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By Gabe Howard

Teenagers have a tendency to be dramatic. Many of us don’t like to admit it, but we were dramatic at that age, too, at least to some extent. Now that we’re parents (or other relatives, mentors, caregivers, or friends) to a teenager, the universe is giving us a taste of it from the other side. Most teenage angst is typical. I remember the first time my mom insulted my favorite band. What she said was, “I don’t like this band.”

What I heard was, “You’re stupid for listening to them and you have awful taste in music.”

When teenagers get angry, watch out. We’ve all said things we regret when angry and the minds of teenagers aren’t fully formed. Many life lessons that we adults take for granted have not yet been experienced by the average teen. When angry, they lash out and will say whatever it is they feel will hurt you.

Threatening to “commit suicide” is a fairly typical escalation point for an upset teenager looking to lash out.

Don’t Ignore Any Suicide Threat, Even If You’re “Sure” They’re Lying

Our society is deficient in mental health education and suicide prevention. The fact is that many adults don’t know what to do when anyone threatens to commit suicide, let alone a kid. Our natural tendency is to ignore things that make us feel uncomfortable or that we don’t understand. However, ignoring teenagers when they threaten suicide is a bad idea – even if you are sure they are just being dramatic. There are only two reasons for individuals to say they are contemplating suicide:

They are considering ending their life and in need of medical care.
They are trying to manipulate you and, in doing so, (unintentionally) making it harder for people who aren’t lying to be taken seriously.
Either reason needs to be taken seriously. Addressing the first reason is obvious; addressing the second ensures that your teen doesn’t minimize the experiences of people who truly need help. Crying wolf doesn’t just hurt them; it causes a ripple effect that prevents people who need care from getting it.

That’s not okay.

What Do You Do When Someone Says He or She Is Considering Suicide?

If someone says that he or she is considering suicide, you immediately get the person medical help. Call 9-1-1, take them to the emergency room, take them to the doctor’s office or local health department. Do not ignore the comment and do not try to handle it on your own. Mental illness, mental health crises, and thoughts of suicide are medical issues that need medical intervention.

Suicide PreventionEven if you are sure the teen is “just being dramatic,” seek medical help anyway. Suicidal threats are not something to take lightly. Many people don’t want to “waste their time” or “waste a doctor’s time” with something that they believe is just a adolescent being manipulative.

And they would be wrong to think that. Suicide is permanent. Would you want to take that risk if there is even a 1% chance that you’re wrong? Also, a teen learning the lesson that threatening suicide isn’t a weapon to be wielded in a disagreement or a tool for manipulation is a very valuable lesson.

So, your teen gets life-saving medical care or a life-changing experience that will make him or her a better person. There is no downside.

For all the manipulation, teenage angst, and dramatic rantings out there, I still take all threats seriously. I’m 99% positive my six-year-old nephew can’t get, and doesn’t have, a gun. But, if he walked up to me and said he had a loaded gun under his bed, I’d still go look.

Wouldn’t you?

Gabe Howard is a professional speaker, writer, and advocate who lives with bipolar and anxiety disorders. He has made it his mission to change the way society reacts to mental illness. He is an award-winning blogger and the creator of the official bipolar shirt. (Get yours now!) Interested in working with Gabe or learning more? He can be reached on Facebook, via email, or on his website, Don’t be shy — he’s not.

By Janice Wood

A new study shows that the age at which an adolescent starts using marijuana affects which parts of the brain will be affected.

Researchers at the Center for BrainHealth at the University of Texas at Dallas found that study participants who began using marijuana when they were 16 or younger had brain variations that indicate arrested brain development in the prefrontal cortex, the part of the brain responsible for judgment, reasoning, and complex thinking.

Those who started using after age 16 showed the opposite effect, demonstrating signs of accelerated brain aging, according to the study, which was published in Developmental Cognitive Neuroscience.

“Science has shown us that changes in the brain occurring during adolescence are complex. Our findings suggest that the timing of cannabis use can result in very disparate patterns of effects,” said Francesca Filbey, Ph.D., principal investigator. “Not only did age of use impact the brain changes, but the amount of cannabis used also influenced the extent of altered brain maturation.”

For the study, the researchers analyzed MRI scans of 42 heavy marijuana users; 20 participants were categorized as early onset users with a mean age of 13.18, while 22 were labeled as late onset users with a mean age of 16.9.

According to self-reports, all the participants, who ranged in age from 21 to 50, began using marijuana during adolescence and continued throughout adulthood, using at least once a week.

According to Filbey, in typical adolescent brain development, the brain prunes neurons, which results in reduced cortical thickness and greater gray and white matter contrast. Typical pruning also leads to increased gyrification, which is the addition of wrinkles or folds on the brain’s surface.

However, in this study, MRI results reveal that the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users.

This indicates that when participants began using marijuana before age 16, the extent of brain alteration was directly proportionate to the number of weekly marijuana use in years and grams consumed.

In contrast, those who began using marijuana after age 16 showed brain changes that would normally manifest later in life: Thinner cortical thickness, and stronger gray and white matter contrast.

“In the early onset group, we found that how many times an individual uses and the amount of marijuana used strongly relates to the degree to which brain development does not follow the normal pruning pattern,” she said.

“The effects observed were above and beyond effects related to alcohol use and age. These findings are in line with the current literature that suggest that cannabis use during adolescence can have long-term consequences.”

Source: Center for BrainHealth at The University of Texas at Dallas

By Janice Wood
A new study has found that 14- and 15-year-olds are at a higher risk than other young people of becoming dependent on prescription opioids within a 12-month period after using them beyond the prescribed amount.

“Many kids start using these drugs other than what’s prescribed because they’re curious to see what it feels like,” said Maria A. Parker, a doctoral student in the Department of Epidemiology and Biostatistics at Michigan State University who led the study.

“The point of our study was to estimate the risk of dependency after someone in this age group starts using them beyond the boundaries of a doctor’s orders.”

The study, based on a nationally representative sample of 12- to 21-year-olds taken each year between 2002 and 2013, focuses on what happens when young people start to use these drugs for other reasons.

Out of about 42,000 respondents, the researchers found that 14- and 15-year-olds were two to three times more likely to become opioid-dependent within a year compared to 20- and 21-year-old users.

The research also reconfirmed earlier studies that found that peak risk for starting to use prescription painkillers above the prescribed intent is seen at 16 and 17 years old, according to the researchers.

The study’s findings come at a time when states, including Michigan, are increasing efforts to combat the growing prescription drug problem.

Earlier this year, Michigan Gov. Rick Snyder created a 21-member task force to tackle the issue and offer recommendations to curb prescription drug abuse.

Statistics show that the use of some prescribed pain relieving pills, such as Vicodin, have quadrupled in the last eight years in Michigan. This increase has contributed to the use of other drugs, such as heroin, according to some researchers.

“It’s important to identify when young people are starting to use these drugs because it allows us to provide prevention or intervention outreach strategies around these ages and much earlier on so things don’t escalate into something worse,” Parker said.

Knowing where the drugs are coming from and educating parents on the prescribed dosages appropriate for their children, as well as the proper places to store drugs, are all ways to help ensure they are using them safely, she added.

Other types of prevention efforts often include peer-resistance programs such as keepin’ it REAL and Botvin LifeSkills Training.

“No age group is free from risk though,” Parker concluded.

The study was published in the journal PeerJ.

Source: Michigan State University

Dec 14

By Traci Pedersen

A new study shows that narcissism in teens may be an underlying factor in those who physically assault their parents.

According to the findings, teens who have been exposed to violence in the home, experienced a lack of affectionate and positive communication and/or had an extremely permissive upbringing are more likely to develop narcissistic traits and become aggressive toward their parents.

Until now, there have been few studies and explanations for why children would assault their parents. This is the first study to analyze the factors that can lead to this type of violence.

“In some cases we can observe that element of narcissism: it concerns adolescents who feel that they should have everything that they want, right here and now. They don’t take no for an answer. When their parents try to establish limits, the children react aggressively,” said Dr. Esther Calvete, lead author of the study and a researcher at the University of Deusto in Spain.

For the study, researchers interviewed 591 adolescents from nine public and eleven private secondary schools in Spain over the course of three years, allowing for analysis of the relationship between narcissism and child-to-parent aggression.

The findings show that exposure to violence during the first year of the study was linked to aggression toward parents during the third year. Similarly, a distant parent-child relationship in the first year of the study was connected to narcissism and an oversized self-image in the teens during the second year, and then aggression toward parents during the last year.

“On occasions adolescents assault their parents because the parents themselves have been violent towards the children or among themselves,” said Calvete.

“Through exposure to family violence, children learn to be violent. Other times, it is the lack of affectionate and positive communication between parents and their children, the lack of quality time that is dedicated to the children, or permissive parenting styles that do not impose limits.”

The researchers say that practices of education and upbringing are key.

“If the parents do not raise their children with a sense of responsibility and respect, it is easy for the children to develop problems of aggressive behavior. If the parents were violent when the children were small, it increases the risk of aggressive behavior in children,” said Calvete.

But the behavior displayed by the parents is not the only driving force. “The temperament of the children is another important component, and some boys and girls are more impulsive and learn violent behavior more easily,” she said.

Overall, these teens have the tendency to feel frustrated and rejected. When this occurs, they usually begin with yelling and insults, and move on to physical aggression.

“For that reason, when a father or mother perceives that that their son or daughter continually disrespects them, threatens them and scares them, it’s a sign that they must act and ask for help,” said Calvete.

“Teenagers can also steal or break their parents’ belongings,” Calvete said, pointing out that there are no differences between boys and girls. “Although the statistics show that the problem is becoming more prevalent in girls.”

