problems such as general agitation. Many clinicians say they prescribe the drug for a year or longer. Unlike risperidone, though, aripiprazole has not been shown to work long term in children with autism. Neither Otsuka nor Bristol-Myers Squibb responded to repeated requests from Spectrum for comment.

From 2014 to 2016, more than 500,000 children were prescribed aripiprazole in the United States. And among children with autism, the number taking antipsychotic medications overall is about one in six, according to one 2016 study. “That is concerning and suggests possible over-prescription or overuse,” says Matthew Siegel, director of the Developmental Disorders Inpatient Research Collaborative at Spring Harbor Hospital in Westbrook, Maine. “Those are our most powerful, potentially most problematic drugs. Should that really be the most common [type of] drug we use?

Adverse events related to aripiprazole use: The most common adverse events reported in autistic children who took aripiprazole, according to data collected by the U.S. Food and Drug Administration. The agency does not verify these reports, and many other adverse events may go unreported. 

High hopes:

Aripiprazole was discovered decades before it was approved for use in children with autism. Scientists at Otsuka Pharmaceutical, based in Tokyo, Japan, started work on the compound in the late 1970s and teamed up with Bristol-Myers Squibb more than a decade later to develop it into pill form. In 2002, the two big companies together brought that pill to market under the brand name Abilify, originally branding it as a novel antipsychotic to treat schizophrenia.

Many doctors say they had high hopes for the drug at first—in part because it purported to work differently from all of its predecessors. Whereas other atypical antipsychotics, including risperidone, inhibit the neurotransmitter dopamine, aripiprazole blocks dopamine only some of the time (the exact mechanism is unknown). For that reason, the drug was expected to cause fewer side effects than risperidone. Because it also acts on the neurotransmitter serotonin, from 2004 to 2016 the FDA signed off on its use for a laundry list of other conditions tied to either dopamine or serotonin, including bipolar disorder, depression, and Tourette syndrome.

The agency approved risperidone for autistic children in 2006, and soon after, Bristol-Myers Squibb and Otsuka started testing aripiprazole for that same use. In a 2009 study of 218 children with autism, they found that those who took the drug for eight weeks significantly improved on a standard test of irritability compared with controls. A second 2009 study in 98 children reinforced those results. Both studies hinted that children treated with aripiprazole may gain weight and have severe muscle tremors, but they concluded that the drug is safe and well tolerated overall.

Based on those trials, in 2009 the FDA approved aripiprazole to treat irritability in autistic children. Some researchers say they remember that soon after, drug representatives were touting aripiprazole as safer and at least as effective as risperidone. “When the sales reps came or when [aripiprazole] was presented, it was presented as, you know, ‘It’s an effective drug but has less weight gain compared to risperidone,’” says Antonio Hardan, professor of psychiatry and behavioral sciences at Stanford University in California. He says he does not remember specific interactions with drug representatives but recalls discussing the new approval with his colleagues. “People were excited about it,” he says.

Sales of aripiprazole skyrocketed. In 2013, it was the highest grossing medication in the U.S. But it also drew lawsuits from thousands of people over side effects. The companies also faced lawsuits over how they marketed the drug. According to charges brought by the U.S. Department of Justice, drug representatives had visited doctors’ offices to promote aripiprazole’s use in children before the FDA had approved it for that use. Otsuka and Bristol-Myers Squibb both denied any wrongdoing, but both agreed to settlements: In 2007, Bristol-Myers Squibb agreed to pay $515 million to the U.S. Department of Justice, and Otsuka agreed to pay the department more than $4 million a year later. Bristol-Myers Squibb also settled a 2016 suit for $19.5 million that alleged it had marketed the drug for off-label use—that is, for conditions the drug was not approved to treat. In 2016, the FDA compelled Otsuka and Bristol-Myers Squibb to update the drug’s warning labels.

According to Michael Oldani, a medical anthropologist at Concordia University in Mequon, Wisconsin, the companies’ aggressive marketing helped to expand aripiprazole’s use to conditions such as autism. By merely conducting studies to extend the drug’s use to children, its makers also became eligible under FDA rules to extend the life of their patent for at least six months from the original expiration date of October 2014. That extension allowed the companies to retain exclusive rights to the drug—and to continue pricing it at about $800 a month for a typical dose. By contrast, generic versions of the drug now available run to about $15 a month.

The companies overplayed the drug’s safety from the outset, Oldani says. He worked as a drug representative for Pfizer from 1989 to 1998. He also served as an expert witness in a 2013 case against Bristol-Myers Squibb related to Abilify’s off-label promotion and side effects. “The big thing for me is always side effects,” Oldani says. “The mythology with [aripiprazole prescriptions] is they were super-duper safe.”

Risky reactions:

At least one thing has become clear after a decade of aripiprazole’s use: The drug’s effects can vary dramatically between people. That’s something Vida Penikas, who has three autistic children, learned firsthand.

When Penikas’ son J. was a toddler, he rarely spoke and was obsessed with anything that could spin. He was diagnosed with autism around age 5. He did well in school and was reasonably happy until he entered middle school, his mother says, when he spiraled into a dark depression. (Spectrum is using the boys’ first initials to protect their privacy.)

Penikas brought J. to their nurse practitioner. It was 2008, the year before aripiprazole was approved for autistic children, but the nurse practitioner recommended the drug “right off the bat,” Penikas says. “He said they’ve seen that Abilify works well with autistic kids.” Almost immediately, J. calmed down. His depression lifted and his outbursts waned. The drug worked so well that J. took aripiprazole until he turned 21 three years ago and no longer seemed to need it.

We think in true clinical practice over long-term treatment that we cannot differentiate weight gain between [the two drugs].

—Craig Erickson 

J.’s younger brother T. had an entirely different experience. He was diagnosed with autism after he started school, and by the time he was 9, he was having intense anxiety attacks. At first, the doctor prescribed several drugs that did little to ease the boy’s anxiety. Based on J.’s experience, Penikas thought aripiprazole might help and suggested it.

It turned out to be a nightmare, she says. Within months, T. became newly obsessed with random objects—at first Tic Tac candies, then duct tape. Soon after, he became aggressive, the opposite of the drug’s intended effect. One day about 10 weeks after he started taking aripiprazole, T. put a kitchen knife to his neck and threatened to stab himself if Penikas kept him from attending a friend’s sleepover. Penikas called 911, and T. was admitted to a psychiatric hospital, where doctors decided to wean him off aripiprazole. When he stopped taking the drug, his aggression waned.

“I would say [aripiprazole] works pretty well for a lot of people,” says Sarah Cheyette, a pediatric neurologist at Sutter Health in San Carlos, California. But there are notable exceptions, she says. Without research to identify who the likely responders are, clinicians have relied largely on their own judgement about when and to whom to prescribe aripiprazole. Some say they prescribe risperidone for children who are hyperactive, compulsive or have erratic sleep patterns, and turn to aripiprazole if a child has a family history of obesity or diabetes, presuming it is associated with less weight gain.

But a growing body of research is beginning to suggest aripiprazole and risperidone may not be as different as doctors have assumed when it comes to side effects. One 2016 analysis of 11 randomized controlled studies of aripiprazole and risperidone found that they are about equally effective. That same year, a head-to-head comparison of the drugs found that weight gain from each is “uncannily similar,” says Craig Erickson, associate professor of psychiatry at the Cincinnati Children’s Hospital in Ohio, who led the study.

Prior to that study, “myself and others would go around the country . . . and we’d say, ‘Hey, we think there’s less weight gain [with aripiprazole]. ’ But then we really came around to this understanding,” Erickson says. “We think in true clinical practice over long-term treatment that we cannot differentiate weight gain between [the two drugs].” Similarly, although physicians have widely used aripiprazole to address self-injury, the drug may work best for children whose aggression comes from autistic meltdowns, according to a reanalysis of the original results.

Erickson says two trials he was involved in at around the same time as the original clinical trials in children might yield additional insight. But results from those trials are not fully available. Data from one of the studies appear on the government’s trial registry, but the results are “not in a level of detail that scientists in the field expect or can fully utilize,” he says. The other study has no public results; the lead investigators of both studies did not respond to multiple requests for comment.

