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.

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. 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.

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.”

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.

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

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.

http://www.aboutkidshealth.ca/En/News/NewsAndFeatures/Pages/My-limbic-system-made-me-do-it.aspx

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.

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 http://www.medindia.net/news/teenage-girls-with-adhd-prone-to-self-injury-suicide-105571-1.htm#ixzz23cLqB2YG

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.

What can parents do to improve relations with teenagers?

Help your teenagers believe in themselves. They will only believe in themselves if you show them that you have confidence in them and faith that they will make the right decisions.
Recognize the efforts of your teenagers. Reassure them that they have the qualities you want for them.

And if conflict with your teenager does arise:

Focus on the behaviour, not the person.
Think ahead to what you will say and how you will say it.
Keep your messages clear and concise.
Stick to one issue at a time.
Do not argue with the way your teen sees things. Instead, state your own beliefs and opinions
Do not talk down to your teenager. There’s nothing more irritating than a condescending tone
Do not lecture or preach. This only provokes hostility. Besides, the average teenager goes “deaf” after hearing about five sentences.
Do not set limits or consequences you cannot enforce.