Once aggressive behavior has emerged in adolescents, treatment should be directed toward reducing the narcissistic views they have developed, according to the researchers.

The findings are published in Developmental Psychology.

By Traci Pedersen

After Violent Video Games, Study Finds Teens Eat and Cheat MoreIn a new study, teens who played violent video games ate more chocolate and were more likely to steal raffle tickets during a lab experiment than were teens who played nonviolent games.

These findings were strongest among teens who scored the highest on tests of moral disengagement — the ability to convince oneself that ethical standards don’t apply to in particular situations.

“When people play violent video games, they show less self-restraint. They eat more, they cheat more,” said Dr. Brad Bushman, co-author of the study and professor of communication and psychology at Ohio State University. “It isn’t just about aggression, although that also increases when people play games like Grand Theft Auto.”

The study included 172 Italian high school students, ages 13 to 19. They played either a violent video game (Grand Theft Auto III or Grand Theft Auto: San Andreas) or a nonviolent game (Pinball 3D or MiniGolf 3D) for 35 minutes.

During the study, a bowl of chocolate M&M’s was placed next to the teens, who were told they could freely eat the candy, but were warned that eating a lot of candy in a short time was unhealthy. Interestingly, teens who played the violent games ate more than three times as much candy as did the other teens.

“They simply showed less restraint in their eating,” Bushman said.

After playing the game, the teens worked on a 10-item logic test in which they could win one raffle ticket for each question they answered correctly. The raffle tickets could then be redeemed for prizes.

After being told how many answers they got correct, the teens were asked to take the appropriate number of raffle tickets out of an envelope — without supervision. Unbeknownst to the players, the researchers were aware of how many tickets were in the envelope so they could later determine if a player took more than he or she had earned.

Results showed that teens who played violent games cheated more than eight times more than did those who played nonviolent games.

The players were also told that they were competing with an unseen “partner” in a game in which the winner got to blast the loser with a loud noise through their headphones. (There was actually no partner.) Teens who played the violent games chose to blast partners with louder noises that lasted longer than did teens who played the nonviolent games.

“We have consistently found in a number of studies that those who play violent games act more aggressively, and this is just more evidence,” Bushman said.

The participants also completed the Moral Disengagement Scale, a measure of how well individuals hold themselves to high moral standards in all situations. One sample question was “Compared to the illegal things people do, taking some things from a store without paying for them is not very serious.”

Among teens who played the violent video games, those who scored higher in moral disengagement were more likely to cheat, eat more chocolate, and act more aggressively. There were no such differences among those who played nonviolent games.

“Very few teens were unaffected by violent video games, but this study helps us address the question of who is most likely to be affected,” Bushman said. “Those who are most morally disengaged are likely to be the ones who show less self-restraint after playing.

“One of the major risk factors for antisocial behavior is simply being male,” he said. “But even girls were more likely to eat extra chocolate and to cheat and to act aggressively when they played Grand Theft Auto versus the mini golf or pinball game. They didn’t reach the level of the boys in the study, but their behavior did change.”

The study is published online in the journal Social Psychological and Personality Science.

Source: Ohio State University

By Janice Wood

The pressure to be constantly available and respond 24/7 on social media can cause depression, anxiety, and reduce sleep quality for teenagers, according to a new study.

For the study, presented at a British Psychological Society conference, researchers Dr. Heather Cleland Woods and Holly Scott of the University of Glasgow provided questionnaires to 467 teenagers regarding their social media use overall, as well as at night time.

A further set of tests measured sleep quality, self-esteem, anxiety, and depression.

The researchers also measured the teens’ emotional investment in social media, which relates to the pressure felt to be available 24/7 and the anxiety around, for example, not responding immediately to texts or posts, they explained.

“Adolescence can be a period of increased vulnerability for the onset of depression and anxiety, and poor sleep quality may contribute to this,” Cleland Woods said. “It is important that we understand how social media use relates to these. Evidence is increasingly supporting a link between social media use and wellbeing, particularly during adolescence, but the causes of this are unclear.”

An analysis of the collected data showed that overall and night-time specific social media use, along with emotional investment, were related to poorer sleep quality and lower self-esteem, coupled with higher anxiety and depression levels.

“While overall social media use impacts on sleep quality, those who log on at night appear to be particularly affected,” Cleland Woods said.

“This may be mostly true of individuals who are highly emotionally invested. This means we have to think about how our kids use social media, in relation to time for switching off.”

Source: The British Psychological Society

Nov 27

by Terese Weinstein Katz

These girls, aged 12 to 15, never crossed the line into full eating disorders. In fact, they became healthy young women with normal-enough eating. Siena switched from a vegetarian diet to a gluten-free one, to one that involved lots of raw vegetables. Bella rarely ate much in front of her friends, though her weight tended to run a little higher than one might expect. Meagan dieted on and off, though never with much persistence. Caroline obsessed about being “fat” so often that her friends began to eye-roll. Kendra went through a phase of only eating “healthy” foods, fearing sweets and junk.

These stories, and a host of similar ones, have become normative in the world of girls approaching and just past puberty. Some, of course, do segue into bulimia or anorexia or binge eating disorder. But this edging toward the “thin line”, just this side of an eating disorder, has become close to inevitable in the life of teen girls. And no wonder: combine the normal anxieties, physical and social changes of this time, with our cultures confusing and unsupportive eating environment. This includes computer-altered images of ultra-thin models, an overabundance of foods with addictive qualities, media saturated with talk of diets meant to transform every body.

All parents these days face the challenge of fostering healthy food attitudes and habits. As I, and others, have written elsewhere, this usually involves a tricky balance of relaxation and firmness. Parents who regulate and restrict food choices usually don’t foster a relaxed and confident approach to food. On the other hand, guidance and role-modeling is surely called for in the midst of all this.

When it comes to this slippery-slope time for adolescent girls, however, parents can face new challenges—even when childhood eating issues have been minimal or non-existent before. So now, do you encourage or freak out if your normal weight teen wants to diet? Do you call a therapist when your daughter says she feels fat, or simply talk her through? Many good books and resources exist to help guide parents with eating disordered children. There are fewer for this very numerous group who may worry and fret and experiment, but essentially prove healthy and pretty much able to navigate through (see Resources, below).

As parents, we don’t necessarily have as much control as we’d like, but as with issues of substance use, we can communicate expectations, educate, and support. And often this does make a difference. Toward this end, I offer 5 guidelines to help the navigation:

1. Work on Your Own Eating Issues. You don’t have to be perfect weight, or without any diet worries at all, to set good examples. On the other hand, constant dieting, talk of being fat, etc., does not help. Eating as healthfully as you can, in as relaxed a manner as you can, is the goal. And where you do still struggle, you can talk honestly with your teen about where you are with it and what you’re trying to improve.

2. Be Firm About Nutritional Basics. While experimentation with different ways of eating may appeal to your adolescent, it is always important to get adequate protein and calories, no matter what. Growth continues to occur, remember, well into young adulthood. Sometimes a visit to a nutritionist or pediatrician—a non-parent professional, in other words—can help. Teens often don’t register that they have very different nutritional needs from the grown-ups that diet books target.

3. Emphasize Strengths Other Than Looks. Ultimately what really matters is who your teen is in all the ways that don’t involve looks and weight. Take interest in, encourage and compliment these other traits and achievements. If you see a few pounds creeping on, you don’t need to discuss it immediately unless asked for input.

4. Be a Family Where Talk is OK. An environment where it is taboo to discuss emotional issues can breed problems. This doesn’t mean everything has to be talked about, just that it would be safe and not bizarre to do so. This may be one of the factors—“we sit and we talk”–that makes family dinner a protective habit for teens.

5. Convey Trust. As alarming as it can be to see your child exhibit less-than-ideal eating attitudes, try to discuss it calmly. It matters that you convey confidence that your teen can understand and do better, that you trust she’s capable of that. (Of course, if this proves not to be true–you can proceed to the next step, seeking professional help.)

In the end, it’s hard for any of us, at any age, to grapple with the confusing food messages and choices in our culture. What’s important is to aim to do your best and not worry about perfection. And when it comes to kids and teens, remember that many who grow up with imperfect diets do become adults who care and make good choices after all.

*The Renfrew Center has excellent educational materials and a book list for parents.
* “Kids” archive has more discussion and ideas on raising kids to eat healthily and without fear

By TRACI PEDERSEN Associate News Editor

According to new research, they need a vivid and detailed picture depicting their future success. Simply knowing that they have the right grades or skills doesn’t seem to motivate.

“Students who have chronic self-doubt may need an extra boost to pursue the dreams they are certainly able to achieve,” said study author Dr. Patrick Carroll, assistant professor of psychology at Ohio State University’s Lima campus.

“This study finds that what they really need is a vivid picture of what will happen if they succeed.”

The study, published in the journal Basic and Applied Social Psychology, involved 67 undergraduate business and psychology students at Ohio State.

The college participants signed up to learn about a faux new master’s degree program in business psychology that would train them for “high-paying consulting positions as business psychologists.”

The goal was to get students interested in the (fake) program in order to observe their reactions to varying levels of validation to their new career dreams. (The researchers followed a protocol to help students who may have been disappointed that there wasn’t a real program.)

The students read a brochure about the business psychologist program and then filled out several questionnaires.

They were asked to rate their self-confidence that they could become a business psychologist, whether they were excited about the possibility of this career, whether they thought they could be admitted to the business psychology program, and whether they intended to apply. They were also asked their overall GPA.

The participants were then divided into four groups. Students in the control group were given an information sheet indicating no GPA requirement for the program. The other three groups were given sheets indicating the GPA requirement was .10 below whatever they had listed as their own GPA.