One outstanding question about aripiprazole is how well it works in the long term. Otsuka completed a small study in 2014, the results of which suggested the drug has limited value past 28 weeks of use; the FDA then required the drug’s makers to add this detail to its label. But many researchers say the study was too small for them to draw conclusions about the drug’s usefulness over a long period. The study also hinted that girls fare worse on aripiprazole than do boys, although the reasons for these differences are unclear. Many researchers say these findings in particular warrant further study.

Spending on Abilify in the U.S., 2006-2019 

Source: IQVIA National Sales Perspectives. Graphic by Krista Fuentes. 

Emerging concerns:

In 2017, the FDA tasked an independent advisory committee—comprising pediatricians from a range of specialties—with reviewing aripiprazole’s side effects in children.

The committee examined a report the FDA had prepared earlier that year highlighting 78 serious cases of adverse events, based on data from the agency’s national drug surveillance program. According to the report, 14 children, including one with autism, had died—5 of them by suicide. The drug’s label warns that aripiprazole is associated with “suicidal thoughts and behaviors,” but the FDA report concluded that aripiprazole could not directly be linked to any of the deaths.

The report also concluded that no new safety warnings were warranted. In half of the non-fatal cases, the drug had stopped being effective. For the other half, the report said, “there were no clear patterns or trends for a new safety signal.”

The committee’s conclusions after reviewing the report, however, were less reassuring. The members expressed concern about weight gain associated with aripiprazole, and other adverse reactions that can be related to weight gain, such as stroke and heart problems, neither of which appears on the drug’s label for use in children. The FDA’s surveillance data, for instance, included five cases of stroke. One 10-year-old boy had developed coronary artery stenosis, a condition normally seen in adults.

“I understand the child had underlying congenital heart disease, but congenital heart disease at 10 years old does not cause coronary artery stenosis or ischemic cardiomyopathy. That, to me, was like, really?” committee member and pediatrician Christy Turer said during a meeting in Rockville, Maryland, in 2017, according to the meeting’s minutes.

When you are in the clinic, you have people with real problems. You can’t just throw your hands up and say, ‘Go home.’

—Eric London

Turer argued that the heart problems, stroke and metabolic issues were all “new safety events” worthy of new warning labels and further study. Another member agreed with her, but the remaining 12 did not. Turer requested that the FDA follow up on her concerns over cardiovascular side effects, but she says she never heard back from agency officials. “[They are] not held to doing that or communicating back to us if they looked into it,” she says.

In response to questions about these concerns, an FDA spokesperson told Spectrum that the agency had decided not to pursue any inquiry into an association between aripiprazole and an increased risk of cardiovascular problems in children. “We did not receive any follow-up information on the cases that provided additional information suggesting that aripiprazole caused the events,” the spokesperson said.

Despite these concerns, some clinicians say that having aripiprazole as an option is better than nothing—at least until research suggests otherwise. “When you are in the clinic, you have people with real problems,” London says. “You can’t just throw your hands up and say, ‘Go home, I have nothing to do for you because the studies don’t work.’”

Amber Lesovoy, though, has a different perspective: She says doing nothing would have been better than using aripiprazole. She still blames the drug for Jaymes’ “unnecessary suffering.”

Jaymes is now 16. He has continued to gain weight, and he has become increasingly violent. His family moved him to a group home about an hour away from their house. But he acts up when he is at the home—about a year ago, for example, he became angry and tried to swallow his hearing aid. Still, it is the safest option for Jaymes and the rest of the family, Lesovoy says.

“Medication is a necessary evil for Jaymes, and I understand that,” she says. “But I really regret certain ones, and Abilify is one of the ones I really regret.”

This article was original published February 19 on Spectrum, the leading site for autism research news.

Antipsychotics for Children With ADHD Should Be a Last Resort

A growing concern is that prescribers may be using such drugs for nonpsychotic conditions in which experts and guidelines recommend psychosocial interventions as first-line treatment. These conditions include disruptive behaviors and attention-deficit hyperactivity disorder (ADHD), with the latter accounting for about half of all antipsychotic drug use in children. ^1,8-11 This is not a new concern. More than 10 years ago, the Agency for Healthcare Research and Quality raised concerns and recommended that organizations monitor antipsychotic medication use in children.¹² The Healthcare Effectiveness Data and Information Set has included a measure for this perceived problem since 2015.

A primary concern is the potential for significant adverse effects (AEs) in children who experience long-term exposure to these drugs. Pharmacists are well aware of antipsychotics’ adverse metabolic effects (ie, hyperlipidemia, hyperprolactinemia, increased risk of type 2 diabetes, and weight gain).^13,14 These conditions have lifelong implications. Other serious risks include cardiac arrhythmias, extrapyramidal AEs, liver toxicity, sedation, and somnolence.^2-7 Aripiprazole and quetiapine carry a boxed warning indicating that in adolescents, children, and young adults who take antidepressants for major depressive disorder and other psychiatric disorders, risk of suicidal behavior and thinking is elevated. (Note that although aripiprazole and quetiapine are not FDA approved for depressive episodes in bipolar I disorder or as adjunctive treatment for major depressive disorder in pediatric patients, they carry this warning.^3,5) A recent study found that using antipsychotic doses higher than 50-mg chlorpromazine equivalents was associated with an increased risk of unexpected death 3.5-fold higher than in children treated with lower doses or those who did not receive an antipsychotic. Thus, the concern is evidence based.¹⁵

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder),¹⁶ and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.^16-24

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD,²⁵ and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment.²⁶ ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts.^27,28 Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.²⁵

ALTERNATIVES TO ANTIPSYCHOTIC DRUGS

Pharmacists can monitor antipsychotic drug prescribing and make a valuable recommendation to the pediatric treatment team. Table 2 lists some guidelines.^15,29,30

CONCLUSION

ADHD can be challenging for health care providers and parents and often has difficult-to-treat comorbidities. Careful selection of treatments can prevent lifelong and serious complications.

Jeannette Y. Wick, MBA, RPh, FASCP, is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES

• Olfson M, King M, Schoenbaum M. Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry. 2015;72(9):867-874. doi:10.1001/jamapsychiatry.2015.0500.
• Zyprexa Relprevv (olanzapine) [prescribing information]. Indianapolis, IN: Lilly USA, LLC; 2009. pi.lilly.com/us/zyprexa_relprevv.pdf. Accessed January 22, 2020.
• Abilify (aripiprazole) [prescribing information]. Rockville, MD: Otsuka America Pharmaceutical, Inc; 2014. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021436s038,021713s030,021729s022,021866s023lbl.pdf. Accessed January 22, 2020.
• Invega (paliperidone palmitate) [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2018. https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/INVEGA-pi.pdf. Accessed January 22, 2007.
• Seroquel (quetiapine) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2012. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020639s064lbl.pdf. Accessed January 22, 2020.
• Risperdal (risperidone) [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc; 2009. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020272s056,020588s044,021346s033,021444s03lbl.pdf. Accessed January 22, 2020.
• Saphis (asenapine) [prescribing information]. Whitehouse Station, NJ: Merck & Co Inc; 2009. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022117s003s004lbl.pdf. Accessed January 22, 2020.
• Olfson M, Blanco C, Liu SM, Wang S, Correll CU. National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry. 2012;69(12):1247-1256. doi: 10.1001/archgenpsychiatry.2012.647.
• Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS. Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiol Drug Saf. 2011;20(2):177-184. doi: 10.1002/pds.2082.
• Matone M, Localio R, Huang Y-S, et al. The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: a national study of US Medicaid-enrolled children. Health Serv Res. 2012;47(5):1836-1860.
• Sultan RS, Correll CU, Schoenbaum M, King M, Walkup JT, Olfson M. National patterns of commonly prescribed psychotropic medications to young people. J Child Adolesc Psychopharmacol. 2018;28(3):158-165. doi: 10.1089/cap.2017.0077.
• Use of first-line psychosocial care for children and adolescents on antipsychotics. Agency for Healthcare Research and Quality website. https://www. ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-148-antipsychotics-psychosocial-care-report.pdf. Accessed December 12. 2019.
• Correll CU, Lencz T, Malhotra AK. Antipsychotic drugs and obesity. Trends Mol Med. 2011;17(2):97-107. doi: 10.1016/j.molmed.2010.10.010.
• Galling B, Correll CU. Do antipsychotics increase diabetes risk in children and adolescents? Expert Opin Drug Saf. 2015;14(2):219-241. doi: 10.1517/14740338.2015.979150.
• Ray WA, Stein CM, Murray KT, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry. 2019;76(2):162-171. doi: 10.1001/jamapsychiatry.2018.3421.
• Pathak P, West D, Martin BC, Helm ME, Henderson C. Evidence-based use of second-generation antipsychotics in a state Medicaid pediatric population, 2001-2005. Psychiatr Serv. 2010;61(2):123-129. doi: 10.1176/ps.2010.61.2.123.
• Pan PY, Fu AT, Yeh CB. Aripiprazole/methylphenidate combination in children and adolescents with disruptive mood dysregulation disorder and attention-deficit/hyperactivity disorder: an open-label study. J Child Adolesc Psychopharmacol. 2018;28(10):682-689. doi: 10.1089/cap.2018.0068.
• Gurnani T, Ivanov I, Newcorn JH. Pharmacotherapy of aggression in child and adolescent psychiatric disorders. J Child Adolesc Psychopharmacol. 2016;26(1):65-73. doi: 10.1089/cap.2015.0167.
• Pringsheim T, Hirsch L, Gardner D, Gorman DA. The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis—part 2: antipsychotics and traditional mood stabilizers. Can J Psychiatry. 2015;60(2):52-61.
• Findling RL, Drury SS, Jensen PS, Rapoport JL; AACAP Committee on Quality Issues. Practice parameter for the use of atypical antipsychotic medications in children and adolescents. American Academy of Child and Adolescent Psychiatry website. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf. Published 2011. Accessed June 18, 2019.
• Armenteros JL, Lewis JE, Davalos M, et al. Risperidone augmentation for treatment-resistant aggression in attention-deficit/hyperactivity disorder: a placebo-controlled pilot study. J Am Acad Child Adolesc Psychiatry. 2007;46(5):558-565. doi: 10.1097/chi.0b013e3180323354.
• Findling RL, Short EJ, Leskovec T, et al. Aripiprazole in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2008;18(4):347-354. doi: 10.1089/cap.2007.0124.
• Tramontina S, Zeni CP, Ketzer CR, Pheula GF, Narvaez J, Rohde LA. Aripiprazole in children and adolescents with bipolar disorder comorbid with attention-deficit/hyperactivity disorder: a pilot randomized clinical trial. J Clin Psychiatry. 2009;70(5):756-764. doi:10.4088/JCP.08m04726.
• Kronenberger WG, Giauque AL, Lafata DE, Bohnstedt BN, Maxey LE, Dunn DW. Quetiapine addition in methylphenidate treatment-resistant adolescents with comorbid ADHD, conduct/oppositional-defiant disorder, and aggression: a prospective, open-label study. J Child Adolesc Psychopharmacol. 2007;17(3):334-347.
• Sultan RS, Wang S, Crystal S, Olfson M. Antipsychotic treatment among youths with attention-deficit/hyperactivity disorder. JAMA Netw Open. 2019;2(7):e197850. doi: 10.1001/jamanetworkopen.2019.7850.
• Martins J, Roberts N, Nesdole R, Reddy PS, Groll D. Attention deficit hyperactivity disorder presentations to the child and adolescent mental health urgent consult clinic. J Can Acad Child Adolesc Psychiatry. 2019;28(2):66-71.
• Connor DF, Glatt SJ, Lopez ID, Jackson D, Melloni RH Jr. Psychopharmacology and aggression—I: a meta-analysis of stimulant effects on overt/covert aggression-related behaviors in ADHD. J Am Acad Child Adolesc Psychiatry. 2002;41(3):253-261.
• Jensen PS, Youngstrom EA, Steiner H, et al. Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: implications for medication studies. J Am Acad Child Adolesc Psychiatry. 2007;46(3):309-322. doi: 10.1097/chi.0b013e31802f1454.
• Solanto MV. Neuropsychopharmacological mechanisms of stimulant drug action in attention-deficit hyperactivity disorder: a review and integration. Behav Brain Res. 1998;94(1):127—152.
• Penfold RB, Stewart C, Hunkeler EM, et al. Use of antipsychotic medications in pediatric populations: what do the data say? Curr Psychiatry Rep. 2013 Dec;15(12):426. doi: 10.1007/s11920-013-0426-8.

90,000 8 skills that are useful for preschoolers and younger students

1. Ability and willingness to learn: cognitive ability and interest in learning

Perception, attention, memory, imagination, speech, thinking are mental cognitive processes that make up the ability and desire to learn. For most children, the development of cognitive interest is a natural process laid down by nature. At preschool age, inquisitive children most of all want to discover something new for themselves.

Closer to 5-7 years old, the child no longer simply perceives information in a finished form, as it was before. An inquisitive mind seeks to find answers to questions on its own. An inquisitive preschooler learns to bring different concepts into one system, analyzes them, compares, searches for patterns and draws conclusions.

Ardent interest and curiosity are the basis of independent motivation of a preschooler and first grader to study.

The elementary school curriculum does not contain separate lessons devoted to the development of cognitive abilities. Therefore, the task of teaching a child to learn largely falls on the parents.

High cognitive interest plus developed attention, memory, thinking and other cognitive abilities will help you get used to school without stress, become more independent, proactive and avoid chronic academic failure.

See also: Benefits of entertaining math and logic problem solving.

The ability to learn on your own cannot be overemphasized. Technology is advancing many times faster than 20 years ago, and specialists of any profession are in a race for new knowledge. Try to imagine what will happen in another 20 years.

2. Creative thinking: the ability to think outside the box, contrary to patterns

The ability to create something new, unconventional – this is how classical psychology defines the concept of “creative thinking”.You shouldn’t associate it exclusively with art: extraordinary solutions are welcomed in any field of activity, be it acting or mobile application development.

At the age of 5-7 years, thinking is not constrained by stereotypes and it is easier for a child to learn to “be creative”. This will help in the future to get out of any difficult situations, simply by connecting creative thinking.

Read also: 10 Ideas and Exercises to Boost Your Creativity.

90,000 What skills to develop in a child and how will it help in the future :: RBC Trends

Photo: Nicolas Picard / Unsplash

A person’s success in the profession is 85% dependent on soft skills. Together with Natalia Gatanova, a psychologist, mother and scientific director of the MiKEBI Foundation, we figure out what it is and how to develop them in young children

What are soft skills and why are they important for a child

Scientists divide human skills into two conditional groups: professional hard skills and supra-professional soft skills.

1. Hard skills – highly specialized skills for performing specific tasks at work.For example, a programmer’s skill is to write python code. hard skills can be learned at school, university, work, courses or trainings.
2. Soft skills – a set of social skills that help a person to solve problems in life: communication, leadership, teamwork, people management, emotional intelligence. Flexible skills cannot be learned in training, they are formed in childhood and develop throughout life.

A simple model of professional competencies in the form of a nesting doll.Inside “hard” skills, outside – “flexible”

(Photo: Moscow School of Management Skolkovo)

According to the results of a joint study by scientists from Harvard, Stanford and the Carnegie Endowment, soft skills determine a person’s success in the profession by 85%, and only 15% depends on highly specialized skills.

In a study by the British Sutton Trust, 88% of young people surveyed, 94% of employers and 97% of teachers said they consider “life skills” as important or more important than academic ones. The changeable VUCA-world requires quick adaptation of a person to a new one. VUCA is an abbreviation of instability (volatility), uncertainty (uncertainty), complexity (complexity) and ambiguity (ambiguity). It is now important to pay attention to the development of flexible skills in the child to help cope with changes and not get lost in the future.

What soft skills to develop in children

Like adults, children have the most important skills – communication, while you need to pay attention to leadership and work in a group, says Natalia Gatanova, scientific director of the MiKEBI Foundation.

• Communication skills. The child must learn to communicate: introduce himself, get acquainted, agree to play together. If necessary, ask for help from adults or peers, offer to provide it yourself.Explain exactly what they need and why. By developing communication skills, the child learns to accept different points of view and argue for his own.
• Leadership qualities. Leadership is self-confidence and self-confidence. The child learns to take responsibility for the decisions made and the people around. If no one wants to play, he himself will offer to start. A kid can feel invisible and fake if he constantly waits for someone to organize the game for him or solve all the problems.Children should feel like full-fledged people who know how to achieve their goal and make the right decisions for this.
• Group work. Ability to work and be in a group with other children helps to achieve big goals, compete and negotiate, develops leadership and communication. Working in a group, the child is not afraid to accept the rules of the game, maintain his role and enjoy it.

Six major megatrends that are changing the world. From the report “Skills of the Future”

Experts from Global Education Futures and WorldSkills Russia recommend developing ten main skills that people will need in the future:

1. Attention management and concentration. Help you cope with information noise and congestion, manage processes and solve complex problems.
2. Creative thinking. In the future, routine tasks will be automated, so the skills of creative thinking and the creation of creative ideas will help to remain in demand in the labor market.
3. Logic. Logic develops computational thinking. Helps solve complex problems and make informed decisions.
4. Spatial thinking and imagination. Helps to relate to the surrounding space, imagine new objects and navigate in it.
5. Information skills. Digital literacy and programming skills are as important as reading skills. These are the basic skills that everyone needs in a challenging new world.
6. Self-organization and time management. Zoomers and millennials are more likely to choose a free schedule and change jobs. Remote work is becoming the norm and sets a new era for self-organization. Skills will help you manage time, projects and life.
7. Emotional intelligence. Through emotions we react to what is happening around us. The skill helps to manage your emotional state, avoid neuroses, depression and apathy.
8. Intercultural communication. Global change is forcing economies, corporations and communities to unite to solve common problems. Intercultural communication skills help build relationships with people from other fields and countries.
9. Ability to learn, unlearn and relearn. Self-learning helps you self-master skills in a rapidly changing world and adapt to changes.
10. Critical thinking. The skill helps to think clearly and rationally, to find logical connections between facts and to formulate strong arguments.

In her TED talk, teacher Rimma Rappoport talks about how flexible skills can be developed in children in Russian lessons

According to the theory of attachment (a psychological model describing the relationship between people, including a mother and a child – RBC Trends ), a child understands his needs if the mother responds to them adequately.That is, if a mother feeds her son when he is cold, he will form a wrong understanding of himself at an unconscious level. Already at the age of three, the child wants to decide for himself: which cartoon to watch, what to wear and what toys to play. He imagines that the world is built around his desires. If a child does not understand himself, he cannot meet his needs.

In the theory of self-determination, there are three basic human needs.

1. Being accepted – the child plays with other children, feels needed and useful.
2. Being independent – the child realizes that he can change something if he wants it. For example, put toys in your own way or choose clothes.
3. Being successful and competent – the child knows that if he is faced with a difficult task, he will cope with it. Adults may not pay attention to this, explaining with the phrase “grow up – you will understand”, but this is not true. You need to treat the child as a full-fledged person.

Psychological comfort and health depend on the satisfaction of basic needs. If a child learns to understand and meet his childhood needs, he will grow up to be an independent adult who calmly responds to difficulties. Such adults are confident that any problem can be solved.

How to develop “flexible” skills in a child

The circles and sections are developing, but you should not rely only on additional education. Soft skills are formed from birth, so it is better to set a personal example for your child and take it seriously.

1. Personal example. The child adopts patterns of behavior, imitating adults. Parents set communication patterns if they openly communicate with people, express feelings, ask for help, and solve problems. For example, if you want your child to say hello, say hello yourself.
2. Ratio. A child is not a small adult who will start living after the age of 18, but a full-fledged person. Take your child seriously and ask for their opinion. If you give a choice, it must be real.For example, the proposal to choose a cup for milk is imaginary, because the child will still have to drink milk. Better ask what he wants to drink: tea, water, milk or juice.
3. Surroundings. Relatives, friends and acquaintances are the inner circle of the child. They set patterns for all forms of communication that develop flexible skills. If a child comes to a development group with an atmosphere of mutual respect and an opportunity for self-expression, soft skills will develop. At the same time, it is not worth putting a shy child into a development group and expecting him to become a leader in it.It is better to give your child a responsible task with the right to make mistakes. If there is a bakery on the ground floor of the house, assign a child to be in charge of the bread in the house. This is a real-life task: take money, go to the store, choose bread and bring it home.

How to see that a child has difficulties, and help with them in time

To see in time the difficulties with the development of soft skills in a child, look at his behavior. For example, if a child comes to a group of children, but cannot find a friend to play for 5-10 minutes, then he has difficulties. The child may not say hello, hide or stand on the sidelines for a long time and watch other children play. Try to talk to him and find out the reasons for this behavior, contact a child psychologist.

Talk to kindergarten teachers, school teachers, or parents of classmates. If it is difficult for adults to work with a child: he refuses everything, bully children, “pulls the blanket over himself,” and this is not a one-time occurrence, then there are difficulties.

Psychotherapist Andrey Kurpatov in the book “Happy Child. Universal rules ”writes that not understanding the reasons for crying children, parents defiantly leave the child alone with his trouble, making a lot of mistakes in emotional upbringing

Soft skills develop gradually throughout life.Some skills shape others. For example, communication develops emotional intelligence and the ability to manage people. There is no specific age for a child to grow up and change from one set of flexible skills to others.

In order for the child to understand his needs and to be able to satisfy them, the mother must respond correctly to the emotions and requests of the child in childhood and give the correct feedback in a timely manner. Then, if the child breaks the toy and cries, he will understand that he is crying because of the broken toy, and not because of the bad mother.You need to believe in your child, love him and give him the opportunity to live, and not prepare for life in the future.

To develop your child’s soft skills:

• Respond to needs at an early age, give timely feedback. This is how the child learns to understand himself and meet basic needs.
• Pay attention to communication, leadership and group work – these are the most important flexible skills for a child.
• Show examples of behavior, communication and work with others by example.
• Treat your child like a full-fledged adult with opinions.
• Be aware of the surrounding environment – ask relatives to set the right example, place the child in development groups with an atmosphere of mutual respect.
• Consult a specialist if your child has difficulties developing communication and flexible skills.
• Love and respect your child.

90,000 10 skills to teach a child in the digital age

The world is changing rapidly, some professions disappear, others appear.It is no longer possible to learn one thing so as not to retrain and acquire new competencies. But there are skills that will always be in demand in the digital world. Specialists of the School of Future Professions “CrashPro” will tell you what should be taught to children.

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We have analyzed the key skills discussed in the report of experts from Global Education Futures and WorldSkills Russia, and added to the list.

1. Concentration and attention management

In the future, routine work will be automated, people will have the most difficult tasks. The ability to concentrate is useful to cope with information overload, to manage complex equipment and systems. Play board games with your child that develop memory and attention, similar game applications can be downloaded on his gadgets. Robotics also improves concentration of attention, because there you need to consistently assemble the structure according to the scheme. This is an exciting activity for children, they can do business for a long time, bringing what they started to the end.

Encourage your child if he loses interest in the middle of class, praise and celebrate when he is done. Tell the children about the “interest graph” as they learn. At first everything is easy and interest is high, but as the material becomes more complex, interest falls and reaches the bottom, at this time most children want to quit classes, they need support and encouragement from an adult. Then the child begins to work out on the sly already at a difficult level, he works again and learns with pleasure.

2. Emotional intelligence

Empathy, compassion, the ability to hear and listen to others – something that machines will never have. Emotional intelligence is now understood as the ability to understand the motives of other people and the ability to manage their own emotions. Emotional intelligence will help to work in a team and better understand colleagues, as well as manage the team. For its development, the child must have time to play with peers; team games and project-based learning can also help – pedagogical technology, when children learn in teams.

3. Digital literacy

We live in a digital age. Online you can buy clothes and groceries, chat and play, you can even find your other half using dating sites or apps. But gadgets are not just entertainment, they should become an instrument of cognition, benefit the child. One cannot live in the digital world without the ability to work with digital technologies, including virtual and augmented reality. In a number of predictions, there is an opinion that programming skills may become as necessary for a person as the ability to read and write.

4. Creativity

Routine tasks are performed by machines, so the ability to think outside the box and create something new will be in demand. Creativity is not built from birth, this skill can be developed. This will be helped by classes where the child creates independently, finds new non-standard solutions.

At the CrashPro School of Future Professions, junior schoolchildren from seven to nine years old are engaged in robotics – at this age it is important to strengthen their attention skills so that children can better cope with the increased academic load.

Computer literacy is taught here from the age of six, and programming – from the age of eight. Creativity develops within the framework of project-based learning, which is used in all CrashPro courses – from animation to programming. Well, children can develop critical thinking in media literacy lessons.