In one of these groups, a “career adviser” simply pointed out that the students’ GPA was higher than the requirement. In another group, the students were given slightly stronger validation: The adviser told the participants that they were exactly what the program was looking for and that it was unlikely they would be rejected if they applied.

The last group received the most validation: Not only were they told that they were qualified and unlikely to be rejected, but the adviser added that it was likely that they would be accepted with full funding and excel in the program and would graduate with several job offers in business psychology.

In the end, the students once again filled out forms asking how confident and excited they were about becoming business psychologists and whether they expected they would be admitted. In addition, the students were given the opportunity to actually apply to the program.

The results were striking. The students in the control group and those who were simply told their GPA exceeded the program requirements showed no self-confidence related to becoming a business psychologist and were unlikely to apply to the program or even ask for more information.

“Even when students learn that they exceed some external admissions requirement to become a business psychologist, they still have to decide whether that means they should pursue that career dream instead of any others,” Carroll said.

“They may need more validation than that to pursue this career goal.”

However, when the adviser clearly detailed the vivid prospect of success, the students were excited about pursuing the new career.

In fact, students who were given the most vivid validation had higher levels of self-confidence immediately after meeting with the adviser. They were also more likely to actually apply to the new program.

“Self-confidence played a key role here. Students felt more confident that they could really be successful as a business psychologist when they received a detailed picture from their adviser,” Carroll said.

“Sometimes students have the grades, the motivation, and the ability but simply lack the necessary self-confidence to wholeheartedly invest in the pursuit of a realistic new goal,” he said.

“This work shows how parents, teachers, and counselors can steer students into the right direction to achieve their dreams.”

Source: Ohio State University, Lima

Oct 18

By RICK NAUERT PHD Senior News Editor

A new study suggests music therapy may be used to reduce depression in children and adolescents with behavioral and emotional problems.

Researchers at Queen’s University Belfast found children who received music therapy had significantly improved self-esteem and significantly reduced depression compared with those who received treatment without music therapy.

Investigators also found that those who received music therapy had improved communicative and interactive skills, compared to those who received usual care options alone.

In what researchers say is the largest study of its kind, 251 children and young people were divided into two groups; 128 underwent the usual care options, while 123 were assigned to music therapy in addition to usual care.

All were being treated for emotional, developmental, or behavioral problems. Early findings suggest that the benefits are sustained in the long term.

Sam Porter, Ph.D., of the School of Nursing and Midwifery at Queen’s University, who led the study, said, “This study is hugely significant in terms of determining effective treatments for children and young people with behavioral problems and mental health needs.”

Valerie Holmes, Ph.D., of the University’s Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, and co-researcher of the study, said, ”This is the largest study ever to be carried out looking at music therapy’s ability to help this very vulnerable group.”

Ciara Reilly, chief executive of the Northern Ireland Music Therapy Trust, noted, ”Music therapy has often been used with children and young people with particular mental health needs, but this is the first time its effectiveness has been shown by a definitive randomized controlled trial in a clinical setting.

“The findings are dramatic and underscore the need for music therapy to be made available as a mainstream treatment option. For a long time we have relied on anecdotal evidence and small-scale research findings about how well music therapy works. Now we have robust clinical evidence to show its beneficial effects.”

By JANICE WOOD Associate News Editor

Mindfulness-based Meditation Eases Cancer Symptoms in TeensMindfulness-based meditation has been found to lessen some symptoms associated with cancer in teens.

That may be because mindfulness-based meditation focuses on the present moment and the connection between the mind and body, according to researchers at the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital.

Teens diagnosed with cancer face not only the physical symptoms of their condition, but also the anxiety and uncertainty related to the progression of the disease, according to the researchers.

They also must live with the anticipation of physical and emotional pain related to illness and treatment, the significant changes implied in living with cancer, as well as the fear of recurrence after remission, researchers noted.

For the clinical trial, the researchers asked 13 teens with cancer to complete questionnaires covering mood — positive and negative emotions, anxiety and depression — sleep and quality of life.

The group was then divided in two: The first group of eight teens was offered eight mindfulness-based meditation sessions, while the remaining five were put on a wait-list, creating a control group.

The eight meditation sessions were 90 minutes long and took place weekly. After the last session, patients from both groups filled out the same questionnaires a second time.

“We analyzed differences in mood, sleep, and quality of life scores for each participant and then between each group to evaluate if mindfulness sessions had a greater impact than the simple passage of time,” said Dr. Catherine Malboeuf-Hurtubise of the university’s Department of Psychology.

“We found that teenagers that participated in the mindfulness group had lower scores in depression after our eight sessions. Girls from the mindfulness group reported sleeping better. We also noticed that they developed mindfulness skills to a greater extent than boys during the sessions.”

The results suggest that mindfulness sessions could be helpful in improving mood and sleep in teenagers with cancer, as previous oncology research suggests with adults, she added.

According to the researchers, differences between the two groups were not large enough to assign observed benefits solely to the mindfulness component of the sessions.

“The social support provided to the adolescents in the mindfulness group could possibly explain observed benefits on mood and sleep,” Malboeuf-Hurtubise said.

“Nonetheless, mindfulness-based interventions for teenagers with cancer appear as a promising option to lighten psychological inconveniences of living with cancer.”

The researchers intend to offer members of the control group an opportunity to take the meditation sessions, she added.

Source: University of Montreal

Feb 18

By RICK NAUERT PHD Senior News Editor

Treatment for Youth Anxiety Is Effective, LastingA new study confirms that current treatment strategies for youth with moderate to severe anxiety disorders are effective and provide long-term benefits.

As published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers found that the majority of youth anxiety disorders responded well to acute treatment with cognitive behavioral therapy (CBT), medication (sertraline), or a combination of both.

Investigators found that youth participants maintained positive treatment response over a six month follow-up period with the help of monthly booster sessions.

As part of the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS), researchers followed 412 children and adolescents ages 7-17 after they completed 12 weeks of acute treatment.

Treatment responders were offered six additional monthly booster sessions, with those initially on medication continuing this treatment; all youth, regardless of status at week 12, were re-evaluated three and six months later by trained clinicians.

Twenty-seven percent of study participants also reported receiving outside (e.g. nonstudy) psychotherapy and/or medication for mental health symptoms over the six month follow-up period.

The study found that over 80 percent of youth rated as positive responders to one of the three CAMS treatments at Week 12 were also rated as responders at both the three and six month follow-up evaluations.

Conversely, only five percent of youth who received combined CBT plus sertraline, and 15-16 percent of youth receiving either CBT-only or sertraline-only, failed to achieve responder status at any time during the study.

Youth in the combined CBT+sertraline group showed greater treatment benefits on some, but not all outcome measures, and used less nonstudy treatments than those in the CBT-only and sertraline-only groups.

Collectively, anxiety disorders are the most common mental disorders in children and adolescents. Often overlooked, severe anxiety can significantly impair children’s school, social, and family functioning, and if untreated, can increase the risk of depression, alcohol and substance abuse, and occupational difficulties in adulthood.

CAMS is the largest randomized controlled comparative treatment trial for child/adolescent anxiety disorders ever conducted.

Participants were recruited at six regionally dispersed sites throughout the United States (University of California Los Angeles, Duke University, Columbia University/New York University, Johns Hopkins University, Temple University, and the Western Psychiatric Institute and Clinics/University of Pittsburgh).

They were randomly assigned to 12 weeks of treatment with cognitive behavioral therapy (Coping cat), the selective serotonin reuptake-inhibiting [SSRI] medication sertraline, cognitive behavioral therapy combined with sertraline, or pill placebo.

All participants had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia, with most having multiple anxiety, or other mental health disorders.

“The results of this study provide further evidence of the benefits of cognitive behavioral therapy and SSRI medication, alone or in combination, for treating clinically significant anxiety in children and adolescents,” said Dr. John Piacentini of the University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior.

“A separate project by the CAMS researchers is now gathering information on how study participants are doing up to 10 years after study participation.”

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on November 26, 2013

A new review on the positive effects of playing video games finds that the interaction may boost children’s learning, health and social skills.

The American Psychological Association (APA) study comes out as debate continues among psychologists and other health professionals regarding the effects of violent media on youth.

An APA task force is conducting a comprehensive review of research on violence in video games and interactive media and will release its findings in 2014.

“Important research has already been conducted for decades on the negative effects of gaming, including addiction, depression and aggression, and we are certainly not suggesting that this should be ignored,” said lead author Isabela Granic, Ph.D.

“However, to understand the impact of video games on children’s and adolescents’ development, a more balanced perspective is needed.”

The article will be published in the journal American Psychologist.

A common viewpoint is that playing video games is intellectually lazy. New research however, suggests such play actually may strengthen a range of cognitive skills such as spatial navigation, reasoning, memory and perception.

This is particularly true for shooter video games that are often violent, the authors said.

A 2013 review of published studies found that playing shooter video games improved a player’s capacity to think about objects in three dimensions, just as well as academic courses to enhance these same skills, according to the study.

“This has critical implications for education and career development, as previous research has established the power of spatial skills for achievement in science, technology, engineering and mathematics,” Granic said.

This enhanced thinking was not found with playing other types of video games, such as puzzles or role-playing games.

Playing video games may also help children develop problem-solving skills, the authors said.

The more adolescents reported playing strategic video games, such as role-playing games, the more they improved in problem solving and school grades the following year, according to a long-term study published in 2013.

Children’s creativity was also enhanced by playing any kind of video game, including violent games, but not when the children used other forms of technology, such as a computer or cell phone, other research revealed.

Simple games that are easy to access and can be played quickly, such as “Angry Birds,” can improve players’ moods, promote relaxation and ward off anxiety, the study said.