5. Intercultural communication

Humanity faces global problems: climate change, overpopulation, environmental pollution and others. Humanity needs to unite to solve them.This has already happened in science – scientists work in international teams. So are big tech companies. Such work requires the ability to communicate with people of other cultures, to find a common language with them. A person with an open mind and unlimited mindset – someone who can interact with different people, regardless of their beliefs – is more likely to achieve success. Study other people’s customs and traditions, introduce the child to a foreign culture.

6. Ability to self-study

This skill is necessary, since a person of the future will have to change about 15 professions in a lifetime.He needs to be flexible, constantly retrain and acquire new skills in order to meet the changing reality. Children need to instill a habit of acquiring new knowledge – the more effectively they learn to assimilate information, the easier it will be for them to cope with changes. Encourage the child’s interest in the environment, answer his questions, if you don’t know, look for answers together, give new information about what interests him.

7. Initiative

Initiative – the desire to influence the phenomena and processes taking place around. An initiative person does not go with the flow, he chooses his own path, knows how to defend his position, is not afraid to take responsibility. You can help a child to become proactive, if you do not overly patronize him, let him make decisions himself, give him the opportunity to choose: in food, education, clothing, and so on.

8. Critical thinking

In an era of excess information and the ability to establish online contacts with a large number of people, the child must distinguish true information from false, good contacts from bad, useful content from rubbish.This must be taught before children start going online on their own.

9. Ability to work in a team

A child should be able to find a common language with people, unite with other team members to solve common problems – after all, the tasks of the future will be difficult, it is impossible to cope with them alone. The skill to act in the common interest should be nurtured from an early age. This will also be helped by project-based learning, where children are taught to interact with each other for a successful project.

10. Self-organization

Most likely, in the future, people will not work from 8:00 am to 5:00 pm. Already, there is an increase in the number of remote workers. In 2017, the International Labor Organization calculated that their share of all workers in developed countries is 17%. And in the USA and Japan already 40% of people work outside the office.

Generations Y and Z tend to change jobs every two to three years and are more likely to choose a free schedule. At the same time, work tasks have to be solved not at a specific time, but as they arise.Employers do not evaluate the number of working hours, but the effectiveness of employees’ actions and the results obtained. To be productive in this way, you need to be able to organize yourself. The importance of self-organization, the ability to manage time, and to separate important and urgent tasks from tasks that can be postponed will increase. Help your child learn time management and plan their day wisely.

Illustrations: Shutterstock (FoxyImage)

Checklist for Parents / Education / Immigration / 420on.cz Prague City Portal

It would seem that you brought an envelope from the hospital yesterday, but today the baby is already three years old. Now the child has become a preschooler. What changes await him in the coming year, psychologically and physically? Especially for parents, we have prepared a checklist that takes into account the peculiarities of the development of children three to four years old.

Physical development of children 3-4 years old

Younger preschool age is a new stage in the life of children. At this age, the baby is usually:

– already knows how to jump, run, climb objects;

– attempts to play group games;

– is gaining weight slightly, only 1-2 kg per year;

– grows by 3-7 cm;

– has up to 20 deciduous teeth.

Mental development of children 3-4 years old

This period is characterized by the fact that the child begins to identify himself as a person and requires appropriate treatment. The little man shows:

– stubbornness;

– negativism;

– attempts to command;

– overestimated independence;

– jealousy.

Parents should remember that it is at this age that the child experiences the first crisis, which they, as older and more experienced, should help to cope with.

Social and communicative development of children 3-4 years old

At this age, it is important to teach a child:

– greet each other when meeting with other children and adults;

– get acquainted with peers;

– share and exchange;

– take part in joint games with other guys;

– apply imagination in joint games;

– be able to tell about yourself: what is his name, what is the name of his parents;

– speak polite words and know the rules of behavior in society.

Intellectual development of a child at 3-4 years old

Beginning at the age of three, the child develops a certain knowledge base that he tries to apply. The kid is actively getting to know the world around him and by his age should already know:

– names and characteristics of 10 pets;

– 5-7 species of birds, be able to show them in the picture;

– 4-5 species of fish;

– 4-5 species of insects;

– names of the main plants growing in the region: up to 5 species of trees and flowers;

– names of vegetables, berries, fruits and mushrooms that grow in the region and are sold on shelves;

– how the characteristics of materials such as wood, glass, stone, plastic differ;

– times of day and their characteristics;

– seasons and how they differ;

– natural phenomena;

– body parts, as well as being able to show them;

– 3-5 popular professions;

– up to 10 types of vehicles;

– how the city differs from the village.

Logical and mathematical development of children 3-4 years old

Between the ages of three and four, basic logical operations and mathematical concepts have improved. If you pay enough attention to the child, then at this age he can confidently:

– count up to 10;

– name the primary colors;

– know geometric shapes;

– to know the concepts more – less, a lot – a little, high – low, etc. etc .;

– compare items according to 1-2 criteria;

– add pictures from fragments;

– find differences between similar pictures.

Parents should actively encourage children of this age to be independent by offering them specific tasks.

Speech development of children 3-4 years old

By the age of three, the baby should be able to:

– make up simple phrases;

– talk about recent events;

– use speech as a way to obtain new information;

– retell a fairy tale based on illustrations;

– talk about yourself;

– try to change words by case.

By the age of four, the child should have mastered the following skills:

– describe the seen image;

– quickly formulate your thoughts;

– know the signs of objects;

– use verbs;

– repeat complex phrases for adults;

– state your name and surname;

– invent your own words, determine the meaning of incomprehensible words.

Artistic development of a child 3-4 years old

An important role in the formation of a child’s psyche is played by the ability to express their feelings through creativity.At the age of 3-4 years, it is advisable for a child to master the following types of creativity:

– drawing with pencils, finger paints, brushes, crayons, sponges, felt-tip pens;

– applications made of colored paper, natural materials, cotton wool;

– modeling from plasticine and clay;

– construction;

– Cutting around the contour with children’s scissors with round ends;

– origami – folding figures without using scissors and glue;

– in addition to activities aimed at developing creative potential, the child should be offered to develop knowledge in painting, music, literature.

Keep your finger on the pulse of your baby’s development. But do not get carried away by fears of not having time to develop the child according to the generally accepted scale. Children develop in different ways! And if, nevertheless, there is a doubt that your child is keeping up with his peers, the personal help of a preschool teacher will not hurt.

Materials provided by the professional teacher Tatyana Fedorovna Antonova. Tatyana Fedorovna, a teacher with 48 years of experience, lives in Prague and at her school teaches children 3-12 years old to read, write, mathematics and Russian in person and online.She teaches her youngest students, aged 3 to 6, the basics of reading and writing, numeracy, logic and the world around her, helps them take the first steps in the development of speech and develop fine motor skills.

90,000 Top 5 essential soft skills for every child

We often hear about soft skills in relation to issues of self-development, career, life and professional success. These are components of a person’s adult life, so the question may naturally arise: what kind of soft skills can children need ?! It seems like it’s too early for them to think about a career, and schools, gymnasiums, sports clubs, creative studios and so on are engaged in the development of children.

The fact of the matter is that schools, gymnasiums and sports clubs develop hard skills, i.e. those skills that are needed for successful study, victory in sports competitions, olympiads in various subjects and other competitions. Indeed, to go to the 6th grade, you need to master the program for the 5th grade and write all the tests. To get the 3rd, 2nd or 1st sports category, you need to pass the standards and take part in competitions of the corresponding level.

With some stretch, we can say that certain soft skills – creativity, creative thinking, the ability to bring what has been started to the end – develop classes in creative studios: art, vocal, dance. But even here there are reporting concerts, regional competitions, exhibitions of drawings with awarding prizes, so hard skills are needed to participate in all of the above, i.e. specific and quite professional skills.

Then what are soft skills for children? Yes, the same as for adults! So we are looking for analogies and develop the younger generation as much as possible.

What soft skills do children need:

1. Communication skills.
2. Emotional Intelligence.
3. Correct speech.
4. Time Management.
5. Creativity and creative thinking.

And now more about each of the soft skills and how to develop this or that skill in a child.

Communication Skills

Communication is an important element of socialization. More precisely, without communication skills, the child simply cannot adapt to society. He should learn to communicate not only with his parents and grandmother, but also with other adults: a teacher, a coach, parents of friends, a salesman in a store, as well as his peers, older and younger children.