“If playing video games simply makes people happier, this seems to be a fundamental emotional benefit to consider,” said Granic.

The authors also highlighted the possibility that video games are effective tools to learn resilience in the face of failure.

By learning to cope with ongoing failures in games, the authors suggest that children build emotional resilience they can rely upon in their everyday lives.

Another stereotype the research challenges is the socially isolated gamer.

More than 70 percent of gamers play with a friend and millions of people worldwide participate in massive virtual worlds through video games such as “Farmville” and “World of Warcraft,” the article noted.

Multiplayer games become virtual social communities, where decisions need to be made quickly about whom to trust or reject and how to lead a group, the authors said.

People who play video games, even if they are violent, that encourage cooperation are more likely to be helpful to others while gaming than those who play the same games competitively, a 2011 study found.

The article emphasized that educators are currently redesigning classroom experiences, integrating video games that can shift the way the next generation of teachers and students approach learning.

Likewise, physicians have begun to use video games to motivate patients to improve their health, the authors said.

In the video game “Re-Mission,” for instance, child cancer patients can control a tiny robot that shoots cancer cells, overcomes bacterial infections and manages nausea and other barriers to adhering to treatments.

A 2008 international study in 34 medical centers found significantly greater adherence to treatment and cancer-related knowledge among children who played “Re-Mission” compared to children who played a different computer game.

“It is this same kind of transformation, based on the foundational principle of play, that we suggest has the potential to transform the field of mental health,” Granic said.

“This is especially true because engaging children and youth is one of the most challenging tasks clinicians face.”

The authors recommended that teams of psychologists, clinicians and game designers work together to develop approaches to mental health care that integrate video game playing with traditional therapy.

Source: American Psychological Association

Nov 12

Do you know where your children go online?


Sexting, bullying and getting round security settings… young people tell Olivia Gordon what really happens on the internet

Cal Davies, 16: ‘Most of my friends who have had have received a question saying, “Why are you so ugly?” or, “When are you going to kill yourself?”‘ Photograph: Laura Pannack for the Guardian
Thirty years ago, children were taught never to accept sweets from strangers, but the equivalent modern message, about staying safe online, doesn’t seem to be getting through. For all its positives, the online world is full of potential hazards to young people. Sexting, bullying and sexual approaches from strangers are online dangers modern teenagers routinely face. And adults’ knowledge of what young people are doing online is often vague and complacent.

Nearly half of British children now have online access in their bedrooms, while a quarter of 12- to 15-year-olds owns a tablet of their own. The number of this age group using smartphones to send, receive and post photos online has risen significantly in the past year, and Ofcom points out that children’s online safety skills have failed to rise at the same rate, with particular risks coming from the lack of privacy on social networking sites. Most parents of five- to 15-year-olds believe they know enough about the internet to keep their children safe, but, according to research by internet security system McAfee in 2012, four-fifths of teenagers say they know how to hide their online behaviour from parents.

Some parents feel their only recourse is to restrict internet access, but James Diamond, of parenting and technology website, says: “A big reason that children don’t tell parents about abuse is that the default reaction of parents is to take the internet away from them.”

Internet safety needs to be taught, with specific ground rules and open communication between generations. Parents need to know that the dark side of the online world can’t be avoided – if they have teenage children, it is almost certainly already in their lives.

Now let the kids tell you what they really do online:

Oct 1

How Much Porn Is Your Kid Watching?


Studies say that almost half of kids between ages 10 and 17 are consuming porn online—and close to a third of teens are sending their own nude photos. Peggy Drexler on how the porn culture could be affecting the next generation’s attitudes towards sex.

There is a scene in HBO’s Girls, where Hannah’s boyfriend has anal sex with her in what may be the un-sexiest sex scene ever presented on television: he is brutal and uncaring; she is passive and unenthusiastic. Interpret it how you will—an affront to all we hold dear; character development; or simply shock value for audiences that are increasingly hard to shock.

But at the core, it’s another example of the rampant dehumanization of sex, where the physical and the emotional seem to be going their separate ways without so much as a backward glance.

I blame porn. I’m not an anti-porn crusader by any means. In terms of the likelihood of change, you might as well be anti-cell phone. Still, the scene—where he didn’t seem to notice her head banging against the bedpost and she didn’t seem to care—is both an example and a reflection of how thoroughly sex for the sake of sex has saturated America’s culture.

As we adjust to this infinite swamp of pornographic availability, three questions emerge. How much porn are kids watching? How is it impacting how they see the connection between sex and emotion? And what—if anything—do parents do about it? How much they’re watching starts with how much is there to watch.

First, videos and DVDs brought porn into the home. Now comes the Internet, and porn is everywhere. As widely reported, a University of Montreal study concluded 90 percent of all pornography now comes from the Web. Just 10 percent comes from video stores. The technology blog Gizmodo puts the number of pornographic web sites at 24.6 million, roughly 12 percent of total web sites. As for breadth of content, a few quick search terms can take you—often by accident—directly to a site that proclaims itself “the largest bestiality site” on the Web. You might want to be there when your child searches: “My Little Pony.”
How much are kids consuming? Study results vary widely, and none are lock-down credible. The University of Montreal study reports that boys seek out pornography by age 10. A University of New Hampshire survey of Internet users ages 10 to 17 published in Pediatrics found that 42 percent said they had viewed online porn in the past 12 months—and 66 of those said the exposure was unwanted.
A significant number of teens report getting into producing porn themselves. A University of Texas Medical Branch study of students in southeast Texas found that 30 percent of U.S. teenagers are sending nude photos over e-mail or texts.

The University of Montreal study reports that boys seek out pornography by age 10.
Two facts are beyond debate. Porn is omnipresent, and kids are encountering it. Much less clear is what to do about it. Regardless of the most determined parental filtering and blocking, kids at the peak of their sexual curiosity will find their way to it. What happens once they arrive, however, is an open question. Predictions tend to vary with agendas.

For boys (the prime consumer), it may poison attitudes toward women, create confidence-sapping comparisons of dimensions and performance, crowd out actual relationships—even carve out new neural pathways. Or it may do nothing at all. Boomers, after all, managed to survive Playboy, Hustler, X-ratings, strip clubs and all the ensuing and incremental media sexual firsts with their sexuality generally undamaged.
Still, we’ve never experienced push-button porn serving up genres from routine to revolting.
In the absence of credible, long-term research, we simply don’t know where the age of insta-porn is taking us. One thing is certain, however: parents are not behind the wheel. From adolescence on, blocking and filtering are simply denial. When biological urgency meets technological capability, the only weapon is to construct a frame of reference; a way to process things past generations have never seen.
How families approach that is an individual decision. But there is a fundamental and consistent message: porn is not sex. It’s a commercial depiction of sex that has nothing to do with real (non-digital) human relationships.

The sexual revolution is now some five decades along. One thing we know about revolutions—sexual or otherwise—is that they don’t go backwards. Porn is here to stay. (Google Glass wearable computer won’t be out until 2014, and there is already a porn app.) Nothing will diminish its presence or its access. But with an open attitude and a real-world perspective, we can help young people understand it for what it is.

As part of its Parents Who Host Lose the Most Underage Drinking Prevention Campaign, Manhasset CASA is proud to feature the work of the Partnership for a Drug-Free America. In its efforts to educate the Manhasset community to the health, safety and legal consequences of underage drinking, this week’s article “Behavior and The Teen Brain” has been provided by the Partnership to explain how the process of a teen’s brain development impacts their behaviors and decision making abilities:

“From early adolescence through their mid-20s, a teen’s brain develops somewhat unevenly, from back to front. This may help explain their endearingly quirky behavior but also makes them prone to risk-taking.

The parts of the adolescent brain which develop first are those which control physical coordination, emotion and motivation. However, the part of the brain which controls reasoning and impulses – known as the Prefrontal Cortex – is near the front of the brain and, therefore, develops last. This part of the brain does not fully mature until the age of 25.

It’s as if, while the other parts of the teen brain are shouting, the Prefrontal Cortex is not quite ready to play referee. This can have noticeable effects on adolescent behavior. You may have noticed some of these effects in your teen:

– difficulty holding back or controlling emotions,

– a preference for physical activity,

– a preference for high excitement and low effort activities (video games, sex, drugs, rock ‘n’ roll),

– poor planning and judgment (rarely thinking of negative consequences),

– more risky, impulsive behaviors, including experimenting with drugs and alcohol.

The development of the adolescent brain and behavior are closely linked. In a wink, hormones can shift your teen’s emotions into overdrive, leading to unpredictable—and sometimes risky—actions. Unfortunately, developing brains may be more prone to damage. This means that experimentation with drugs and alcohol can have lasting, harmful effects on your teen’s health.

Research shows that alcohol abuse during the teenage years negatively impacts the memory center of the brain (the hippocampus).

The use of drugs and alcohol may also disrupt the development of the adolescent brain in unhealthy ways, making it harder for teens to cope with social situations and the normal pressures of life.

Moreover, the brain’s reward circuits (the dopamine system) get thrown out of whack when under the influence. This causes a teen to feel in a funk when not using drugs or alcohol—and going back for more only makes things worse.

It is important to urge your teen to take healthy risks. Not only will participation in constructive activities—such as athletics or the arts—help him or her form positive lifestyle habits, it will help your teen’s forebrain develop as well. For more information regarding the teen brain, go to “A Parent’s Guide to the Teen Brain” at”

Manhasset CASA’s Parents Who Host Lose the Most: Don’t be a party to teenage drinking. It’s against the law campaign, was originally developed by the Drug-Free Action Alliance. CASA has partnered with many members of the community to educate parents and residents to the health, safety and legal consequences of underage drinking. For more information about the campaign or Manhasset CASA, call (516) 267-7548 or go to

By Traci Pedersen Associate News Editor
New research shows that teens and young adults are frequently using social networking sites and mobile technology to express suicidal thoughts and intentions as well as to reach out for help.