This is usually not difficult if the child attended kindergarten and at least one sports section before school. In any other case, parents will have to put in extra effort to teach communication skills. For example, a child can be instructed to make a small purchase – bread and a carton of milk – at a nearby store, giving him the required amount. Before going to the store, you should instruct on what kind of bread – white or black – you need to buy, and what is the name of your favorite milk in the family, so that the child can ask the seller for what he needs.

If your child is a “victim” of the fashion for home education, which does not involve any kindergartens and even small groups of English for children, then you will have to additionally teach him to communicate with peers, younger and older children. It is optimal if your friends have children of a suitable age – for example, give or take 1-3 years. Then you can agree on the departure of families to the country or to nature, where communication between children is tied up quickly enough.

If you yourself are not so sociable as to travel with friends to nature, or your friends, by the will of fate, have left for another city or country, then you should think about an additional collective activity for the child – team sports, classes in a dance ensemble , handicraft circles.

Emotional intelligence

Emotional intelligence is the ability to perceive the feelings of others and control your own emotions. If children understand quickly enough with the ability to perceive the emotions of other people – small manipulators instantly feel someone else’s weakness, then it is difficult for children to take control of their emotions.

First, in childhood, the physiological ability to control one’s feelings – fear, anger, joy – is not yet fully formed.Secondly, children do not yet realize the need to control their emotions. The classics of the genre are traditional hysterics in shopping malls shouting “I want” and “Buy”. How to deal with child tantrums is a separate topic.

But explaining to a child the rules of behavior in a public place, teaching them to adequately express their emotions is a systematic work, and adults must do it. Of course, adults in this case should themselves be a model of behavior, politeness, and culture of communication. And also carriers of information about how exactly the child should act if he needs something.

And also about teaching adequate responses. Here it is important to start with the development of observation, explaining the relationships between emotions and the ways of expressing them, both on the example of the people around them, and on examples from the life of the child himself. For example, to explain that when a child is in pain, he cries and sympathizes with him, and if someone else is crying, it means that the other is now feeling bad and painful, and he also needs sympathy.

This will help to instill in the child such qualities as the ability to empathize, provide emotional support to others, and not remain in the status of a little manipulator, whom they will increasingly ignore with age.Thus, the development of emotional intelligence will help the child not only interact with the world around him, but also preserve his psyche, protect him from ridicule, bullying, and communication failures.

Correct speech

Correct speech is a guarantee that the child in the future will be able to correctly convey his thoughts to others, will be heard and correctly understood. Correct speech has several components:

1. Ability to logically and consistently formulate your thoughts.
2. Absence of diction defects.
3. Correct sound production.
4. Diaphragmatic breathing.
5. Ability to control the volume and tempo of speech.
6. Coordination of hearing and voice.

Let’s analyze it in order. The ability to logically and consistently formulate your thoughts is, first of all, the ability to think logically. Thinking and speech abilities are directly related to the development of fine motor skills of the fingers. It should be developed from an early age: Lego constructor, modeling from plasticine, drawing, at an older age – embroidery and, possibly, knitting.

Schoolchildren should be encouraged to read in every possible way, including by example. If a child has never seen how dad or mom read, it is difficult to expect that he will grow up to be a book reader and generally a versatile personality.

The development of good diction has two main aspects. Firstly, the child must be physically healthy, have the correct bite, the normal length of the frenum under the tongue, not have diseases of the ENT organs and pinches in the cervical spine. Secondly, the child must have correct speech habits: the ability to pronounce letters clearly, not to “chew” the endings of words, not to distort words and the timbre of speech.

The latter is directly related to the technique of breathing and sound production. It happens that children deliberately “nasal”, constantly begging for something, and it happens that nasal develops as a result of ENT diseases. It also happens that slurred speech is due to a lack of understanding of the importance of the culture of speech as such, or maybe the child is simply not trained to take a breath of the required depth so that there is enough air for the entire phrase.

To exclude illness, a child with any speech impairments should be shown to doctors: ENT, neurologist and speech therapist.ENT diseases and minor neurological disorders are quite treatable, and the speech therapist will identify defects in the structure of the speech apparatus and, if necessary, correct them. The most common violation is the insufficient length of the bridle under the tongue, which complicates the normal pronunciation of many letters, the development of correct speech and, in the future, oratory skills. The bridle can be lengthened on an outpatient basis using local anesthesia.

And, finally, the ability to control the volume and tempo of speech, to coordinate hearing and voice is formed only closer to school age, and even in the elementary grades, so there is no need to demand too much from children.It’s great if a child wants and loves to sing – then he can be enrolled in individual vocal lessons, where he will be helped in a light, unobtrusive form to master the coordination between hearing and voice, and will be taught to control the volume and the rate of the pronunciation of sounds.

Time Management

Yes, children also need to learn to manage time. Firstly, it will help them to keep up everywhere: do homework, play sports, chat with friends, read books. Secondly, parents will be spared the “I’m bored” whining because the child will always have something to do.But for this, time management skills need to be instilled from a very early age.

What is the best way to do this? To begin with, a child should always have time in a day, which he can dispose of at his own discretion. This does not in any way contradict the need to observe the daily regimen and adhere to the set time for getting up, breakfast, lunch, walk, daytime sleep, dinner. It’s just that you need to add, as they say in the army, “personal time” to the regime, and observe how the child will dispose of it.

Will he pester you and pester you, how bored he is, or tries to smash his toys and furniture in the room to smithereens – observing his preferences can be a clue for parents on many issues.And, by the way, not only in time management. And even if the child just goes to sleep right on the carpet among the toys – this is also a signal. For example, to the fact that you should reduce the load and not take the child to 100,500 sections and circles at the same time.

Creativity and creative thinking

And finally, creativity and creative thinking. We have already briefly touched on this topic, and now we will develop it a little. Whether a child wants to become a web designer in the future, or whether he wants to be a home appliance repairman, whether he be a lawyer or an auto mechanic, creativity and creativity will always come in handy for him.

Yes, creativity is needed not only for the layout of websites and applications, but also for the search for interchangeable parts for equipment in the absence of the necessary spare parts in stock. By the way, some parts from cars are quite suitable for washing machines and water heaters. But, in order to start looking for details for the “washing machine” at the car market, you need to be free from limiting thinking and stereotyped patterns of behavior.

Here the recipes are known: creative studios, theater circles, music schools – of course, taking into account the wishes and abilities of the child.And, of course, a clear demonstration of the creative approach and variability of solving various problems in everyday life. You can easily explain the mathematical formula x = 2y visually by drawing two lines where the x line will be twice the y line. Or two geometric shapes: a square with the code designation y and a rectangle x, which will be exactly 2 times the size of the square. And then invite the child to look for different ways to convey the same information himself.

These are some of the basic soft skills that need to be developed in children, and the sooner the better.And remember that children are, first of all, children, so do not ask too much of them. Actually, that is why we have chosen only 5 basic soft skills, without which today it will be difficult for both children and you, if your children do not possess them. Remember also that no one has canceled the power of personal example, so constantly develop yourself and learn something new. For our part, we can help you by offering our Best Self-Education Techniques program, where you will learn to quickly and easily perceive any new information and hone any new skills.

I wish you and your children success and health!

90,000 Children from 3 to 4 years old

Development of Children from 3 years old to 4 years old. You are in the section “Children from 3 to 4 years old”.

In this section, we will help you find out and determine the level of development of your child, namely, what your child should know and be able to do at the age of 3 to 4 years.
What a 3 year old child should know and be able to do.

This article is intended for your information and gives approximate norms of the degree of formation of the mental processes of your child at this age.You can test its potential in different areas of knowledge, find out in which areas of knowledge your child excels, and which ones require additional attention and time.

In this section “Children from 3 to 4 years old” we have collected all the material published on our website, which will help you and your child to study, prepare for the next, more in-depth stage of classes.

You can use the materials for your lessons at home, in kindergarten or in primary school.
Mathematics
A child aged 3 to 4 should be able to:

1. The child should be able to count to three and show the appropriate number of fingers on his hand.
2. The child must be able to master the concepts: one – many, large – small, tall – low, etc.
3. The child must know the basic colors (red, yellow, green, blue, white, black).
4. The child must know the basic geometric shapes (circle, square, triangle).
5. The child should be able to compare objects in size, color, shape. Be able to compare the number of items.
6. A child should be able to match a pair to an object with a given sign.