The findings suggest that suicide prevention and intervention efforts aimed at young adults should use social networking and other types of technology, said researchers.

For the study, researchers conducted an analysis of public profiles on MySpace. They downloaded profile pages of a 41,000-member sample of 13- to 24-year-olds from March 3-4, 2008, and again in December 2008, this time with comments included.

Of 2 million downloaded comments, the researchers narrowed it down to 1,083 that contained suggestions of suicidality, and eventually arrived at 64 posts that were clear discussions of suicide.

“Obviously this is a place where adolescents are expressing their feelings,” said Cash. “It leads me to believe that we need to think about using social media as an intervention and as a way to connect with people.”

Cash’s interest in this subject began in part by media reports about teens using social media to express suicidal thoughts and behaviors.

“We wanted to know: Is that accurate, or are these isolated incidents? We found that in a short period of time, there were dozens of examples of teens with suicidal thoughts using MySpace to talk to their friends,” she said.

“There’s a lot of drama and angst in teenagers so in a lot of cases, they might say something ‘will kill them’ but not really mean it. Teasing out that hyperbole was an intense process,” Cash said. Song lyrics also made up a surprising number of references to suicide, she added.

The three most common suicidal phrases were “kill myself” (51.6 percent), “want to die” (15.6 percent) and “suicide” (14.1 percent).

Researchers also determined that 42 percent of the comments referred to problems with family or other relationships — including 15.6 percent that were about break-ups — and 6.3 percent that pointed to mental health problems or substance abuse.

Very few of the posts identified how the teens would carry out a suicide attempt, but 3 percent mentioned guns, 1.6 percent referred to a knife and 1.6 percent combined being hit by a car and a knife.

Final results of Cash’s survey showed that respondents first chose talking to a friend or family member when they were depressed, followed by sending texts, talking on the phone, using instant messaging and posting to a social networking site.

Less common responses included talking to a health-care provider, posting to a blog, calling a suicide prevention hotline and posting to an online suicide support group.

“It appears that our methods of reaching out to adolescents and young adults is not actually meeting them where they are. If, as adults, we’re saying, ‘this is what we think you need’ and they tell us they’re not going to use it, should we keep pumping resources into suicide hotlines?” Cash said.

“We need to find new ways to connect with them and help them with whatever they’re struggling with, or, in other words, meet them where they are in ways that make sense to them.”

The researchers are going to conduct a study similar to the MySpace analysis by looking at young adults’ Twitter messages for suicidal content. They would like to analyze Facebook, but too few of the profiles are public, said lead author Scottye Cash, Ph.D., associate professor of social work at Ohio State University.

The MySpace research is published in a recent issue of the journal Cyberpsychology, Behavior and Social Networking. They presented the survey findings at a meeting of the American Academy of Child and Adolescent Psychiatry.

Source: Ohio State University

Apr 9

All day long we’re surrounded by faces. We see them on the subway sitting two by two, pass them on the sidewalk as we make our way to work, then nod to them in the elevator.

But most of those faces don’t tell us much about the emotional life of the person behind the face.

“People don’t just go around the world smiling or grimacing or frowning,” says psychologist Marcus Munafo of the University of Bristol. “The majority of the facial expressions that you come into contact with — people walking past you in the street, for example — will be ambiguous to some extent.” And because most of the faces we encounter are emotionally ambiguous, we’re forced into interpretations. Does the expression of that man coming toward you have the smallest tinge of threat around the eyes. Or is that just surprise?

“When you see someone just looking relatively neutral,” Munafo explains, “then it’s really down to you which of those interpretations you choose, and different groups of people see different things.” Research has shown that when depressed people look out at the ambiguous faces around them, they see sadness in those faces more often than people who are not depressed. People with anxiety see fear. But it’s people with aggression that particularly interested Munafo and a group of his colleagues in the U.K.

“People with aggression show a tendency to interpret ambiguity as reflecting hostility,” Munafo says.

Which makes sense. “If you’ve grown up in a tough environment where actually a lot of the time people are out to get you, then that default assumption is probably a relatively safe assumption to make,” Munafo points out. “The problem is when you take that assumption into a more benign environment, into the wider world, if you like, and start responding inappropriately to people who have no hostile intent.”

Then the strategy that you developed to help you survive becomes a kind of prison. You see aggression everywhere and respond aggressively, which causes the people around you to actually be aggressive, even if they didn’t begin that way. It’s a vicious cycle. So is there some way to alter the cycle? To retune the perceptual biases that aggressive people carry into the world?

Munafo and his colleagues designed an experiment to find out. The results were published in a recent issue of the journal Psychological Science. Their experiment took place in a youth program for troubled teens, two-thirds of whom already had some kind of criminal conviction.

There they set up an intervention that attempted to retrain the way those kids interpreted faces. To begin, the kids were placed at computers and asked to identify the emotions in a series of faces that flashed on the screen. Some of the faces were clearly happy, and some were clearly angry; but most were somewhere in the middle. “There were 15 faces along the continuum,” Munafo says, “and people were simply asked to judge whether that face was happy or angry.”

In the first round, the goal was simply to identify the point on the continuum where each teen stopped seeing happiness in an ambiguous face and started seeing anger — in other words, their set point. Next the teens were divided into two groups. One group essentially got no treatment; in the other, the researchers attempted to shift the point on the continuum where they started seeing angry faces.

To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. They did this by showing the kids the same faces in the same way, only after each face, they were given feedback.

Here’s the trick: For two of the faces that they previously described as angry, if they called them angry again, the feedback informed them that they were mistaken: It wasn’t an angry face, it was a happy face.

For a week, day after day, the kids looked at the faces again and again, relearning which faces were angry and which were happy. Then the researchers tracked the number of aggressive incidents the kids were involved in. For weeks, they followed both the kids who got the treatment and the kids who didn’t. The staff at the program evaluated each teen without knowing whether or not they had been retrained. What they found surprised them.

The kids who had been trained to visually see differently interacted with the world in a different way: They came at the world with less aggression. “There was a 30 percent difference between the two groups,” Munafo says.

In fact, researchers have been trying this approach — of modifying visual biases — in people with anxiety and depression, and have gotten similar results. Ian Penton-Voak, another psychologist, says the value of the work is clear. “It demonstrates that the way you see the emotional world around you affects your behavior in a kind of causal way,” he says. That’s an insight the researchers hope might ultimately lead to new interventions.

Apr 1

How Anxiety Leads to Disruptive Behavior


Caroline Miller

Editorial Director
Child Mind Institute
Kids who seem oppositional are often severely anxious
A 10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room and down the hall. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the Emergency Room.

To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria.

But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Dr. Jerry Bubrick, director of the Anxiety & Mood Disorders Center at the Child Mind Institute. “He can’t tolerate any—even constructive—criticism. He just will shut down altogether. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.”

James’s story illustrates something that parents and teachers may not realize—that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety—anxiety he may, depending on his age, not be able to articulate effectively, or not even fully recognize that he’s feeling.

“Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Dr. Rachel Busman, a clinical psychologist at the Child Mind Institute, “but you can also see tantrums and complete meltdowns.”

A great masquerader

Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

“Anxiety is one of those diagnoses that is a great masquerader,” explains Dr. Laura Prager, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.”

The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in his own room or separating from his parents, avoidance of certain activities, a behaviorally inhibited temperament. “Anyone would recognize those symptoms,” notes Dr. Prager, who is also an assistant professor at the Harvard Medical School, and co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.

“When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what that means,” she explains, “but it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.”

To demonstrate the surprising range of ways young children express anxiety, Dr. Prager mentions a case she had just seen of a young child who presented with hallucinations, but whose diagnosis she predicted will end up being somewhere on the anxiety spectrum. “Little kids who say they’re hearing things or seeing things, for example, may or may not be doing that. These may not be the frank hallucinations we see in older patients who are schizophrenic, for example. They might be a manifestation of anxiety and this is the way the child expresses it.”

Problems at school

It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere.

Dr. Nancy Rappaport, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.”

Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.”

When a teacher is able to build a relationship with a child, to find out what’s really going on with him, what’s provoking the behavior, she can often give him tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.

“When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make her miserable, it changes her approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.” If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.

Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or oppositionality.

“I’ll see a child who’s having difficulty in school: not paying attention, getting up out of his seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “His behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why she has to answer so many questions, and why he’s so wrapped up in what other kids are doing, whether they’re following the rules.”

People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance.

How to identify anxiety

“It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.”

First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.”

And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.

Dr. Busman also notes that a child with severe anxiety who’s struggling in school might also have attentional or learning issues, but she might need to be treated for the anxiety before she can really be evaluated for those. She uses the example of a teenager with OCD who she’s “doing terribly” in school. “She’s ritualizing three to four hours a day, and having constant intrusive thoughts—so we need to treat that, to get the anxiety under control before we ask, how is she learning?”

Mar. 15, 2013 — Secondary school students who follow an in-class mindfulness programme report reduced indications of depression, anxiety and stress up to six months later. Moreover, these students were less likely to develop pronounced depression-like symptoms. The study, conducted by Professor Filip Raes (Faculty of Psychology and Educational Sciences, KU Leuven), is the first to examine mindfulness in a large sample of adolescents in a school-based setting.

Mindfullness is a form of meditation therapy focused on exercising ‘attentiveness’. Depression is often rooted in a downward spiral of negative feelings and worries. Once a person learns to more quickly recognise these feelings and thoughts, he or she can intervene before depression sinks in.

While mindfulness has already been widely tested and applied in patients with depression, this is the first time the method has been studied in a large group of adolescents in a school-based setting, using a randomised controlled design. The study was carried out at five middle schools in Flanders, Belgium. About 400 students between the ages of 13 and 20 took part. The students were divided into a test group and a control group. The test group received mindfulness training, and the control group received no training. Before the study, both groups completed a questionnaire with questions indicative of depression, stress or anxiety symptoms. Both groups completed the questionnaire again directly after the training, and then a third time six months later.

Before the start of the training, both the test group (21%) and the control group (24%) had a similar percentage of students reporting evidence of depression. After the mindfulness training, that number was significantly lower in the test group: 15% versus 27% in the control group. This difference persisted six months after the training: 16% of the test group versus 31% of the control group reported evidence of depression. The results suggest that mindfulness can lead to a decrease in symptoms associated with depression and, moreover, that it protects against the later development of depression-like symptoms.

The study was carried out in cooperation with the Belgian not-for-profit Mindfulness and with support from the Go for Happiness Foundation.

By Monte Morin They call it “pre-drinking,” “pre-partying” or “pre-funking,” and it usually involves chugging cheap alcoholic drinks before heading out to a bar, club or sporting event.

While addiction experts estimate that 65% to 75% of college-age youths engage in such boozy behavior, a Swiss study concludes that such “pre-loaded” evenings are far more likely to end in blackouts, unprotected sex, unplanned drug use or injury.
“Pre-drinking is a pernicious drinking pattern,” said coauthor Florian Labhart, a researcher at Addiction Info Switzerland, in Lausanne. “Excessive consumption and adverse consequences are not simply related to the type of people who pre-drink, but rather to the practice of pre-drinking itself.”
The study, to be published in an upcoming issue of Alcoholism: Clinical & Experimental Research, examined the drinking habits of more than 250 Swiss students.

For five weeks, the test subjects were surveyed via Internet and cellphone text messages. Each Thursday, Friday and Saturday night, the students were questioned hourly about how many drinks they had just consumed.

Researchers found that when students drank prior to going to a bar or club, they drank more than the would otherwise. On average, pre-drinking students consumed seven drinks, and students who drank only at a bar or event consumed just over four drinks.

This increased drinking was associated with a greater likelihood of blackouts, hangovers, absences from work or school or alcohol poisoning. Pre-drinkers were also found to engage more often in unintended drug use, unsafe sex, drunken driving or violent behavior.

The study found that while students who drank only at a bar or club stood an 18% chance of experiencing negative consequences, students who drank beforehand stood a 24% chance of seeing their evening end in mishap.

Study authors cited several motivations for pre-drinking, which practitioners also called “pre-gaming,” “pre-loading” or “frontloading.”

“Reasons given for pre-drinking include saving money, getting in the mood for partying, becoming intoxicated and socializing with friends or facilitating contacts with potential sexual partners,” the authors wrote.

Shannon R. Kenney, a sociology professor at Loyola Marymount University in Los Angeles, said pre-drinking behavior was likely as prevalent, or more so, in the United States, where the legal drinking age was much higher. In Switzerland, youths can legally purchase alcohol at age 16.

Kenney, who did not participate in the study, said the concept of pre-drinking has only recently been studied by addiction experts. Because of its risky nature and prevalence, she said, it warranted closer examination.

Study authors noted several possible shortcomings in their study. Among them was that only students with Internet capable cellphones could participate. Also, the study questions were extremely short, so that they could be read on a small cellphone screen or answered by someone in an intoxicated state.

Dec 21

Dec. 3, 2012 By Brenda Goodman, MA — Most teens with mental illnesses don’t take medications for their conditions, a new survey finds.

The study contradicts reports of widespread and indiscriminate pill-popping in high schoolers. If anything, researchers say, many kids may not be getting enough help for real problems that are affecting their lives.

“The one thing that we heard over and over when we started this study was that parents are getting their kids prescriptions for stimulants so they can do better on the SATs,” says researcher Kathleen Merikangas, PhD, chief of the genetic epidemiology branch in the intramural research program at the National Institute of Mental Health in Bethesda, Md.

But researchers, who questioned teens for the study, say they found no evidence of that trend.

“I was surprised that the rates were as low as they were. I thought the frequency of medication use was lower than we would have expected,” Merikangas says.

She points out that not treating mental health problems in teens can often lead to serious problems. They include failing grades, disruptive or criminal behavior, substance abuse, and suicide.

“As a society, we need to think about access to care before all of these bad outcomes occur,” Merikangas says.

Psychiatric Medications in Teens

Previous studies have relied on insurance claims to estimate rates of medication use in children and teens. Those studies have found sharp rises with psychiatrists prescribing to kids, especially poor children.

One 2006 study found that prescriptions of psychotropic drugs written to teens had shot up 250% between 1994 and 2001. It’s not always clear from claims data why the drugs are prescribed or even if they’re taken.

The new study, published in the Archives of Pediatric and Adolescent Medicine, took a different approach.

Researchers surveyed more than 10,000 teens in the U.S. who were between the ages of 13 and 18. The teens were carefully selected to reflect the makeup of the general population.

Researchers interviewed the teens at home and asked about any symptoms of mental problems in the past year that had been severe enough to affect their day-to-day functioning. When they reported taking medications, researchers had them produce the pill bottle so they could write down the drug name.

About half the teens in the study met the criteria for a mental disorder, and 22% were classified as being severely affected by their problems.

Despite that, only 14.1% of kids had taken any kind of psychotropic drug. The highest rates of medication use were in kids who met the criteria for attention deficit hyperactivity disorder (ADHD). Nearly 1 in 3 kids with ADHD reported taking a psychotropic medication. About 1 in 5 had been prescribed stimulants to help manage their condition.

In contrast, teens who were anxious, depressed, or bipolar were less likely to be prescribed a drug that could help. About 11% of teens diagnosed with an anxiety disorder were prescribed medications. About 20% of kids with depression or bipolar disorder were taking a mood-altering medication.

The study also found that the majority of kids who had been prescribed a psychotropic drug had a mental disorder severe enough to disrupt their day-to-day lives.
Many Kids Need Better Mental Health Care

“Not only were they not overprescribed, one could say that this group was inadequately treated,” says Victor Fornari, MD, director of the division of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.

Fornari, who wasn’t involved in the research, praised the study for its careful methods. He says it reflects attitudes he often sees in his own practice.

“There’s enormous resistance. Many families, maybe 50%, refuse treatment, even when they are told their child has a psychiatric disorder,” Fornari tells WebMD.

Health coverage may be another factor behind the lower-than-expected rates of medication use seen in teens.

In an editorial on the study, David Rubin, MD, a pediatrician at the Children’s Hospital of Philadelphia, points out that many middle-class families simply can’t afford mental health care. These teens are often covered on their parents’ private insurance plans, which rarely cover mental health visits.

“The take-home message is that as a country it should bother us that many children do not have access to the appropriate services they need, and that rates of medication use (whether high or low) are really a symptom of a mental health system that does not meet the standard of what any parent — whether rich or poor — would hope for their children if they were in crisis,” Rubin says.

By Kaitlin Bell Barnett

I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.

How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?

Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.

A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.

Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.

Among Kids With Diagnosable Disorders, Low Rates of Recent Medication Use

The study, which was published online in the Archives of Pediatrics and Adolescent Medicine, surveyed a large, nationally representative sample of more than 10,000 teens ages 13 to 18.

It found that about 14 percent of kids with DSM-IV psychiatric diagnoses had been treated with medication in the past year.

The percentage ranged widely, however, depending on the condition. Thirty-one percent of teens with diagnosable ADHD reported having taken medication for that condition in the past 12 months, compared to just 11 percent of those with anxiety disorders.

Researchers Find ‘No Compelling Evidence’ For Overmedication

The research team – which includes several major figures in this field – considered these percentages to be reasonable, especially considering the amount of distress and dysfunction involved in the kids they surveyed. “There was no compelling evidence for either misuse or overuse of psychotropic medications,” they wrote.

“The majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings,” they added, “had a mental disorder with severe consequences… functional impairment, suicidality, or associated behavioral and developmental difficulties.”

The study also found that most kids were taking a medication commonly prescribed for their diagnosis, such as antidepressants for depression, or stimulants for ADHD.

Antipsychotic use, which has been growing dramatically in recent years and is the subject of much debate about alleged overprescribing, was very low overall, ranging from 0.1 percent of those with anxiety as their primary diagnosis to 2 percent of those with developmental disorders as their primary problem.

Moreover, just 2.5 percent of kids who didn’t qualify for a psychiatric diagnosis reported having taken meds in the past year.

But even this small percentage of kids who didn’t meet the formal criteria sufficient for a diagnosis at the time they were surveyed weren’t necessarily inappropriately mediated: 78 percent reported having a prior mental or developmental disorder (like autism) that caused distress or impairment.

What’s Missing From The Study

It’s important to note that this study collected data between 2001 and 2004, so it’s possible medication use in teens – or at least the use of certain medications, like antipsychotics – has expanded since then.

And an important measurement was missing from the article that would provide key context about under- or over-treatment. Although researchers queried teens and families about where they received mental health services (in school, from a general practitioner, a mental health specialist, etc.), the text of the article didn’t indicate what percentage of the medicated kids were also receiving other services, such as psychotherapy. It also didn’t indicate what percentage of the unmedicated kids were receiving other services.

That’s crucial, because medication isn’t the only treatment out there. Other therapies have been shown to be effective, and a number of studies have found combined therapy and medication to be superior to either treatment alone.

Therefore, the issue isn’t so much what percentage of kids are taking medications – or even what percentage of kids with a bona fide diagnosis are taking them, the focus of this study.