Study materials:
1. Flashcards for playing with children
2. Colorful Playhouses
3. Cards We teach the child to count
4. Connect the numbers and color the drawing
5. Game learning geometric shapes
6. Video-Learning to Count
7. Cards Numbers for boys
eight.Introducing your child to Geometric Shapes
9. Cards with numbers from 0 to 10
10. How to playfully teach a child to count
11. Game for the study of Geometric Shapes
12. Cards Numbers for girls
13. Puzzles-double geometric shapes
14. Puzzles-double Numbers and Counting
15. Geometric shapes. Develop fine motor skills
16. Exploring Geometric Shapes
17. Learning to Count. Workbook
18. Learn to write Numbers from 1-9
19. Puzzle Score from 1 to 10
twenty.Didactic games in mathematics
21. Puzzle Score from 1 to 10
22. Mathematics with Dice for Children

Logical thinking
– Development of Thinking, Memory, Attention
A child aged 3 to 4 years should be able to:

1. The child should be able to put together a cut picture from 2-4 parts.
2. The child should be able to find and explain inconsistencies in the pictures.
3. The child should be able to find an extra object and explain why he made such a choice.
4. The child should be able to find similarities and differences between objects.
5. The child should be able to memorize 2-3 pictures.
6. The child should be able to memorize 3-4 words that the adult repeated several times.
7. The child should be able to memorize and repeat the movements shown by the adult 1-2 times,
8. The child should be able to memorize any detail or feature of an object.
9. The child should be able to do the task for 5 minutes without being distracted.
10. The child must find paired objects.To be able to choose the right one from a group of objects.
11. The child should be able to pay attention to the properties and attributes of objects, to find similarities and differences between objects.

Study materials:
1. Cards from the series find a pair
2. Find the shadow of the picture
3. Develop Logical Thinking
4. Activity cards
5. Puzzles
6. Pick up patch
7. Add missing item
8. Entertaining activities with a child
9. Play as opposed to
10.We orient ourselves in space. Right and Left
11. Game – “What is What?”
12. Game Catch a Fish
13. Game Association: Match
14. Game for the Development of Memory and Attention
15. Guess Whose Shadow

Speech Development
A child aged 3 to 4 should be able to:

1. A child should be able not only to visually perceive images, but also to describe what he saw.
2. The child easily forms simple sentences, gradually moves on to complex ones (from 5-6 words).
3. The child should be able to divide objects into groups: furniture, dishes, clothes, etc.
4. The child should be able to name one attribute of each object.
5. The child must know the names of the basic actions of people and animals (lies, sits, runs, etc. )
6. The child must be able to repeat rhymes and songs after an adult.
7. The child must know his first and last name.
8. The child should be able to control the strength of his voice, speak loudly – quietly.

Study materials:
one.Alphabet Letters-Puzzles
2. We study the letter A. What does the beech A look like.
3. Learning vowels
4. First Alphabet for Children
5. Alphabet in the form of cards
6. Colored Alphabet Letters
7. Lotto Learning Letters
8. Cards with Letters and Pictures
9. Pure clauses
10. Music game for the development of speech
11. Cards – What Letter the Word begins with

World around
A child aged 3 to 4 years should be able to:

one.The child should know the names and be able to show domestic (cow, goat, horse, cat, dog, etc.) and wild (wolf, hare, fox, etc.) animals.
2. The child should know the names of 3-4 birds (sparrow, swallow, crow), 3-4 fish (whale, catfish, shark) and 3-4 insects (grasshopper, butterfly, bee).
3. The child should know the names of the main plants: 3-4 trees (birch, oak, apple) and 3-4 flowers (chamomile, tulip, rose).
4. The child should know what vegetables, fruits, berries, mushrooms are.
5.The child should have an idea of ​​the materials from which the surrounding objects are made.
6. The child must know the parts of the day – morning, afternoon, evening, night.
7. The child should be able to name natural phenomena – rain, snow, wind.

Study materials:
1. Cards Human Body Parts
2. Cards with the image of Transport
3. Cards with Fruit
4. Cards with Vegetables
5. Cards exploring Colors
6. Cards Furniture
7. Cards “animals and what they eat”
eight.Cards “Clothes and Footwear”
9. Cards Animals & Birds
10. Fruits and berries. Exploring and Coloring
11. Vegetables. Exploring and Coloring
12. Fruits and Berries (coloring cards)
13. Vegetables (flashcards – coloring pages)
14. Unique Books – Seasons
15. Cards Insects
16. Crockery and Cutlery
17. Cards Game “What for What”
18. Cards Insects 2.
19. Educational Games with Clothespins

Household Skills
A child aged 3 to 4 years should be able to:

one.The child should be able to dress things independently (without fasteners).
2. The child should be able to cut paper with scissors.
3. The child should be able to use pencils, markers, pens, etc. Be able to draw circles, points, lines.
4. The child should be able to trace and color pictures.
5. The child must know the basic rules of hygiene.

Study materials:
1. Stencils for painting
2. Fruit from paper
3. Paper toys
four.Herringbone applique
5. Crafts from juice boxes
6. Applique Flowers
7. Miracle palms, making applications
8. Do-it-yourself space machine
9. Cars with eyes
10. Book My Home
11. Little Pony Bus
12. Palm frame – for babies
13. Plasticine and beads
14. Button Applications
15. Do-it-yourself Christmas tree from the pine cone
16. Cheerful Chupa-Chups

Read also article for Parents What you need to know about Child Development.

Find out what a child should know and be able to do by age. Take advantage of the tutorials on our website.

Calendar of child development up to 1 year (by months)
Child from 1 to 2 years
Child from 2 to 3 years
Child from 4 to 5 years
Child from 5 to 7 years

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90,000 Child development from 1-3 years old – Aptaclub.lv

Child development from 1 to 2 years

At the age of about one and three months, the child masters the ability to walk and improves this skill. He can walk and hold the ball. Holding an adult’s hand, he can climb stairs, step over small obstacles, and maintain balance.

Having reached one year and six months, the baby is already able not only to walk independently, but also to sit down, sit, jump, squat, climb stairs and descend, throw the ball up, down and forward, as well as in other ways to consciously control his body.

At the age of one year and nine months, the baby, upon request or independently, can walk on a board that is slightly raised above the floor or on a gymnastic bench, throw a ball into a basket on the table, climb onto a sofa or chair, or get down from them.

Child’s social and emotional skills

When a baby is one year old, he usually imitates the facial expressions, movements and expressions of emotions of adults. He emotionally reacts to the mood of another child, strangers, unexpected events, new impressions.His attention is easily distracted, his emotional state can change quickly. He accompanies his actions with appropriate facial expressions and other expressions of emotion.

At one year and six months, the child begins to more actively show his negative emotions, most often – anger, which he expresses by waving his hands, stamping his feet, etc. He experiences criticism, remarks and rejoices at his success, is interested in the activities of other children. Negative actions are possible – does not allow other children to play with their toys or even takes toys away from them.He imitates the emotional reactions of adults – regrets, sympathizes. She agrees to remain under the supervision of close relatives, although she is still emotionally connected with her mother.

When a child is one year and nine months old, he imitates the reactions of adults in situations of joy, grief, anxiety. He perceives the intonation of an adult’s voice, and accompanies games with emotional exclamations and facial expressions. May be offended and show that he is unhappy with the punishment or prohibition by his facial expression. Knows how to react emotionally in a variety of ways to music.

Cognitive skills of the child

At about a year and three months, after repeating specific actions, the child is able to remember that after playing the game you need to put toys in a box, after dinner put a mug in the sink, etc. It can also fulfill requests – find, bring, put in place, find objects that match others in color. Can put circles on the pyramid and remove them. He recognizes parents and other relatives in photographs, and himself in the mirror.He can repeat the already mastered skills of the game – feed the doll, put the bear to sleep, push the car, accompanying it with the appropriate sounds.

At a year and six months, a baby, at the request of an adult, can find objects of a certain shape and size, round and square, large and small. Distinguishes 2-3 colors, can find an object of this color, which is called by an adult. Knows how to find similar items regardless of their color and size.

In a year and nine months, the baby already distinguishes 3-4 colors, three sizes of the same shape (large, smaller, smallest), knows how to find the largest and smallest of 5 objects.