Rather, the more salient questions are whether kids with troubling emotional and behavioral problems have appropriate and sufficient access to treatment, and whether they and their families consider that treatment – and those who administer it – adequate and effective.

An editorial accompanying the article made that point convincingly.

The editorial also pointed out that this study included a relatively high percentage of well-off kids with private insurance, which might account for the low rates of medication use. Previous studies have shown that kids with public insurance, especially foster children, are far more likely to be medicated at higher rates.

So What Do We Still Need To Know?

Although this study provides valuable information showing that relatively few teens take medication for their psychiatric disorders, we need a study that examines how common psychiatric diagnoses, medication use and other treatment modalities are in youngsters from diverse backgrounds.

And that same study should also measure kids and families’ opinions about access to and effectiveness of different kinds of treatment, as well as their level of satisfaction with the medical and with mental health professionals who administer it.

Dec 7

Casual sex linked to teen depression


Casual sex increases a teenager’s odds for clinical-level depression nearly threefold. The effects are the same for boys and girls, though younger teens (13-15 years old) who had so-called “nonromantic sex” faced substantially greater risks for depression. Dating alone was not linked to depressive symptoms.

Published in the Journal of Abnormal Psychology, the the study provides evidence that “context is key” when trying to understand how teen relationships and sex affect their well-being.

“Many historical and media perspectives have presented adolescent sexuality as an indicator of problematic or even socially deviant behavior,” says Jane Mendle, assistant professor of human development in Cornell University’s College of Human Ecology. “But this study and other recent findings are showing that’s not the case, and adolescent dating and sexuality can be viewed as normal developmental behavior.”

Using a novel behavioral genetics approach that compares siblings growing up in the same home, Mendle and her co-authors analyzed responses from 1,551 sibling pairs ages 13-18 from the National Longitudinal Study of Adolescent Health, a nationally representative sample of US high school students initiated in the mid-1990s. Among other topics, teens answered questions about their mental health and dating and sexual history. Nearly two-thirds of the sample’s youth had dated, and two-thirds were virgins.

By comparing siblings in their study, the authors could control for family and environmental influences that might also raise one’s risk for depression.

“We designed the study to give us a purer way to isolate many of the factors that could be contributing to depression,” Mendle says. “It allows us to compare specific types of social activities—in this case, dating and romantic and nonromantic sex—to see their overall effect.”

The paper notes that not all the associations at play can be unraveled, however. For instance, some teens who have depressive symptoms or clinical depression may be more likely to engage in casual sexual behaviors.

Mendle, a licensed clinical psychologist who studies how such developmental processes as puberty and sexual maturation influence teens’ emotional growth, believes adolescent sexuality is important to study because it is closely tied to how well people transition into adulthood.

“One of the hallmarks of adolescence is the formation of romantic relationships, and we know that what happens in adolescence is strongly related to your psychological, physical and financial well-being for years to come,” Mendle says. “Findings like this can help shape the dialogue and public debate about how to best support teen sexual health, psychological development and other areas.”

Nov 24

Adolescents and Self-Injury


Adolescents self-harming behavior appears to be on the rise today. These days, adolescents are faced with more decisions, stressors, and transitions than ever before. As a means to cope with these changes, some have turned to a behavior called cutting or other means of self-injury as an outlet to cope with painful and distressing emotions. There are many beliefs as to why this has been on the increase.

Self-injury can include a variety of behaviors but is most commonly associated with:
• Intentional carving or cutting of the skin
• Sub dermal tissue scratching
• Burning
• Ripping or pulling skin or hair
• Swallowing toxic substances
• Self bruising

In today’s competitive, fast-paced cultural environment, there is tremendous pressure put upon teenagers to achieve academic excellence, to outperform peers in classes and activities, on top of higher academic standards and heavy course loads. In addition in many families, parents put in long works hours and have less time to spend in family pursuits, leaving many adolescents feeling frustrated and disconnected from family members.

Many self-harming adolescents have voiced their concerns about feeling emotionally disconnected and invalidated in the various social contexts in which they interact on a day-to-day basis. They will often report that they are having difficulty managing their self-defeating thoughts and painful or angry or depressed feeling related to stressors. Self-injury becomes an efficient way to gain quick relief from emotional distress or other major stressors in their lives.

There are many ways to treat self-harm. One effective method is that of cognitive-behavioral skills training, which includes having the adolescent identify the activating events leading one to self harm. Identifying these cognitions, (beliefs and attitudes one has in response to these events), and the emotional or behavioral response that follows is the key. By developing such skills in identifying how one has self-defeating thoughts that lead to self-injury, adolescents via skills training, learn how to stop these negative thoughts and patterns, and learn other effective ways of channeling this energy into something positive.

In addition to skills training, the therapist must also provide to clients an arsenal of techniques and strategies for managing any emotional distress they might be experiencing. The more techniques the adolescent can utilize on his or her own, the less likely he or she is to self-injure in the future. For example, such strategies can take the form of relaxation training, visualization, meditation, and exercise. Deep breathing is an effective way to assist one in soothing oneself when faced with stressful events, as is visualizing a safe place one can focus on. Mindfulness is another form of meditation that offers both deep relaxation and insight. It promotes a way of being that focuses on what is present, where one can cultivate a deep acceptance and ability to relax more fully in the present moment rather than focusing on other stressors that cause discomfort.

Family therapy is another effective means of helping adolescents build connections in order to build strong, supportive and meaningful relationships. By exploring family communication and how family members interact with one another, in addition to exploring strengths and resources within the family, patterns can be altered in order to promote healthier family interactions, which support the adolescent.

Oct 7

How to Recognize Teens at Risk for Self-Harm


By Janice Wood Associate News Editor

It’s a startling statistic: Suicide is the third-leading cause of death for teens, according to the Centers for Disease Control and Prevention.

In response, a University of Missouri public health expert has identified factors that will help parents, medical professionals and educators recognize teens at risk for self injury and suicide.

“For many young people, suicide represents an escape from unbearable situations — problems that seem impossible to solve or negative emotions that feel overwhelming,” said Lindsay Taliaferro, Ph.D., an assistant professor of health sciences.

“Adults can help these teens dissect their problems, help them develop healthful coping strategies, and facilitate access to mental health care so their problems don’t seem insurmountable.”

Taliaferro analyzed data from the 2007 Minnesota Student Survey to pinpoint factors associated with self-injury.

Of the more than 60,000 Minnesota high school students who completed the survey, more than 4,000 teens — roughly the same size as the student bodies at two large high schools — reported injuring themselves in the past year. Nearly half of those who reported self-injury also had attempted suicide.

“Of the teens who engaged in non-suicidal self injury, hopelessness was a prominent factor that differentiated those who attempted suicide from those who did not have a history of suicide attempts,” Taliaferro said.

Parents, teachers and medical professionals sometimes avoid talking to teens about self-harm because they aren’t sure how to help, she said, noting that adults don’t need to solve all the teen’s problems, just act as a sounding board.

“Sometimes just talking about their feelings allows young people to articulate what they’re going through and to feel understood, which can provide comfort,” she said.

Taliaferro recommends that parents strengthen connections with their teens and help foster connections between their children and other positive adult influences.

“One of the most important protective factors against teens engaging in self-injury was parent connectedness, and, for females, connections with other prosocial adults also were associated with reduced likelihood of engaging in self-injury,” Taliaferro said.

Although parents play influential roles in teens’ lives, Taliaferro said mental health professionals are the best resources for troubled teens. Medical professionals, such as primary care physicians, can also serve crucial roles by identifying teens who self-injure and referring them to community support systems and mental health specialists before their behaviors escalate, Taliaferro said.

Taliaferro’s study was published in Academic Pediatrics. She collaborated with researchers at the University of Wisconsin-Eau Claire, the University of Minnesota and the Pennsylvania State University.

Source: University of Missouri

Oct 4

Two behaviours, two brain systems

The peak of inappropriate behaviour and emotional reactivity during adolescence is described as risky and impulsive. However, impulsivity, or lack of cognitive control, should not be treated as the same phenomenon as the act of taking a risk. In fact, separate regions in the brain mediate each behaviour, and each region matures according to a different timetable.

At the front of the brain is a region called the prefrontal cortex, which is associated with cognitive control and managing emotion. The prefrontal cortex is the last brain region to fully develop, with maturation continuing through the teen years. As the frontal lobes mature, the ability to regulate impulsivity and make better goal-oriented choices improves. As a result, some researchers have proposed that the immaturity of the prefrontal cortex explains the poor judgment of adolescents. But if this neurobiological model of teenage behaviour was correct, it would follow that children, whose frontal lobes are even less developed, would make poorer decisions than teenagers do. This is not the case. So what else could be going on?

Risk-taking is linked to an older part of the brain: the limbic system. This set of structures, deep in the brain below the cortex, is involved with judging incentives and emotional information. Unlike the prefrontal cortex, which develops slowly into adulthood, these subcortical limbic systems are almost completely developed by adolescence. Brain imaging shows that risk-taking and processing emotional information intensifies the activation of the limbic system, and that this intensification is exaggerated during the teen years. This means that when a risky choice has a strong emotional incentive, such as winning the admiration of peers, the limbic system is strongly activated by the emotional heft of the situation. The emotional, incentive-driven limbic system wins over the immature prefrontal control system – and a risky choice is made.

There is evidence from animal studies to support this model, with structures of the limbic system maturing earlier than those of the frontal cortex in many species. During adolescence, many animal species become more socially active with peers, fight with their parents, and are more likely to engage in novelty-seeking and risk-taking behaviours. At the same time, sexual hormones increase. The authors suggest that this developmental pattern, which is consistent with adolescents seeking sexual partners, may have evolved to promote leaving family and village to find a mate. Heightened emotional reactivity during this period could give some protection from the dangers in a novel environment by enhancing vigilance and awareness of threats.

Sep 1

Persistent teen use of pot may lower IQ


DURHAM, N.C., Aug. 27 (UPI) — Persistent, dependent use of marijuana before age 18 — more than once a week — was correlated to a drop in IQ points, a U.S. researcher says.

Lead researcher Madeline Meier, a post-doctoral researcher at Duke University, and a team of international colleagues said a long-range study cohort of more than 1,037 New Zealanders born in 1972-1973 found about 5 percent were considered marijuana-dependent, or were using more than once a week before age 18.

A dependent user is one who keeps using despite significant health, social or family problems, Meier said.

At age 38, all of the study participants were given a battery of psychological tests to assess memory, processing speed, reasoning and visual processing.

The study, published in the Proceedings of the National Academy of Sciences, found an average decline in IQ of 8 points when their age 13 and age 38 IQ tests were compared. Quitting pot did not appear to reverse the loss, the study said.

The decline in IQ among persistent marijuana users could not be explained by alcohol or other drug use or by having less education, Meier said.

“Somebody who loses 8 IQ points as an adolescent may be disadvantaged compared to their same-age peers for years to come,” Meier said in a statement.

Aug 15

by Thilaka Ravi Girls with Attention Deficit Hyperactivity Disorder (ADHD) and their families wait for a likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women, but a new study reveals girls with ADHD are prone to self harm as they grow into young adults.

New findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide. “Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood,” said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood.

“Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound,” he added.

The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can “outgrow” ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said.

The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years.

In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child’s age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy.

The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity.

The study’s major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said.

“A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor,” the study said.

In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD.

That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced.

For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior.

Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said.

“The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood,” the study concluded. “Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood.”

That said, Hinshaw added, “ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years.” Read more: Teenage Girls With ADHD Prone to Self-injury, Suicide | Medindia

SUNDAY, Aug. 5 (HealthDay News)By By Barbara Bronson Gray
— For anyone raising teenagers, the idea of helping them feel grateful for everyday things may seem like a long shot; just getting them to mumble a “thank you” every now and then can be a monumental accomplishment.

But a new study suggests that helping teens learn to count their blessings can actually play an important role in positive mental health. As gratitude increases, so do life satisfaction, happiness, positive attitudes, hope and even academic performance.

Giacomo Bono, study author and a professor of psychology at California State University, Dominguez Hills, said it seems there’s not much time these days for teens to pause and consider their appreciation of their friendships, activities they enjoy or even the food on the table.

But among those kids who say they feel grateful for a variety of things in their lives, Bono found an association with critical life skills such as cooperation, a sense of purpose, creativity and persistence.

“Gratefulness allows us to understand what matters most to us and translate that to a broader goal,” said Bono. He is expected to present his research Sunday at the American Psychological Association annual meeting in Orlando, Fla.

The study involved 700 students living in New York, aged 10 to 14. The participants were white (67 percent), Asian American (11 percent), black (10 percent) and Hispanic (1.4 percent), and about 11 percent were other ethnicities or did not identify their race. The researchers took into account for socioeconomic factors and parental educational attainment, but not for religious beliefs.

The study authors defined grateful teens as having a disposition and moods that enabled them to respond positively to the good people and things in their lives, Bono said.

Students completed questionnaires in school at the beginning of the study and then four years later. Bono compared the results from the least grateful to the most grateful. He found those who were among the most grateful gained 15 percent more of a sense of meaning in their lives, became 15 percent more satisfied with their lives overall and became 17 percent more happy and hopeful about their lives. That group also had a 13 percent drop in negative emotions and a 15 percent decrease in symptoms of depression.

Bono said there’s a strong link between having a sense of satisfaction with life and feeling grateful. “People who are grateful are more optimistic and hopeful, feeling they have the resources to be successful in their future,” said Bono.

An expert involved in working with teens said it makes sense that gratitude would increase a teenager’s sense of purpose in life. “I help kids become more aware of what they’re grateful for, not just in treating depression, but in materialistic, busy, media-driven lives,” said Alec Miller, chief of child and adolescent psychology at Montefiore Medical Center in New York City.

Interestingly, socioeconomic status doesn’t appear to be linked to gratefulness. “You don’t have to be rich to feel grateful,” said Bono. “We’ve found poor kids are very appreciative when other people help them out.”

Miller agreed. “I see Medicaid kids and children from wealthy homes in Westchester County, and I don’t see any greater or lesser sense of gratitude from one group or another. It’s fairly low in both groups,” he said. “Unfortunately, our society isn’t focused much on gratefulness; it’s become out of vogue to talk about it,” said Miller. “But I give these researchers credit for reviving interest in the topic.”

Miller said he often asks kids what they’re grateful for. When they can’t identify anything much at all, he sees it as a danger sign of increased risk of severe depression and suicide. But developing a sense of gratitude in kids can help prevent the gradual erosion of self-esteem and build their sense of purpose and ability, he noted.

How can parents help instill a sense of gratitude in their children? Bono suggested parents start paying attention to their own sense of gratefulness and model it. “Talk about what you’re grateful for, and ask your kids what they appreciate,” he said. He also advised mentioning people who have helped in their lives: a teacher who stayed after class, a coach who made a difference. “Talking about gratitude helps guide us all to the things that matter most,” he noted.

By David Sack, M.D.

Addicts aren’t the only ones who are haunted by the shame of addiction. Parents are often plagued with worry: “If only I had been a better parent, maybe none of this would’ve happened.”

Addiction is not parents’ fault (about half the risk is genetic), but you can influence the course of your child’s life by helping them develop the skills that protect against addiction.

#1 Coping Skills

One of the most important goals in treating addiction is equipping addicts with effective coping skills. The skills they learned in childhood might have been tempered by difficult life events, or perhaps they never developed appropriate coping mechanisms at all.

In either case, a need to self-medicate anger, disappointment and other difficult emotions is one of the most common reasons people turn to drugs and alcohol.

By learning how to cope with the full range of emotions – both the ones that feel good and the ones that feel miserable – children become resilient. Coping skills can be as basic as proper self-care (diet, sleep and exercise) or healthy distraction (talking to a friend or taking a walk), or they can be as complex as learning to differentiate between the things we can control and those we cannot.

#2 Social Skills

Human beings crave connection with other human beings. Studies show that social skills are essential for children to make friends, do well in school, and cope with life’s ups and downs. Those who aren’t able to lean on others for support are at greater risk of anxiety, depression and substance abuse.

Talking to children about other people’s feelings, beliefs and desires helps build empathy, a fundamental tool for social interaction. This dialogue can begin as early as age two or three by describing the way characters in books or television shows might be feeling in a given situation and how they might deal with those feelings. Skills such as appropriate eye contact, sharing, taking turns, active listening and assertive communication can also be taught directly and through role modeling.

#3 Life Skills

It’s surprising how many people arrive in drug rehab with minimal life skills. They haven’t balanced a checkbook, prepared a basic meal or washed their own laundry, and it shows in their confidence and ability to function each day. While young children wouldn’t be expected to have mastered these skill sets, the groundwork can be put in place early on.

School doesn’t always equip children with the real-world skills they will need to navigate adolescence and adulthood. Parents play a critical role in teaching their children healthy study habits, money management, cleaning their room, staying organized and creating a daily routine.

#4 Emotional Regulation Skills

Poor impulse control and a need for immediate gratification are strongly correlated with addiction. Although these qualities are normal at certain developmental stages, most children begin to use self-regulation skills without outside intervention. Those who have an extreme or persistent lack of self-control are at higher risk of bullying, academic difficulties, substance abuse and other problem behaviors.

Studies show that self-regulation skills in kindergarten predict literacy, vocabulary and early mathematics skills and are important for social development. Taking a time out, labeling and validating a child’s feelings (both pleasant and unpleasant), and offering positive feedback for appropriate behavior are all useful strategies that aid in responding to emotions appropriately.

Harsh discipline, yelling and spanking, on the other hand, do not teach self-regulation. It is also important for parents to consistently set limits and enforce consequences so that children understand the expectations.

#5 Critical Thinking Skills

Critical thinking encourages children to think for themselves rather than giving in to peer pressure. Schools are effective at teaching children what to think but not necessarily how to think. Starting as early as kindergarten, parents can help their children develop these skills by asking open-ended questions and working through a variety of possible solutions. After a decision is made, it can be helpful to reflect on it and ask your child what they might do differently next time.

#6 Distress Tolerance Skills

Many of the most dreaded behaviors that arise in children, including drug use, are the result of mismanaged stress. While distress tolerance skills alone will not prevent addiction, they do empower children to sit with their emotions without trying to escape or numb them.

One of the greatest disservices modern parents do to their children is getting in the way of the child’s innate learning process. “Helicopter parenting” – the increasingly common practice of hovering over children so they don’t get hurt or have to face problems – has contributed to a society that values immediate gratification over resilience. By intervening in arguments between a child and their friends or doing a tough homework assignment for their child, for example, parents deprive their child of valuable lessons and the skills to cope with stress, as well as the confidence boost that goes along with each small success.

Instead, let your kid be a kid. Life is full of moderate stressors that encourage the development of new skills and provide a sense of mastery. You can supplement this process by introducing your child to novel experiences like making a new friend or trying a new game and allowing them to work through problems on their own.

All of these skill sets can be gained through a combination of experiences at school, explicit teaching and, most importantly, parental role modeling. If you accept accountability for your own feelings, provide plenty of praise and support without overprotecting, and avoid using drugs or alcohol yourself, you can put your child in the best possible position to avoid addiction and other serious problems later on.

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