Language skills of the child

At the age of about a year and three months, the active vocabulary of the baby (those that he uses every day) reaches 20, including the “words” invented by him. Passive vocabulary (words that he understands) grows rapidly. Knows the names of loved ones, remembers the names of games, items of clothing, body parts and can show them. At the age of one year and six months, his vocabulary is already about 40 words.

At a year and nine months, the baby usually already uses two-word sentences, can answer the questions “Where?”, “What is it?”, “What is he doing?” etc.n. The active vocabulary is increasing.

Child development from 2 to 3 years old

At the age of two years, the child knows how to hold a felt-tip pen or pencil well, but still draws only meaningless figures. He can already walk on an uneven surface, climb over small grooves, jump from a height of 10-15 centimeters, sometimes catch a ball thrown from a close distance with both hands. Upon reaching the age of three, the child learns to ride a bicycle, swing on a swing, ski, swim, skate, play football.

Social and emotional skills of the child

From the age of two, the baby is already proud of his achievements and wants to be evaluated positively. He is familiar with feelings of affection, love, anger, resentment, joy. The child is aware of his gender. At first he is wary of strangers, but if your attitude is benevolent, he is sympathetic and friendly. Distinguishes between people of strong and weak character and treats them differently – does not obey or respects.

Having overcome the three-year milestone, the child can already control his emotions ─ not shouting in public places, not running down the street.Feelings of shame and guilt are familiar to him. He can appreciate the negative actions of others and say that you cannot fight, break, take away things, offend and tease others. Can be jealous, angry, cunning, mischievous. Emotionally empathizes with the heroes of plays, books, films. Notices the emotions of others and takes them into account (does not make noise if dad is sleeping). He is kindly disposed towards other children, wants to play together, shares toys.

Cognitive skills of the child

At the age of about two years, the child can hold attention for about half an hour.He knows how to place a geometric object in the appropriate frame. Distinguishes 3-4 colors, can name them and find by sample. Distinguishes between weight, texture and temperature of objects (light, heavy, soft, hard, cold, warm). Knows how to build a path, a fence, a house, etc. from cubes. Can fulfill three consecutive requests – take, carry and put.

At the age of about two years and three months, games for a child become not only entertainment, but also a developing activity. At this age, he can play on his own for 40 minutes or even an hour.At two years and six months, the child is able to distinguish objects of different sizes of the same color, distinguishes 4-6 geometric shapes, is able to put structures of 10 or more cubes of different colors and sizes according to the pattern. He is able to understand and remember the rules of a group children’s game, participates in such games. He remembers the music he likes, he likes to dance.

Child’s language skills

At about two years of age, a toddler’s vocabulary is approximately 250-300 words, including abbreviations or transformed words.Uses sentences of 2-3 words. Assesses himself: “good”, “big”, “beautiful”; says “thank you”, “goodbye”, “good afternoon” with his own speech characteristics. Remembers the names of playmates, recognizes them. Can show parts of the face and body named by an adult.

At two years and three months, a child can build a sentence of 3-4 words. At two years and six months, the baby can already answer, for example, the following questions: “What is your name?” (abbreviated or completely). The first interest in letters and numbers appears.2-3 sentences can tell about the plot seen in the picture. Can name his emotions, feelings – I am having fun, I am in pain, I want, etc.

At the age of two years and nine months, as well as after three years, the child’s vocabulary is steadily increasing. Mastering letters and numbers begins. Speaks in phrases of 5-6 words. Forms new words. The active vocabulary contains about 1500 words. It can show its age on the fingers.

Between 24 and 36 months (2-3 years), your baby develops important skills and increasingly reveals his unique personality.Getting nutrients consistently throughout this phase will help keep your little one learning and providing the energy they need to stay active and agile. Find out what nutrients are important during this time and how to ensure that your little one gets enough of them (even when they are in their whims).

Physical development of your baby from 24 to 36 months

The development of your baby continues at a rapid pace! The kid learns about himself, as well as about his relationships with people around him and the world around him, becoming much more physically capable and self-confident.By the time your toddler is 2 years old, you can probably tell if he is right-handed or left-handed. In fact, this was determined while still in the womb, but it may take a while to figure out for sure, since at this age children usually use both hands the same way. Left-handedness is relatively rare; only 7 to 10% of the adult population is left-handed. Whichever hand your little one prefers, he will often use his preferred side to doodle, push the ball, and eat on his own.He might even be able to use his dominant hand to brush his teeth – with a little help.

Emotional development of your baby from 24 to 36 months

At the age of 24 to 36 months, your baby goes through an important stage of emotional development. He learns about feelings and becomes more attentive to the feelings of others. Sometimes the baby’s emotions are off the charts, which can scare him. Toddlers sometimes experience more emotions than they can handle or handle, and this sometimes results in tantrums, or even biting or fighting.This happens to most children at some point, and the main thing for you is to stay calm. Overreaction can make children anxious, so try to avoid big emotional outbursts: explaining your own emotions can be a good way to calm yourself down and get a rational perspective on the situation.

You can help your toddler learn to deal with emotions by naming them and explaining that it is completely normal to feel angry, sad, or frustrated.Be open when you feel these emotions – this will help your baby know that everyone has feelings.

Optimal nutrition for your baby’s development

By this time, your child will have learned to eat on their own and will increasingly express their opinions and make decisions about their favorite / less favorite foods. When you start giving your child adult food, it is important to remember that a toddler is not a “little adult”. Every bite counts, every meal should provide your little one with the nutrients they need and promote healthy eating habits!

The continued development of your baby from 24 to 36 months requires a constant supply of nutrients. Iron and Vitamin D are vital for this developmental stage.

Iron is a mineral that helps circulate oxygen throughout the body and promotes the development of your baby’s brain. Iron is found in high amounts in foods such as meat, oily fish, and eggs, but is also available from plant sources, including beans and dark green leafy vegetables. Most toddlers under 3 years of age do not get their recommended iron intake, so every parent should be aware of this vital nutrient! Even if your child is fussy about food, try to persuade him to eat at least one food rich in iron every day.You can prepare iron-rich foods that are easy to eat by offering your baby soft roasts, stews, or very thinly sliced ​​meats. Because vitamin C helps your toddler’s body absorb iron, vegetables served with every meal or fruit as a dessert will increase your baby’s iron intake. However, if your baby still refuses to eat iron-rich foods despite your best efforts, iron-fortified milk may be an easier way to meet your baby’s needs.

Vitamin D, on the other hand, is important for healthy bone development as it helps your toddler’s body absorb calcium and phosphorus, which are vital for your 2-year-old’s growing bones. The body produces vitamin D in response to direct sunlight hitting the skin, but unfortunately, not all countries are equally sunny. Food sources rich in vitamin D include meat and fatty fish. Including them in your child’s diet on a regular basis can actually help increase their vitamin intake!

Because many toddlers are not getting the recommended daily amounts of certain nutrients, it is recommended that you use daily supplements to increase your intake of vitamins A, C, and D. Aptamil Milk Drinks 3 & 4 are another good way to complement your baby’s diet – some types are fortified with vitamin D as well as other important nutrients!

Look for recipes that include the following nutrient-rich foods to support your baby’s development during this phase:

Iron-rich:

• Homemade beef burgers.

• Spinach and broccoli frittata.

• Scrambled eggs and sausage.

• Baked beans on finger-shaped toast.

With vitamin D content:

• Tuna in mayonnaise with jacket potatoes.

• Pieces of hard boiled egg.

• Sardines in tomato sauce, mashed and mixed with spaghetti.

Stages of Amazing Development

The information below shows what you can expect at every stage of your baby’s development.Remember that all babies are different! They grow and learn at different rates, so don’t expect your little one to follow the schedule exactly – this is just a rough guide.

At 2 years old, your baby can:

• Run.

• Build a tower with 6 cubes.

• Speak in simple sentences.

• Understand the difference between a woman and a man.

• Talk about yourself, name certain body parts and hum melodies.

• Becomes ready for potty training.

• Understand the concepts of “earlier” and “later”.

• Enjoy playing with other little ones.

• To ask a lot: “Why?”.

At 2.5 years old Your baby can:

• Walk very well with balance.

• Brush your teeth (with your help for now!), Wash and dry your hands.

• Dress and put on shoes (for example, put on jumpers and boots).

• Color and draw pictures, and even be able to draw straight lines and circles.